RESUMEN
OBJECTIVES: Currently, premixed putty-type bioceramic cements (PPBCs) have become popular materials for root-end fillings. This study investigated three root-end filling techniques using PPBCs and calcium silicate-based sealers including EDTA pretreatment. MATERIALS AND METHODS: Ninety root segments were prepared and standardized with an artificial fin and lateral canal, and assigned to three groups (n = 30). Root-end fillings were placed using BC-RRM Putty alone (Group PA), injection of BC sealer followed by BC-RRM Putty (Lid Technique: Group LT) or BC-RRM Putty with BC sealer coating (Deep putty packing technique: Group DP). Half of each group was pretreated with 17% EDTA. The radiographic images of the specimens were assessed by five graders and push-out bond strength tests were conducted. The data were analyzed with a general linear model including two-way ANOVA and chi-square test at a significance level of 5%. RESULTS: DP approach demonstrated significantly higher bond strength than LT (P < 0.05). However, there was no statistically significant difference in bond strength between PA and either DP or LT. EDTA pretreatment had no significant effect on push-out bond strength. Radiographically, for the main canal, PA and DP scored significantly higher than LT. In the fin, PA scored significantly higher than others (P < 0.05). CONCLUSION: Our study highlights variations in root-end filling techniques. Injecting a bulk of bioceramic sealer before the placement of PPBCs may reduce bond strength and radiopacity. The application of PPBCs alone or in the deep putty technique demonstrates potential for favorable outcomes. EDTA pretreatment did not enhance bond-strength. CLINICAL RELEVANCE: Careful selection and application of bioceramic materials and techniques in root-end fillings may influence the outcome of endodontic root-end surgery. When PPBCs and calcium silicate-based sealers are used together for root-end fillings, sealer followed by deep putty application may offer improved bond strength and radiographic fill compared to the lid technique.
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Compuestos de Calcio , Ensayo de Materiales , Materiales de Obturación del Conducto Radicular , Silicatos , Materiales de Obturación del Conducto Radicular/química , Silicatos/química , Compuestos de Calcio/química , Técnicas In Vitro , Humanos , Recubrimiento Dental Adhesivo/métodos , Cerámica/química , Cementos Dentales/química , Obturación Retrógrada/métodos , Ácido Edético/química , Análisis del Estrés DentalRESUMEN
BACKGROUND: Apical surgery with standard retrograde maneuvers may be challenging in certain cases. Simplifying apical surgery to reduce operating time and streamline retrograde manipulation is an emerging need in clinical endodontics. AIM OF THE STUDY: The aim of the study was to compare the bacterial sealing ability of a calcium silicate-based sealer with the single cone technique combined with root end resection only, and calcium silicate-based sealer as a retrograde filling versus MTA retrofilling, and to analyze bacterial viability using confocal laser scanning microscope (CLSM). MATERIALS AND METHODS: In this in vitro experimental study, 50 extracted human maxillary incisor teeth were instrumented and randomly divided into five groups: three experimental groups, a positive control group, and a negative control group (n = 10/group). In the experimental groups, the roots were obturated using the single cone technique (SCT) and a calcium silicate-based sealer. In group 1, the roots were resected 3 mm from the apex with no further retrograde preparation or filling. In groups 2 and 3, the roots were resected, retroprepared, and retrofilled with either a calcium silicate-based sealer or MTA, respectively. Group 4 (positive control) was filled with a single gutta-percha cone without any sealer. In group 5 (negative control), the canals were left empty, and the roots were sealed with wax and nail varnish. A bacterial leakage model using Enterococcus faecalis was employed to assess the sealing ability over a 30-day period, checking for turbidity and analyzing colony forming units (CFUs) per milliliter. Five specimens from each group were examined using CLSM for bacterial viability. Data for the bacterial sealing ability were statistically analyzed using chi-squared and Kruskal-Wallis tests. RESULTS: The three experimental groups did not show significant differences in terms of bacterial leakage, or bacterial counts (CFUs) (P > 0.05). However, significant differences were observed when comparing the experimental groups to the positive control group. Notably, the calcium silicate-based sealer, when used as a retrofilling, yielded the best sealing ability. CLSM imaging revealed viable bacterial penetration in all the positive control group specimens while for the experimental groups, dead bacteria was the prominent feature seen. CONCLUSION: Within the limitations of this study, it could be concluded that the bacterial sealing ability of calcium silicate-based sealer with the single cone technique combined with root end resection only and calcium silicate-based sealer as a retrograde filling were comparable with MTA retrofilling during endodontic surgical procedures.
Asunto(s)
Compuestos de Calcio , Materiales de Obturación del Conducto Radicular , Silicatos , Silicatos/uso terapéutico , Compuestos de Calcio/uso terapéutico , Humanos , Materiales de Obturación del Conducto Radicular/farmacología , Materiales de Obturación del Conducto Radicular/uso terapéutico , Óxidos/farmacología , Óxidos/uso terapéutico , Combinación de Medicamentos , Compuestos de Aluminio/uso terapéutico , Técnicas In Vitro , Microscopía Confocal , Filtración Dental/microbiología , Obturación Retrógrada/métodos , Enterococcus faecalis/efectos de los fármacos , Viabilidad Microbiana , Incisivo , Apicectomía/métodosRESUMEN
AIM: Root canal treatment of teeth with necrotic pulps and apical periodontitis may be complicated by limited access to the root canals due to restorations and dystrophic calcifications. The objective of this study was to evaluate retrograde root canal as a primary treatment using a surgical approach as an alternative to conventional orthograde treatment. METHODOLOGY: Patients with apical periodontitis in the anterior region of the maxilla were consecutively recruited to the study over a period of 4 years. Fifty-seven patients met the inclusion criteria and received retrograde root canal treatment. A clinical and radiographic evaluation was made after 1 and 2 years postoperatively. RESULTS: Clinical and radiographically evaluation after 2 years revealed a successful outcome (as defined in this study) in 90% of the cases. CONCLUSION: Retrograde root canal as a primary treatment was a reliable alternative to treat apical periodontitis on single- and two-rooted teeth with limited orthograde access to the root canals in the maxilla.
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Obturación Retrógrada/métodos , Tratamiento del Conducto Radicular/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Maxilar , Persona de Mediana Edad , Periodontitis Periapical/diagnóstico por imagen , Periodontitis Periapical/terapia , Estudios Prospectivos , Radiografía Dental , Adulto JovenRESUMEN
The objective of this investigation was to determine and decrease dye leakage of fast-setting mineral trioxide aggregate (FSMTA). Specimens using differing setting times or concentrations of calcium sulfate modified FSMTA were assessed for dye penetration. Based on the results, no statistical difference was found in the dye leakage of FSMTA compared with regular mineral trioxide aggregate (MTA). The addition of 10 percent calcium sulfate resulted in a statistical reduction in dye leakage compared to both unmodified FSMTA and regular MTA.
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Compuestos de Aluminio/química , Compuestos de Calcio/química , Colorantes , Filtración Dental/clasificación , Óxidos/química , Materiales de Obturación del Conducto Radicular/química , Silicatos/química , Apicectomía/métodos , Sulfato de Calcio/química , Combinación de Medicamentos , Humanos , Ensayo de Materiales , Azul de Metileno , Obturación Retrógrada/métodos , Preparación del Conducto Radicular/métodos , Factores de TiempoRESUMEN
BACKGROUND: The aim of this research was to compare the apical sealing ability of different root-end filling materials (SuperEBA(®), ProRoot MTA(®), thermoplasticized gutta-percha + AH-Plus(®), thermoplasticized RealSeal(®)), by means of microbial indicators. MATERIALS AND METHODS: Thus, 50 human single-rooted teeth were employed, which were shaped until size 5 0, retro - prepared with ultrasonic tips and assigned to 4 groups, retro-filled with each material or controls. A platform was employed, which was split in two halves: upper chamber-where the microbial suspension containing the biological indicators was introduced (E. faecalis + S. aureus + P. aeruginosa + B. subtilis + C. albicans); and a lower chamber containing the culture medium brain, heart influsion, where 3 mm of the apical region of teeth were kept immersed. Lectures were made daily for 60 days, using the turbidity of the culture medium as indicative of microbial contamination. Statistical analyses were carried out at 5% level of significance. RESULTS: The results showed microbial leakage at least in some specimens in all of the groups. RealSeal(®) has more microbial leakage, statistically significant, compared to ProRoot(®) MTA and SuperEBA(®). No significant differences were observed when compared ProRoot(®) MTA and SuperEBA(®). The gutta-percha + AH Plus results showed no statistically significant differences when compared with the other groups. CONCLUSIONS: All the tested materials showed microbial leakage. Root-end fillings with Super-EBA or MTA had the lowest bacterial filtration and RealSeal shows highest bacterial filtration.
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Recubrimiento Dental Adhesivo , Obturación Retrógrada/métodos , Materiales de Obturación del Conducto Radicular/química , Compuestos de Aluminio/química , Bacillus subtilis/aislamiento & purificación , Compuestos de Calcio/química , Candida albicans/aislamiento & purificación , Resinas Compuestas/química , Filtración Dental/microbiología , Recubrimientos Dentinarios/química , Combinación de Medicamentos , Enterococcus faecalis/aislamiento & purificación , Resinas Epoxi/química , Gutapercha/química , Humanos , Humedad , Ensayo de Materiales , Nefelometría y Turbidimetría/métodos , Óxidos/química , Pseudomonas aeruginosa/aislamiento & purificación , Distribución Aleatoria , Preparación del Conducto Radicular/métodos , Silicatos/química , Staphylococcus aureus/aislamiento & purificación , Temperatura , Factores de TiempoRESUMEN
PURPOSE: A healthy gingival condition after endodontic surgery may depend on adequate soft tissue management. The aim of this study was to compare 2 incision techniques, papilla base incision (PBI) and intrasulcular flap (IS), which are currently used in endodontic surgery. MATERIALS AND METHODS: In the present nonrandomized controlled clinical trial, patients requiring endodontic surgery on a single tooth were enrolled. PBI was used in 1 group and IS was used in the other group. The primary outcomes were changes in periodontal probing depth, gingival recession, and height of the interproximal mesial and distal papillae. Outcome variables were assessed preoperatively and 6 months after surgery. Between-group differences were evaluated through appropriate statistical analysis, with significance set at a P value equal to .05. RESULTS: Each group was composed of 12 patients and the 2 groups were comparable at baseline. Two weeks after surgery, papilla height decreased significantly in the IS group (2.05 and 1.80 mm at the mesial and distal aspects, respectively), whereas no significant decrease in papilla height was observed in the PBI group (0.10 and 0.20 mm). No statistically significant difference between groups was observed after 6 months. No significant difference between groups was found for gingival recession or probing depth at any follow-up time. CONCLUSIONS: Better soft tissue preservation in the early postoperative period was achieved using the PBI approach compared with the IS approach. The PBI can be recommended for endodontic surgical procedures involving esthetic regions.
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Apicectomía/métodos , Encía/cirugía , Colgajos Quirúrgicos/cirugía , Adulto , Índice de Placa Dental , Femenino , Estudios de Seguimiento , Encía/patología , Recesión Gingival/clasificación , Humanos , Masculino , Microcirugia/instrumentación , Persona de Mediana Edad , Índice Periodontal , Bolsa Periodontal/clasificación , Obturación Retrógrada/métodos , Método Simple Ciego , Cuello del Diente/patología , Resultado del Tratamiento , Procedimientos Quirúrgicos Ultrasónicos/métodos , Cicatrización de Heridas/fisiologíaRESUMEN
PURPOSE: The aim of the present prospective, randomized, controlled, clinical study was to compare the outcomes of periradicular surgery of the maxillary first molar tooth using the vestibular approach between 2 preoperative radiologic evaluation methods: cone beam computed tomography (CBCT) and conventional radiography. PATIENTS AND METHODS: Periradicular surgery was applied to the maxillary first molar tooth in 40 patients. The patients were divided into 2 groups. The patients in group 1 underwent examination and preoperative planning with CBCT, and the patients in group 2 underwent examination and preoperative planning with conventional radiography. The outcomes of the treatment were evaluated radiographically and clinically, and the data were analyzed statistically. RESULTS: The mean operative time was significantly shorter in group 1 than in group 2. According to the radiographic and clinical healing criteria used in the present study, the healing of patients in group 1 was rated as a success in 35%, an improvement in 40%, and a failure in 25%. In the group 2 patients, healing was rated as a success in 42.1%, an improvement in 31.6%, and a failure in 26.3%. Sinus membrane elevation was performed in 92.3% of all patients. Sinus membrane perforation occurred in 20% of the patients in group 1 and 36.8% of the patients in group 2. CONCLUSIONS: Periradicular surgery of maxillary first molars using a vestibular approach is a viable treatment method with a low complication rate. Preoperative CBCT examination demonstrated positive contributions to the treatment outcomes.
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Maxilar/cirugía , Diente Molar/cirugía , Raíz del Diente/cirugía , Absceso/etiología , Apicectomía/métodos , Tomografía Computarizada de Haz Cónico/métodos , Fístula Dental/etiología , Edema/etiología , Femenino , Estudios de Seguimiento , Humanos , Complicaciones Intraoperatorias , Masculino , Maxilar/diagnóstico por imagen , Seno Maxilar/diagnóstico por imagen , Seno Maxilar/lesiones , Diente Molar/diagnóstico por imagen , Mucosa Nasal/lesiones , Tempo Operativo , Osteotomía/métodos , Dimensión del Dolor , Planificación de Atención al Paciente , Enfermedades Periapicales/diagnóstico por imagen , Enfermedades Periapicales/cirugía , Complicaciones Posoperatorias , Estudios Prospectivos , Obturación Retrógrada/métodos , Preparación del Conducto Radicular/métodos , Colgajos Quirúrgicos/cirugía , Ápice del Diente/diagnóstico por imagen , Ápice del Diente/cirugía , Raíz del Diente/diagnóstico por imagen , Resultado del Tratamiento , Cicatrización de Heridas/fisiologíaAsunto(s)
Neoplasias de los Genitales Masculinos/diagnóstico por imagen , Neurofibroma/diagnóstico por imagen , Vesículas Seminales/diagnóstico por imagen , Urografía , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Neurofibroma/patología , Obturación Retrógrada , Vesículas Seminales/patología , Tomografía Computarizada por Rayos XRESUMEN
In this study, we compared outcomes of traditional apicoectomy versus modern apicoectomy, by means of a controlled clinical trial with a 5-year follow-up. The study investigated 938 teeth in 843 patients. On the basis of the procedure performed, the teeth were grouped in 3 groups. Differences between the groups were the method of osteotomy (type of instruments used), type of preparation of retrograde cavity (different apicoectomy angles and instruments used for root-end preparation), and root-end filling material used (gray mineral trioxide aggregate or silver amalgam). Outcome (tooth healing) was estimated after 1 and 5 years, postoperatively. Clinical success rates after 1 year were 67% (306 teeth), 90% (186 teeth), and 94% (256 teeth) according to traditional apicoectomy (group 1), modern microsurgical apicoectomy using burns for osteotomy (group 2) or using piezo-osteotomy (group 3), respectively. After 1 year, group comparison results were statistically significant (P < 0.0001). Linear trend test was also statistically significant (P < 0.0001), pointing out larger healing from group 1 to group 3. After 5 years, teeth were classified into 2 groups on the basis of root-end filling material used. Clinical success was 90.8% (197 teeth) in the silver amalgam group versus 96% (309 teeth) in the mineral trioxide aggregate group (P < 0.00214). Multiple logistic regression analysis found that surgical technique was independently associated to tooth healing. In conclusion, modern apicoectomy resulted in a probability of success more than 5 times higher (odds ratio, 5.20 [95% confidence interval, 3.94-6.92]; P < 0.001) compared with the traditional technique.
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Apicectomía/métodos , Microcirugia/métodos , Osteotomía/métodos , Obturación Retrógrada/métodos , Adulto , Compuestos de Aluminio , Apicectomía/instrumentación , Compuestos de Calcio , Amalgama Dental , Combinación de Medicamentos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Microcirugia/instrumentación , Persona de Mediana Edad , Osteotomía/instrumentación , Óxidos , Obturación Retrógrada/instrumentación , Silicatos , Adulto JovenRESUMEN
AIM: To investigate the composition of materials and leachate of a hydrated prototype cement composed of tricalcium silicate and radiopacifier and compare this to other tricalcium silicate-based cements (Biodentine and Bioaggregate) to assess whether the additives in the proprietary brand cements affect the hydration of the materials, using Intermediate Restorative Material (IRM), a standard root-end filling material as a control. METHODOLOGY: The materials investigated included a prototype-radiopacified tricalcium silicate cement, Biodentine, Bioaggregate and Intermediate Restorative Material (IRM). The pH and calcium ion concentration of the leachate were investigated. The hydrated cements were characterized using scanning electron microscopy (SEM) and X-ray energy dispersive analysis (EDX), X-ray diffraction (XRD) and Fourier transform infrared spectroscopy (FT-IR). RESULTS: All the cements tested were alkaline. The tricalcium silicate-based cements leached calcium in solution. Scanning electron microscopy of the prototype-radiopacified tricalcium silicate cement, Biodentine and Bioaggregate displayed hydrating cement grains, surrounded by a matrix composed of calcium silicate hydrate and calcium hydroxide. The presence of calcium hydroxide was evident from the XRD plots. FT-IR indicated the occurrence of a poorly crystalline calcium silicate hydrate. Biodentine displayed the presence of calcium carbonate. Bioaggregate incorporated a phosphate-containing phase. IRM consisted of zinc oxide interspersed in an organic matrix. CONCLUSIONS: The hydration of prototype-radiopacified tricalcium silicate cement, Biodentine and Bioaggregate resulted in the formation of calcium silicate hydrate and calcium hydroxide, which was leached in solution. The hydrated materials were composed of a cementitous phase that was rich in calcium and silicon and a radiopacifying material. Biodentine included calcium carbonate, and Bioaggregate included silica and calcium phosphate in the powders. IRM was composed of zinc oxide interspersed in a matrix of organic material.
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Obturación Retrógrada/métodos , Materiales de Obturación del Conducto Radicular/química , Adsorción , Calcio/química , Carbonato de Calcio/química , Compuestos de Calcio/química , Hidróxido de Calcio/química , Medios de Contraste/química , Cristalografía , Microanálisis por Sonda Electrónica , Humanos , Concentración de Iones de Hidrógeno , Hidroxiapatitas/química , Ensayo de Materiales , Metilmetacrilatos/química , Microscopía Electrónica de Rastreo , Fosfatos/química , Silicatos/química , Espectroscopía Infrarroja por Transformada de Fourier , Agua/química , Difracción de Rayos X , Óxido de Zinc/química , Cemento de Óxido de Zinc-Eugenol/químicaRESUMEN
AIM: To investigate the effect of two solutions differing by pH (7.4 and 4.0) on the physicochemical properties of a radiopaque dicalcium silicate cement. METHODOLOGY: The cement was prepared by hand-mixing the dicalcium silicate powder with distilled water in a liquid-to-powder ratio of 0.4 mL g(-1) . A total of 253 cement specimens with dimension of 6 mm (diameter) × 3 mm (height) were used. The morphology, weight loss, porosity and diametral tensile strength of the cement were evaluated after soaking in a solution for different time intervals, in addition to pH changes in the cement-immersed solutions. RESULTS: After soaking in a pH 7.4 solution for 1 day, the particle size of precipitated apatite spherulites on the cement surfaces was greater than that obtained in a pH 4.0 solution. Solution pH did not result in a significant difference (P > 0.05) in diametral tensile strength of cement specimens at the same soaking time-point. On day 30, the sample was associated with a weight loss of 0.8% in a pH 4.0 solution, whereas in a pH 7.4 solution, a weight increase of 0.2% occurred. A greater porosity of the cement soaked in a pH 4.0 was found compared with that in the solution with pH 7.4. Soaking time affected significantly (P < 0.05) the porosity, weight change and strength of the cements in an acidic environment more than at pH 7.4. CONCLUSIONS: High apatite-forming activity and low degradation were the characteristics of a radiopaque dicalcium silicate cement.
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Compuestos de Calcio/química , Obturación Retrógrada/métodos , Materiales de Obturación del Conducto Radicular/química , Cemento de Silicato/química , Silicatos/química , Apatitas/química , Cloruro de Calcio , Fenómenos Químicos , Medios de Contraste/química , Humanos , Ácido Clorhídrico/química , Concentración de Iones de Hidrógeno , Inmersión , Cloruro de Magnesio/química , Ensayo de Materiales , Metilaminas/química , Tamaño de la Partícula , Fosfatos/química , Porosidad , Cloruro de Potasio/química , Compuestos de Potasio/química , Bicarbonato de Sodio/química , Cloruro de Sodio/química , Estrés Mecánico , Sulfatos/química , Propiedades de Superficie , Resistencia a la Tracción , Factores de TiempoRESUMEN
OBJECTIVES: The aim of this study was to evaluate the physical properties and cytotoxicity of a novel root-end filling material (EPC) which is made from epoxy resin and Portland cement as a mineral trioxide aggregate (MTA) substitute. MATERIALS AND METHODS: EPC, developed as a root-end filling material, was compared with MTA and a mixture of AH Plus sealer and MTA (AMTA) with regard to the setting time, radio-opacity, and microleakage. Setting times were evaluated using Vicat apparatus. Digital radiographs were taken to evaluate the aluminium equivalent radio-opacity using an aluminium step wedge. Extracted single-rooted teeth were used for leakage test using methylene blue dye. After canal shaping and obturation, the apical 3-mm root was resected, and a root-end cavity with a depth of 3 mm was prepared. The root-end cavities were filled with MTA, AMTA, and EPC for 15 specimens in each of three groups. After setting in humid conditions for 24 h, the specimens were tested for apical leakage. For evaluation of the biocompatibility of EPC, cell (human gingival fibroblast) viability was compared for MTA and Portland cement by MTT assay, and cell morphological changes were compared for MTA and AH Plus by fluorescence microscopy using DAPI and F-actin staining. The setting time, radio-opacity, and microleakage were compared using one-way ANOVA and Scheffe's post hoc comparison, and the cytotoxicity was compared using the nonparametric Kruskal-Wallis rank sum test. Statistical significance was set at 95%. RESULTS: EPC had a shorter setting time and less microleakage compared with MTA (p < 0.05). EPC showed 5-mm aluminium thickness radio-opacity and similar biocompatibility to MTA. CONCLUSIONS: Under the conditions of this study, EPC, a novel composite made from a mixture of epoxy resin and Portland cement, was found to be a useful material for root-end filling, with favourable radio-opacity, short setting time, low microleakage, and clinically acceptable low cytotoxicity. CLINICAL RELEVANCE: The novel root-end filling material would be a potentially useful material for a surgical endodontic procedure with favourable properties.
Asunto(s)
Cementos Dentales , Resinas Epoxi/química , Materiales de Obturación del Conducto Radicular/química , Materiales Biocompatibles/química , Supervivencia Celular/efectos de los fármacos , Filtración Dental , Resinas Epoxi/toxicidad , Encía/citología , Encía/efectos de los fármacos , Glutamatos/química , Glutamatos/toxicidad , Guanina/análogos & derivados , Guanina/química , Guanina/toxicidad , Humanos , Ensayo de Materiales , Pemetrexed , Obturación Retrógrada , Materiales de Obturación del Conducto Radicular/toxicidadRESUMEN
BACKGROUND: Enamel matrix-derived proteins (Emdogain) stimulate the proliferation of periodontal ligament cells, contributing to their regeneration. AIM: This study was to perform histometric assessment of root surface resorption in replanted teeth with the use of Emdogain®. MATERIALS AND METHODS: Male Wistar rats (Rattus norvegicus), weighing 180 to 200 gm, were anesthetized, subjected to extraction of the upper right incisor tooth, which was then replanted into the alveoli with the following treatment: (a) control group--tooth with root canal filled with calcium hydroxide paste and (b) treated group--tooth with root canal filled with enamel matrix-derived protein. The animals were sacrificed 25 days after tooth replantation. The maxilla was processed to obtain thin sections (6 µ) and stained with hematoxylin and eosin. The resorption volume percentage of each dental element was calculated from the cementoenamel junction to the apex. RESULTS: Quantification of resorption revealed that Emdogaintreated teeth showed a lower percentage of resorption (31.58%) compared to controls (80.48%) (statistically significant values--t-test p-value=0.0431). CONCLUSION: It was concluded that Emdogain used as root canal filling has properties capable of showing a lower percentage of resorption in replanted teeth.
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Proteínas del Esmalte Dental/uso terapéutico , Materiales de Obturación del Conducto Radicular/uso terapéutico , Resorción Radicular/etiología , Reimplante Dental/métodos , Animales , Hidróxido de Calcio/uso terapéutico , Procesamiento de Imagen Asistido por Computador/métodos , Incisivo/cirugía , Masculino , Ratas , Ratas Wistar , Obturación Retrógrada/métodos , Preparación del Conducto Radicular/métodos , Resorción Radicular/patología , Factores de Tiempo , Ápice del Diente/patología , Cuello del Diente/patología , Extracción Dental/métodos , Diente no Vital/patologíaRESUMEN
PURPOSE: To investigate the periapical tissue response of 4 different retrograde root-filling materials, ie, intermediate restorative material, thermoplasticized gutta-percha, reinforced zinc oxide cement (Super-EBA), and mineral trioxide aggregate (MTA), in conjunction with an ultrasonic root-end preparation technique in an animal model. MATERIALS AND METHODS: Vital roots of the third and fourth right mandibular premolars in 6 healthy mongrel dogs were apicectomized and sealed with 1 of the materials using a standardized surgical procedure. After 120 days, the animals were sacrificed and the specimens were analyzed radiologically, histologically, and scanning electron microscopically. The Fisher exact test was performed on the 2 outcome values. RESULTS: Twenty-three sections were analyzed histologically. Evaluation showed better re-establishment of the periapical tissues and generally lower inflammatory infiltration in the sections from teeth treated with the intermediate restorative material and the MTA. New root cement on the resected dentin surfaces was seen on all sections regardless of the used material. New hard tissue formation, directly on the surface of the material, was seen only in the MTA sections. There was no statistical difference in outcome among the tested materials. CONCLUSIONS: The results from this dog model favor the intermediate restorative material and MTA as retrograde fillings when evaluating the bone defect regeneration. MTA has the most favorable periapical tissue response when comparing the biocompatibility of the materials tested.
Asunto(s)
Compuestos de Aluminio/uso terapéutico , Compuestos de Calcio/uso terapéutico , Recubrimientos Dentinarios/uso terapéutico , Gutapercha/uso terapéutico , Metilmetacrilatos/uso terapéutico , Óxidos/uso terapéutico , Tejido Periapical/efectos de los fármacos , Obturación Retrógrada/métodos , Materiales de Obturación del Conducto Radicular/uso terapéutico , Silicatos/uso terapéutico , Cemento de Óxido de Zinc-Eugenol/uso terapéutico , Óxido de Zinc/uso terapéutico , Proceso Alveolar/patología , Animales , Apicectomía/métodos , Diente Premolar/cirugía , Materiales Biocompatibles/uso terapéutico , Cemento Dental/patología , Dentina/patología , Perros , Combinación de Medicamentos , Mandíbula/cirugía , Microscopía Electrónica de Rastreo , Modelos Animales , Osteotomía/métodos , Periodontitis Periapical/patología , Tejido Periapical/patología , Preparación del Conducto Radicular/métodos , Factores de Tiempo , Procedimientos Quirúrgicos Ultrasónicos/métodosRESUMEN
AIM: To report a case of apical fenestration and overfilling in which unusual pain characteristics made differential diagnosis challenging. SUMMARY: A 32-year-old woman with diffuse, spontaneous, moderate pain in the maxillary left posterior sector, exacerbated by masticatory and facial muscle movement, with intense sporadic electric-shooting pain, underwent clinical examination and 3D cone beam computed tomography (CBCT). Apical fenestration with protrusion of the mesial root of tooth 26 beyond the buccal cortical plate, extrusion of canal filling material into the soft tissues and a periosteal reaction were detected. Surgery was performed under the operating microscope. The filling material and surrounding fibrous tissue were located, dissected from healthy soft tissues and removed. The mesiobuccal root apex was resected with a bur to within the bony crypt. A root end was prepared and filled with Tech Biosealer RootEnd™ (Isasan, Como, Italy). At the 2-week recall, the patient had complete resolution of the symptoms and good soft-tissue healing. The 1-year recall examination and intra-oral radiography confirmed complete resolution of the symptoms and health of periradicular tissues. KEY LEARNING POINTS: Apical fenestration may occur in 9% of cases and may be considered an anatomic predisposing factor for persistent pain after root canal treatment. This complication provides a considerable differential diagnostic challenge and is often misdiagnosed and mistreated. When correctly diagnosed through an accurate, multidisciplinary approach, it may be managed with a simple surgical procedure in which the endodontist should play a key role. Misdiagnosis and over treatment of apical fenestration, through the surgical management of chronic facial pain conditions, could lead to severe exacerbation of chronic pain, which may potentially become persistent or, indeed, intractable.
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Extravasación de Materiales Terapéuticos y Diagnósticos/cirugía , Dolor Facial/etiología , Enfermedades Periapicales/cirugía , Tratamiento del Conducto Radicular/efectos adversos , Ápice del Diente/cirugía , Adulto , Apicectomía , Tomografía Computarizada de Haz Cónico , Diagnóstico Diferencial , Femenino , Humanos , Enfermedades Periapicales/diagnóstico por imagen , Obturación Retrógrada , Ápice del Diente/diagnóstico por imagenRESUMEN
AIM: To design and evaluate the impact of virtual reality (VR) pre-surgical practice on the performance of actual endodontic microsurgery. METHODOLOGY: The VR system operates on a laptop with a 1.6-GHz Intel processor and 2 GB of main memory. Volumetric cone-beam computed tomography (CBCT) data were acquired from a fresh cadaveric porcine mandible prior to endodontic microsurgery. Ten inexperienced endodontic trainees were randomized as to whether they performed endodontic microsurgery with or without virtual pre-surgical practice. The VR simulator has microinstruments to perform surgical procedures under magnification. After the initial endodontic microsurgery, all participants served as their own controls by performing another procedure with or without virtual pre-surgical practice. All procedures were videotaped and assessed by two independent observers using an endodontic competency rating scale (from 6 to 30). RESULTS: A significant difference was observed between the scores for endodontic microsurgery on molar teeth completed with virtual pre-surgical practice and those completed without virtual presurgical practice, median 24.5 (range = 17-28) versus median 18.75 (range = 14-26.5), P = 0.041. A significant difference was observed between the scores for osteotomy on a molar tooth completed with virtual pre-surgical practice and those completed without virtual pre-surgical practice, median 4.5 (range = 3.5-4.5) versus median 3 (range = 2-4), P = 0.042. CONCLUSIONS: Pre-surgical practice in a virtual environment using the 3D computerized model generated from the original CBCT image data improved endodontic microsurgery performance.
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Simulación por Computador , Tomografía Computarizada de Haz Cónico , Endodoncia/educación , Microcirugia/educación , Interfaz Usuario-Computador , Adulto , Animales , Diente Premolar/diagnóstico por imagen , Diente Premolar/cirugía , Competencia Clínica , Instrucción por Computador , Estudios Cruzados , Femenino , Humanos , Masculino , Diente Molar/diagnóstico por imagen , Diente Molar/cirugía , Obturación Retrógrada , Sus scrofaRESUMEN
AIM: To verify the in vitro cytocompatibility of iRoot BP Plus (iRoot) and to compare it with White ProRoot MTA (MTA). METHODOLOGY: Thirty-six human maxillary incisor root canals were prepared using a step-back flaring technique. The apical 3 mm was resected perpendicular to the long axis at the roots, and root-end cavities were prepared with the aid of an ultrasonic device plus a diamond retrotip with continuous irrigation using water, producing standardized preparations. After that, the root-end cavities were filled with iRoot or MTA, and each root was exposed to cell culture media for 24 or 48 h. Human osteoblast cells were exposed to the extracts thus obtained, and a multiparametric cell viability assay was performed, evaluating mitochondrial activity, membrane integrity and cell density. The results were analysed by one-way analysis of variance, complemented with the Duncan post-test (P < 0.05). RESULTS: Cells exposed to MTA revealed a cytocompatibility pattern similar to the untreated cells (negative control), at both experimental times (P > 0.05). iRoot, however, promoted a significantly poorer viability than MTA and the control, after 48 h of exposure (P < 0.001). Nevertheless, iRoot did not induce critical cytotoxic effects because cell viability remained higher than 70% of the control group in most tests performed. CONCLUSION: iRoot and MTA were biocompatible and did not induce critical cytotoxic effects.
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Materiales Biocompatibles/farmacología , Compuestos de Calcio/farmacología , Osteoblastos/efectos de los fármacos , Cemento de Silicato/farmacología , Silicatos/farmacología , Compuestos de Aluminio/farmacología , Recuento de Células , Técnicas de Cultivo de Célula , Membrana Celular/efectos de los fármacos , Forma de la Célula/efectos de los fármacos , Supervivencia Celular/efectos de los fármacos , Medios de Cultivo Condicionados , Combinación de Medicamentos , Humanos , Mitocondrias/efectos de los fármacos , Óxidos/farmacología , Obturación Retrógrada/métodos , Preparación del Conducto Radicular/métodos , Factores de Tiempo , Técnicas de Cultivo de Tejidos , Cemento de Óxido de Zinc-Eugenol/toxicidadRESUMEN
AIM: To present the case of a maxillary left lateral incisor with Oehlers' type III dens invaginatus in which cone beam computed tomography (CBCT) was used as an adjunctive resource in the diagnosis as well as in the planning and 2-year follow-up of the nonsurgical/surgical treatment. SUMMARY: The tooth had two root canals: a primary (main) canal with vital pulp that appeared to be closed apically and an invaginated canal that was necrotic, wide-open at the portal of exit and associated with a large chronic periapical lesion extending to the apex of the maxillary left central incisor. Radiographic tracking of a sinus tract in the labial gingiva of the affected tooth with a gutta-percha point revealed its origin to be the invagination. The CBCT scans revealed that the periapical radiolucency was significantly larger than seen radiographically as well as an increased thickness of the buccal cortical plate. Conventional root canal treatment of the primary canal was undertaken. As nonsurgical access to the invaginated canal was not possible, endodontic surgery was performed for curettage of the lesion, root-end cavity preparation using ultrasonic tips and root canal filling with white mineral trioxide aggregate (MTA). CBCT scanning after 17 months and clinical and radiographic follow-up after 24 months revealed complete periapical repair and absence of symptoms. KEY LEARNING POINTS: The combination of nonsurgical and surgical treatments produced periapical repair in a tooth with type III dens invaginatus with two root canals. CBCT may aid the diagnosis as well as the management plan and follow-up of teeth with this developmental anomaly.
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Tomografía Computarizada de Haz Cónico , Dens in Dente/diagnóstico por imagen , Incisivo/anomalías , Planificación de Atención al Paciente , Compuestos de Aluminio/uso terapéutico , Compuestos de Calcio/uso terapéutico , Niño , Dens in Dente/terapia , Fístula Dental/diagnóstico por imagen , Fístula Dental/terapia , Cavidad Pulpar/anomalías , Cavidad Pulpar/diagnóstico por imagen , Necrosis de la Pulpa Dental/diagnóstico por imagen , Necrosis de la Pulpa Dental/terapia , Combinación de Medicamentos , Estudios de Seguimiento , Humanos , Incisivo/diagnóstico por imagen , Masculino , Óxidos/uso terapéutico , Periodontitis Periapical/diagnóstico por imagen , Periodontitis Periapical/terapia , Obturación Retrógrada/métodos , Materiales de Obturación del Conducto Radicular/uso terapéutico , Preparación del Conducto Radicular/métodos , Tratamiento del Conducto Radicular/métodos , Silicatos/uso terapéuticoRESUMEN
AIM: To determine the effect of increasing the proportion of zinc on partially stabilized cement (PSC) produced using a one-step sol gel process. METHODOLOGY: A one-step sol-gel process of Portland cement-based PSC with Zn was synthesized by replacing iron nitrate. The crystalline phases of the PSC-Zn powder were analysed by using X-ray diffraction (XRD). The experimental groups [i.e., MTA, PSC-Fe (control), PSC with 1% Zn, PSC with 3% Zn, and PSC with 5% Zn] were immersed in simulated body fluid for 3 h, 1 and 3 days to evaluate the hydration product formation. The microstructure and surface morphology were analysed using scanning electron microscopy (SEM). Initial and final setting times of the materials were determined using an ASTM Vicat needle testing machine. To evaluate the cytotoxicity of PSC-Zn system, primary osteoblasts cell lines were used. RESULTS: The addition of increased weight percentages of Zn, resulted in a more unstable phase which favoured the formation of a monoclinic structure of C3 S with an increased hydration reaction of PSC and reduced setting time. The cytotoxicity testing of PSC with Zn revealed that the material was not toxic. CONCLUSIONS: The newly synthesized PSC-Zn material had short setting time and was biocompatible.
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Compuestos de Calcio/síntesis química , Obturación Retrógrada/métodos , Materiales de Obturación del Conducto Radicular/síntesis química , Cemento de Silicato/síntesis química , Silicatos/síntesis química , Zinc/química , Animales , Materiales Biocompatibles/síntesis química , Materiales Biocompatibles/química , Materiales Biocompatibles/farmacología , Líquidos Corporales/química , Compuestos de Calcio/química , Compuestos de Calcio/farmacología , Recuento de Células , Técnicas de Cultivo de Célula , Proliferación Celular/efectos de los fármacos , Supervivencia Celular/efectos de los fármacos , Cristalización , Compuestos Férricos , L-Lactato Deshidrogenasa/análisis , Ensayo de Materiales , Microscopía Electrónica de Rastreo , Nitratos , Osteoblastos/efectos de los fármacos , Transición de Fase , Polvos , Ratas , Ratas Wistar , Materiales de Obturación del Conducto Radicular/química , Materiales de Obturación del Conducto Radicular/farmacología , Cemento de Silicato/química , Cemento de Silicato/farmacología , Silicatos/química , Silicatos/farmacología , Propiedades de Superficie , Factores de Tiempo , Difracción de Rayos X , Zinc/farmacologíaRESUMEN
Clinicians do not frequently see impacted dilacerated maxillary incisors in their patients. When they do, there are several diagnostic and management challenges for correcting root dilacerations. An unfavorable esthetic outcome might occur as a result of soft-tissue complications during surgical eruption procedures. We present 2 patients with an impacted and dilacerated maxillary central incisor. Computed tomography scans with 3-dimensional reformation were used to accurately assess the positions of the dilacerated teeth, the degree of dilaceration, and the stage of root formation. The therapy primarily involved 2-stage crown exposure surgery combined with orthodontic traction. An apicoectomy was performed on 1 dilacerated tooth; the other exhibited pulp vitality. This article highlights the periodontal surgical strategies for the esthetic management of inverted crowns. Through periodontal plastic surgery and interdisciplinary cooperation, the impacted dilacerated central incisors were properly aligned, and successful esthetic results were achieved.