Correlation Between Proinflammatory Cytokine Expression and Clinical Data in Apical Granuloma.

INTRODUCTION: This study was intended to evaluate the expression of inflammatory cytokines commonly secreted by CD4+ T cells (IL-2, IL-5, IL-17, TGF-ß, TNF-α, and IFN-γ) in apical granulomas and correlate with the clinical conditions and time elapsed since root canal treatment. METHODS: Eighteen biopsy specimens obtained by periradicular surgery of teeth with post-treatment apical periodontitis and diagnosed as apical granuloma were available from the oral pathology laboratory. Silanized slides containing paraffin sections were used for immunohistochemical reactions. Images were analyzed by using an optical microscopy and each slide was subdivided into 5 fields at high magnification. RESULTS: IFN-γ and TGF-ß were the cytokines with the highest expression levels. There were statistically significant differences when comparing IL-2 and IFN-γ (P < .05), and IL-2 and TGF-ß (P < .05). Comparison between the detected cytokines and clinical data and time of treatment demonstrated significant correlation (P < .05) between lower expression of IL-2 and the presence of painful symptoms, absence of sinus tract, and treatments performed more than 4 years before. It was also possible to observe a significant correlation between lower expression of IL-5 and treatments performed less than 4 years before (P < .05). CONCLUSION: IFN-γ and TGF-ß were highly expressed in apical granulomas. However, only IL-2 and IL-5 levels were associated with clinical data and time since previous root canal treatment.

Natural canal deviation and dentin thickness of mesial root canals of mandibular first molars assessed by microcomputed tomography

Abstract The aim of this study was to assess the centralization and dentin thickness of mesial root canals of the first mandibular molars by microcomputed tomography (micro-CT). Material and methods: Ninety-nine mandibular molars of Vertucci's type IV canals were scanned by micro-CT. The mesiodistal deviation and centroid were assessed, in both mesiobuccal (MB) and mesiolingual (ML) canals, for the apical 4mm and the full canal length. Results: The dentin thickness was similar for both MB and ML canals. The narrowest thickness was in the distal wall of an MB canal (0.07mm), while the widest was found in the mesial wall of an MB canal (2.46mm). In centroid analysis, both the MB and ML canals exhibited deviations when compared to the root centroid, along the full canal length and the apical 4mm. For the MB canal, the mean deviation was 0.83mm (0.02 mm-2.30 mm) for the full canal and 0.18mm (0.01 mm-1.01 mm) for apical 4mm. Similarly, for the ML canal, the mean deviation measured 0.83 mm (0.05mm-3.99mm) for the full canal and 0.21 mm (0.01mm-1.01mm) for the apical 4 mm. Overall, deviations were observed towards the mesial of the roots, with 69% for MB and 57% for ML canals for the full canal, and 51% for MB canals within the 4 mm. The exception was the ML canal, which exhibited a higher deviation towards distal in the apical 4mm, accounting for 52% of cases. The dentin thickness was consistent between the mesial canals of mandibular molars. However, there is no centrality of mesial canals in their roots, with frequent deviation to mesial.

Resumo O objetivo deste trabalho foi avaliar a centralização e a espessura da dentina dos canais radiculares mesiais de primeiros molares inferiores por meio de microtomografia computadorizada (micro-CT). Material e métodos: Noventa e nove molares inferiores com canais tipo IV de Vertucci foram escaneados por micro-TC. O desvio mesiodistal e o centroide foram avaliados para os canais mesiovestibular (MB) e mesiolingual (ML), nos 4mm apicais e em todo o comprimento do canal. Resultados: A espessura da dentina foi semelhante para os canais MB e ML. A espessura mais estreita foi encontrada na parede distal de um canal MB (0,07mm), enquanto a mais larga foi encontrada na parede mesial de um canal MB (2,46mm). Na análise centroide, tanto o canal MB quanto o ML exibiram desvios quando comparados ao centroide da raiz, ao longo de todo o comprimento do canal e nos 4 mm apicais. Para o canal MB, o desvio médio foi de 0,83mm (0,02mm-2,30mm) para canal inteiro e 0,18mm (0,01mm-1,01mm) para o apical de 4mm. Da mesma forma, para o canal ML, o desvio médio mediu 0,83 mm (0,05 mm-3,99 mm) para o canal inteiro e 0,21 mm (0,01 mm-1,01 mm) para os 4 mm apicais. No geral, foram observados desvios em direção mesial das raízes, sendo 69% para canais MB e 57% para canais ML para canal inteiro, e 51% para canais MB dentro dos 4 mm. A exceção foi o canal ML, que apresentou maior desvio para distal nos 4mm apicais, representando 52% dos casos. A espessura da dentina foi consistente entre os canais mesiais dos molares inferiores. Entretanto, não há centralidade dos canais mesiais em suas raízes, com frequente desvio para mesial.

Morphological assessment of the isthmus in mesial root canals of first mandibular molars / Avaliação morfológica do istmo nos canais radiculares mesiais dos primeiros molares inferiores

ABSTRACT Root canal morphology and its anatomical variations pose a great challenge to endodontists Aim The aim of this in silico study was to perform a qualitative and quantitative analysis of the threedimensional morphological characteristics of the isthmus in the mesial root canals of mandibular molars using microcomputed tomography (micro-CT) Material and Method Six hundred first mandibular molars were selected, including 317 with two mesial canals with isthmuses between the canals, and fully formed root. Isthmus morphology was determined in 3D longitudinal sections using Fan et al. (2010) classification. Root length, and the volume and area of apical and coronal level were measured. Additionally, the structural model index (SMI) of the canals were also assessed Results The prevalence of isthmuses in the mesial root canals was 32% type II, 29% type III, 22% type IV, and 17% type I. The root length was found to be 9.1±0.5 mm, the volume and area, of all root canal system, were 41.8±40.1 mm3 and 63.6±24.2 mm2 respectively. The isthmi volume and area alone were 11.06±9.03 mm3 and 30.02±11.02 mm2. The study confirmed that isthmuses are present in mesial canals of mandibular first molars, being more frequent in the apical third Conclusion The high prevalence of isthmuses with complex morphological features underscores the importance of using intracanal medications to disinfect areas unprepared by instruments.

RESUMO A morfologia do canal radicular e suas variações anatômicas representam um grande desafio para os endodontistas. O objetivo deste estudo ex vivo foi realizar uma análise qualitativa e quantitativa das características morfológicas tridimensionais do istmo nos canais mesiais de molares inferiores por meio de microtomografia computadorizada (micro-CT) Material e Método Foram selecionados 600 primeiros molares inferiores, incluindo 317 com dois canais mesiais com istmos e raiz totalmente formada. A morfologia do istmo foi determinada em cortes longitudinais 3D usando a classificação Fan et al. (2010). Foram mensurados o comprimento da raiz, o volume e a área apical e coronal e da cavidade pulpar. Adicionalmente, também foram avaliados o structure model index (SMI) dos canais Resultados A prevalência de istmos nos canais mesiais foi de 32% tipo II, 29% tipo III, 22% tipo IV e 17% tipo I. O comprimento da raiz foi de 9,1±0,5 mm, o volume e a área de todo o sistema de canais radiculares foram de 41.8±40.1 mm3 e 63.6±24.2 mm2, respectivamente. O volume e área do istmo isoladamente foram 11.06±9,03 mm3 e 30.02±11.02 mm2. O estudo confirmou que os istmos estão presentes em canais mesiais dos primeiros molares inferiores, sendo mais frequentes no terço apical Conclusão A alta prevalência de istmos com características morfológicas complexas ressalta a importância do uso de medicação intracanal para desinfecção de áreas não tocadas por instrumentos.

Antibiotic indication in endodontics by Colombian dentists with different levels of training: a survey / Indicação dos antibióticos em Endodontia por dentistas colombianos com diferentes níveis de formação: uma pesquisa por questionário

ABSTRACT Aim: This study investigated how Colombian dentists with different academic levels indicate antibiotics with therapeutic purposes in endodontics. Materials and method: A cross-sectional survey was conducted among 559 dentists in the form of an online questionnaire. Results: Three hundred and twenty questionnaires were answered (57.2%). There were significant differences among respondents. For irreversible pulpitis, 140 dentists (43.7%) said they prescribe antibiotics (57.5% of general practitioners, 20.1% of specialists and 38.9% of those with Master's and/or PhD degrees), while for symptomatic apical periodontitis, 183 (57.2%) did so (74.1% of general practitioners, 28.4% of specialists and 50.0% of those with Master's and/or PhD degrees) (p < 0.05). Amoxicillin was the most frequently prescribed antibiotic, and its association with clavulanic acid was the most often cited for acute periradicular abscess with systemic involvement. Conclusions: The greatest misunderstandings in prescribing antibiotics occurred among general practitioners. Considering all clinical conditions that do not require antibiotics, 60% of general practitioners and 34% of specialists, on average, indicated antibiotics.

RESUMO Objetivo: Este estudo investigou como dentistas colombianos com diferentes níveis acadêmicos indicaram antibióticos com fins terapêuticos em Endodontia. Materiais e método: Realizou-se um levantamento transversal com 559 dentistas. Foi enviado um questionário online. Resultados: Foram respondidos 320 questionários (57,2%). Houve diferenças significativas entre os profissionais com diferentes níveis de formação. Para pulpite irreversível, 140 (43,7%) dentistas afirmaram indicar antibióticos (57,5% clínicos gerais, 20,1% especialistas e 38,9% com mestrado e/ou doutorado), enquanto para periodontite apical sintomática, 183 (57,2%) prescrevem estes medicamentos (74,1% clínicos, 28,4% especialistas e 50,0% com mestrado e doutorado) (p < 0,05). A amoxicilina foi a mais indicada entre os profissionais, e sua associação com ácido clavulânico foi a mais referida para abscesso perirradicular agudo com acometimento sistêmico. Conclusões: Os maiores equívocos na prescrição de antibióticos ocorreram com os clínicos gerais. Considerando todas as condições clínicas que não requerem antibióticos, 60% dos clínicos gerais e 34% dos especialistas, em média, indicaram estes medicamentos.

Micro-computed tomographic evaluation of root canal morphology in mandibular first premolars from a Colombian population / Avaliaçao microromográfica da morfologia interna de canais de primeiros pré-molares de uma populaçao colombiana

ABSTRACT Dental anatomy can vary significantly between different populations from different countries. Dental anatomical variations are of great interest to the dental professional, especially to endodontists, since they can influence the outcome of endodontic treatment. The purpose of the present study was to describe the anatomical variations of the root canal in mandibular first premolars in a populationfrom Colombia, using micro-computed tomography. Fifty mandibular first premolars were scanned on a SkyScan 1174 and the microcomputed tomographic images were reconstructed. Anatomy was assessed using three-dimensional models. The parameters used were: Vertucci's classification, area and volume, perimeter, circularity, and major and minor diameter at 1, 2 and 3 mm from the apical foramen. According to the Vertucci's classification, teeth were classified as: types I (40%), V (24%), VII (4%) and III (4%), with 28% not classifiable. C-shaped canals were found in 1.8% of the sample. Mean evaluations at 1, 2, 3 mm of the foramen were as follows, respectively: perimeter 1.07 ± 0.57, 1.27 ± 0.78 and 1.57 ± 0.84 mm; circularity 0.59 ± 0.19, 0.57 ± 0.20 and 0.56 ± 0.22; maximum diameter 0.41 ± 0.23, 0.48 ± 0.33 and 0.60 ± 0.37 mm; minimum diameter 0.24 ± 0.10, 0.26 ± 0.11 and 0.21 ± 0.13 mm. Mean total area and volume were 61.27 ± 16.47 mm2 and 12.47 ± 4.95 mm3, respectively. There was wide anatomical variation in mandibular first premolars from Colombian individuals, reinforcing the need for proper anatomical knowledge to establish more effective strategies for endodontic treatment.

RESUMO A anatomia dentària pode variar significativamente entre diferentes populagoes, de diferentes países. As variagoes anatómicas dentais sao de grande interesse para o profissionai da odontologia, principalmente para os endodontistas, pois podem influenciar no resultado do tratamento endodóntico. Descrever as variagoes anatómicas do canal radicular dos primeiros pré-molares inferiores em uma populagao da Colómbia, usando a micro tomografia computadorizada. Cinquenta primeiros pré-molares inferiores foram digitalizados em um SkyScan 1174 e as imagens tomográficas foram reconstruidas e a anatomia foi avaliada por meio de modelos tridimensionais. Os parámetros utilizados foram: classificagao de Vertucci, área e volume, perímetro, circularidade e diámetros maior e menor a 1, 2 e 3 mm do forame apical. De acordo com a classificagao de Vertucci, os dentes foram classificados em: tipos I (40%), V (24%), VII (4%) e III (4%), sendo 28% nao classificáveis. Canais em forma de C foram encontrados em 1,8% da amostra. As avaliaçoes médias em 1, 2, 3 mm do forame foram as seguintes, respectivamente: perímetro 1,07 ± 0,57, 1,27 ± 0,78 e 1,57 ± 0,84 mm; circularidade 0,59 ± 0,19, 0,57 ± 0,20 e 0,56 ± 0,22; diámetro maior 0,41 ± 0,23, 0,48 ± 0,33 e 0,60 ± 0,37 mm; diámetro menor 0,24 ± 0,10, 0,26 ± 0,11 e 0,21 ± 0,13 mm. A média da área total e do volume foram 61,27 ± 16,47 mm2 e 12,47 ± 4,95 mm3, respectivamente. Houve uma grande variaçâo anatómica nos primeiros pré-molares inferiores de colombianos, reforçando a necessidade de conhecimento anatómico adequado para estabelecer estratégias mais eficazes para o tratamento endodóntico.

Disinfection and outcome of root canal treatment using single-file or multifile systems and Ca(OH)2 medication

Abstract This clinical study reports on the antibacterial effects and outcome of endodontic treatment using either a single-file or a multifile system, associated with calcium hydroxide interappointment medication. The root canals of single-rooted teeth with apical periodontitis were treated by using either Reciproc or BioRaCe instrument systems, 2.5% NaOCl irrigation, and calcium hydroxide medication. Bacteriological samples taken before preparation and immediately before obturation were evaluated for total bacterial counts by quantitative real-time polymerase chain reaction (qPCR). Patients were followed up and the treatment outcome was assessed by clinical and radiographic criteria. Decreasing lesions were classified as success in a lenient criterion or failure in a rigid one. Bacteria were detected in all initial samples (47 cases) and were significantly reduced after treatment in both groups (p<0.001). In the Reciproc and BioRaCe groups, 7/25 (28%) and 11/22 (50%) root canals yielded negative qPCR results before obturation, respectively (p>0.05). Quantitative bacterial reduction was similar between groups (p>0.05). The success rate in the BioRaCe group was 95.5% and 77% in the loose and rigid criterion, respectively. In the Reciproc group, corresponding figures were 88% and 76%. Differences in outcome were not significant (p>0.05). No diseased case showed negative qPCR results for bacteria. A difference of >1 Log10 counts was observed between healed and diseased cases. Root canal treatments of teeth with apical periodontitis using a single-file or a multifile system for preparation, associated with NaOCl irrigation and calcium hydroxide interappointment medication, showed similar antibacterial effectiveness and success rate.

Resumo Este estudo clínico relata os efeitos antibacterianos e o resultado de tratamentos endodônticos usando um sistema de instrumentação de instrumento único ou de múltiplos instrumentos, associado à medicação intracanal com hidróxido de cálcio. Os canais radiculares de 80 dentes unirradiculares com lesão perirradicular foram tratados com os sistemas Reciproc ou BioRaCe, irrigação com NaOCl a 2,5% e medicação com pasta de hidróxido de cálcio por 7 a 10 dias. Amostras bacteriológicas foram colhidas antes do preparo e imediatamente antes da obturação e examinadas quanto à contagem total de bactérias pela reação em cadeia da polimerase em tempo real quantitativa (qPCR). Os pacientes foram acompanhados e o resultado do tratamento foi avaliado por critérios clínicos e radiográficos (índice periapical). Os casos com lesões que diminuíram mas não desapareceram foram classificados como sucesso em um critério leniente ou fracasso em um critério rígido. Quarenta e sete pacientes estavam disponíveis para avaliação bacteriológica e de resultados. Bactérias foram detectadas em todas as amostras iniciais desses casos e foram significativamente reduzidas após o tratamento nos dois grupos (p<0,001). Nos grupos Reciproc e BioRaCe, os canais radiculares apresentaram resultados negativos na qPCR em 7/25 (28%) e 11/22 (50%) casos antes da obturação, respectivamente (p>0,05). A redução bacteriana foi semelhante entre os grupos (p>0,05). O período médio (mediana) de acompanhamento foi de 20,5 (18,5) meses para BioRaCe e 17,4 (18) meses para Reciproc (p>0,05). No grupo BioRaCe, a taxa de sucesso foi de 95,5% e 77% nos critérios leniente e rígido, respectivamente. No grupo Reciproc, os valores correspondentes foram 88% e 76%. As diferenças no resultado não foram estatisticamente significativas (p>0,05). Nenhum caso de doença pós-tratamento mostrou resultados negativos de qPCR para bactérias. Foi observada uma diferença >1 Log10 nas contagens bacterianas entre os casos curados e doentes. O tratamento do canal radicular de dentes com lesão perirradicular utilizando um sistema de instrumento único ou múltiplos no preparo, associado à irrigação com NaOCl e medicação entre consultas com hidróxido de cálcio, mostrou eficácia antibacteriana e taxa de sucesso semelhantes.

Polymorphism of the CD14 and TLR4 genes and post-treatment apical periodontitis.

INTRODUCTION: This study investigated the association of CD14 -260C>T and TLR4 +896A>G gene polymorphisms with post-treatment apical periodontitis in Brazilian individuals. METHODS: The study population consisted of 41 patients with post-treatment apical periodontitis and 42 individuals with root canal-treated teeth exhibiting healed/healing periradicular tissues (controls). All teeth had apical periodontitis lesions at the time of treatment, which was completed at least 1 year previously. Saliva was collected from the participants; DNA was extracted and used for CD14 and TLR4 genotyping using the polymerase chain reaction-restriction fragment length polymorphism approach and a real-time polymerase chain reaction TaqMan assay (Applied Biosystems, Foster City, CA), respectively. RESULTS: No specific genotype or allele of the CD14 and TLR4 genes or any combination thereof was positively associated with post-treatment apical periodontitis (P > .05). CONCLUSIONS: Data from the present study suggest that polymorphisms in the CD14 and TLR4 genes do not influence the response to endodontic treatment of teeth with apical periodontitis.

Princípios biológicos do tratamento endodôntico de dentes com polpa necrosada e lesão perirradicular / Biological principles of endodontic treatment of teeth with pulp necrosis and apical lesions

O profissional que pratica a Endodontia se depara rotineiramente com três condições básicas que requerem tratamento endodôntico: polpas vitais, polpas necrosadas e casos de retratamento. O sucesso do tratamento endodôntico depende do reconhecimento das idiossincrasias de cada uma destas três condições. Canais radiculares contendo polpa necrosada e lesão perirradicular representam um problema infeccioso e devem ser tratados de forma diferenciada dos dentes com polpa viva (sem infecção). O sucesso do tratamento endodôntico nestes casos vai depender do controle da infecção exercido pelo preparo químico-mecânico, medicação intracanal e obturação. Este artigo revisa os princípios biológicos do tratamento de dentes com polpa necrosada e infectada, visando fornecer ao clínico as condições para a melhora no resultado do tratamento endodôntico destes casos.

The clinician who practices endodontics routinely faces three conditions that require treatment: vital pulps, necrotic pulps and retreatment cases. The successful treatment of these three conditions depends on the recognition of their respective idiosyncrasies. Canals of necrotic teeth associated with apical periodontitis represent an infectious problem and should be treated differently from vital teeth (non-infected). The success of the endodontic treatment will depend on effective infection control promoted by chemomechanical preparation, intracanal medication and obturation. This paper reviews the biologic principles of the endodontic treatment of teeth with necrotic pulps and apical periodontitis, with the purpose to provide the clinician with better conditions to improve the treatment outcome.

Princípios biológicos do tratamento endodôntico de dentes com polpa viva / Biological principles of endodontic treatment of teeth with vital pulp

Na clínica endodôntica diuturna, o profissional se depara basicamente com três condições que requerem tratamento: polpas vitais, polpas necrosadas e casos de retratamento. O sucesso do tratamento endodôntico depende do reconhecimento das idiossincrasias de cada uma destas três condições. Canais radiculares contendo polpa viva são isentos de infecção, a qual geralmente se restringe à porção exposta da polpa coronária. O sucesso do tratamento endodôntico nestes casos então vai depender principalmente da manutenção da cadeia asséptica durante os procedimentos intracanais. Este artigo revisa os princípios biológicos do tratamento de dentes com polpa viva, visando fornecer ao clínico condições para melhorar o resultado do tratamento endodôntico destes casos.

Herpesvirus carriage in saliva and posttreatment apical periodontitis: searching for association.

OBJECTIVE: Herpesvirus infection can cause immunosuppression and then act as a modifier of apical periodontitis, influencing the disease severity and response to treatment. The purpose of this study was to investigate if herpesvirus infection, as inferred by salivary carriage, may influence the endodontic treatment outcome. STUDY DESIGN: The study population included 72 patients who had root canals treated more than 1 year previously because of necrotic pulps and apical periodontitis. At the follow-up examination, 27 of these patients presented with posttreatment apical periodontitis (failure) and 45 individuals exhibited healed/healing periradicular tissues (success). Saliva was collected from these individuals, DNA was extracted, subjected to multiple displacement amplification, and screened by polymerase chain reaction (PCR) assays for the presence of 6 herpesviruses: herpes simplex virus types 1 and 2 (HSV-1/2), Epstein-Barr virus (EBV), human cytomegalovirus (HCMV), human herpesvirus-6 (HHV-6), and human herpesvirus-8 (HHV-8). RESULTS: Except for HSV-1/2, all other herpesviruses were detected in saliva from both healed/healing and diseased groups. HHV-8 was the most frequent herpesvirus found in saliva (84% in success, 89% in failure), followed by HCMV (22% in success, 30% in failure), EBV (16% in success, 18.5% in failure) and HHV-6 (7% in success, 15% in failure). No significant association of herpesvirus carriage in saliva with poor treatment outcome was discernible in the population studied (P > .05). CONCLUSIONS: Data from the present study suggest that herpesvirus infection may not influence the outcome of endodontic treatment. Further longitudinal studies are warranted to confirm these findings.

Clinical outcome of the endodontic treatment of teeth with apical periodontitis using an antimicrobial protocol.

OBJECTIVE: This study investigated the long-term (1-4 years) outcome of the endodontic treatment of teeth with apical periodontitis lesions performed by undergraduate students using a defined antimicrobial protocol. STUDY DESIGN: Treatment protocol included a crown-down instrumentation technique, apical enlargement to predetermined sizes and apical level, irrigation with 2.5% sodium hypochlorite, and intracanal medication with calcium hydroxide/camphorated paramonochlorophenol (CPMC) paste. The first 100 teeth from patients who returned for follow-up were examined. The outcome was assessed based on radiographic and clinical criteria as healed (success), healing (uncertain), or not healed (failure). RESULTS: Overall results showed that 76% of the teeth healed, 19% were healing, and 5% had not healed. Most healed cases (75%) or failed cases (80%) were already evident at 2 years. Seven cases took 4 years to heal completely. CONCLUSIONS: The low failure rate observed in this study reinforces the importance of using an evidence-based antimicrobial strategy during endodontic treatment of teeth with apical periodontitis.

Eficácia antimicrobiana de diferentes medicamentos intracanais sobre Enterococcus faecalis, Candida albicans e Actinomyces radicidentis / Antimicrobial efficacy of different intracanal medicaments on Enterococcus faecalis, Candida albicans e Actinomyces radicidentis

O objetivo deste estudo in vitro foi investigar a eficácia de diferentes medicamentos intracanais contra Enterococcus faecalis, Candida albicans e Actinomyces radicidentis, três espécies microbianas detectadas em casos de fracasso da terapia endodôntica e com reconhecidos níveis de resistência ao hidróxido de cálcio. Os seguintes medicamentos foram testados: pasta de solução aquosa de clorexidina a 0,2% óxido de zinco e pastas de hidróxido de cálcio em glicerina, clorexidina a 0,2%, panamonoclorofenol, canforado/glicerina, iodeto de potássio iodetado ou iodo povidine. Os resultados demonstraram que a clorexidina associada ao óxido de zinco ou ao hidróxido de cálcio apresentou maior atividade antimicrobiana quando comparada aos outros medicamentos. Isso sugere que pastas contendo clorexidina podem ser consideradas para uso como medicamentação intracanal.