Fifteen years of engine-driven nickel-titanium reciprocating instruments, what do we know so far? An umbrella review.

Numerous systematic reviews (SRs) have produced conflicting findings on engine-driven nickel-titanium reciprocating instruments (reciprocating instruments) since Yared's seminal study 15 years ago. This umbrella review analysed SRs examining the clinical and laboratory evidence regarding reciprocating instruments for root canal treatment. SRs that evaluated qualitatively and/or quantitatively the outcomes postoperative pain, oral health-related quality of life (OHRQoL), shaping ability, debris extrusion, microbial load, endotoxins reduction, cyclic fatigue, file fracture, dentinal cracks and root canal filling removal were included. The AMSTAR 2 tool was used to evaluate SRs quality, while the ROBIS tool to assess risk of bias (RoB). Forty SRs were included. The SRs revealed predominantly 'high' RoB and 'critically low' quality. Most focused on technical outcomes, exhibiting significant methodological and statistical heterogeneity. Findings suggest comparable efficacy between reciprocating and rotary instruments. However, due to the scarcity of high-quality evidence, future well-designed studies and reviews considering core outcome measures are needed.

Does radiotherapy treatment alter the pulp condition in patients with head and neck cancer? A systematic review.

The main purpose of this study was to answer the question: "Can radiotherapy cause changes in the dental pulp condition of patients treated with irradiation in the head and neck region?" Clinical observational studies in adults with head and neck cancer undergoing treatment with ionizing radiation, longitudinal or cross-sectional follow-up to measure oxygen saturation (SpO2), and/or pulp sensitivity test to cold stimulation, were considered eligible. A systematic literature search was performed in six different databases, including the gray literature, and in article references. Two independent evaluators selected the studies, extracted the data, recorded the data on electronic spreadsheets, and then evaluated the methodological quality using the Checklist for Quasi-Experimental Studies tool devised by JBI. The data were assessed qualitatively using the Synthesis Without Metanalysis (SWiM) guidelines. After removing the duplicate articles, carefully analyzing the titles and abstracts, and reading the papers in full, seven studies were included. Four of the studies evaluated applied the cold sensitivity test, two associated pulse oximetry and cold sensitivity, and only one used just pulse oximetry. Evaluation using the cold sensitivity test and pulse oximetry in the initial periods before radiotherapy showed a decrease in the sensitive response and in SpO2 levels during a maximum period of 1 year. However, analyses thereafter indicated a normal response in both tests from 5 to 6 years after the end of radiotherapy treatment. Radiotherapy causes changes in pulp behavior patterns in the short term; however, recovery and return to average values occurs after long periods.

Mechanism of action of Bioactive Endodontic Materials

Abstract A continuous search for bioactive materials capable of supporting the replacement of damaged pulp tissue, with effective sealing potential and biocompatibility, has represented the attention of studies over the last decades. This study involves a narrative review of the literature developed by searching representative research in PUBMED/MEDLINE and searches in textbooks associated with the mechanism of action of bioactive materials (calcium hydroxide, mineral trioxide aggregate (MTA), and calcium silicate cements). The reflective analysis of the particularities of the chemical elements of these materials, considering the tissue and antibacterial mechanism of action, allows a better understanding of the characteristics and similarities in their tissue responses. Calcium hydroxide paste remains the antibacterial substance of choice as intracanal dressing for the treatment of root canal system infections. Calcium silicate cements, including MTA, show a favorable biological response with the stimulation of mineralized tissue deposition in sealed areas when in contact with connective tissue. This is due to the similarity between the chemical elements, especially ionic dissociation, the potential stimulation of enzymes in tissues, and the contribution towards an alkaline environment due to the pH of these materials. The behavior of bioactive materials, especially MTA and the new calcium silicate cements in the biological sealing activity, has been shown to be effective. Contemporary endodontics has access to bioactive materials with similar properties, which can stimulate a biological seal in lateral and furcation root perforations, root-end fillings and root fillings, pulp capping, pulpotomy, apexification, and regenerative endodontic procedures, in addition to other clinical conditions.

Resumo Uma busca contínua de materiais bioativos com capacidade de substituir o tecido pulpar danificado, com efetiva capacidade de selamento e biocompatibilidade, tem representado a atenção e foco de muitos estudos ao longo das últimas décadas. Este estudo envolve uma revisão narrativa da literatura desenvolvida por meio de pesquisas representativas encontradas no PUBMED/MEDLINE e pesquisas em livros didáticos associadas ao mecanismo de ação de materiais bioativos (hidróxido de cálcio, agregado de trióxido mineral (MTA) e cimentos de silicato de cálcio). A presente análise reflexiva das particularidades dos elementos químicos destes materiais bioativos, considerando o mecanismo de ação tecidual e antibacteriano, possibilita um melhor entendimento das características e similaridades no comportamento tecidual. A pasta de hidróxido de cálcio continua sendo a substância antibacteriana de escolha como medicação intracanal para o tratamento das infecções do sistema de canais radiculares. Este fato se deve a disponibilidade química de íons cálcio e hidroxila do hidróxido de cálcio aos tecidos, e a inibição enzimática bacteriana. Os cimentos de silicato de cálcio, dentre os quais inclui o MTA, apresentam uma resposta biológica favorável ao estímulo à deposição de tecido mineralizado nas áreas seladas e em contato com tecido conjuntivo. Este fato é decorrente da similaridade entre os elementos químicos, em especial devido a dissociação iônica, ao potencial estímulo de enzimas teciduais, e a contribuição com um meio alcalino decorrente do pH destes materiais. O comportamento dos materiais bioativos, em especial o MTA e os novos cimentos de silicato de cálcio na atividade de selamento biológico mostraram efetivos. A endodontia contemporânea atualmente conta com o potencial de materiais bioativos com propriedades análogas capaz de estimular o selamento biológico em perfurações radiculares laterais e de furca, em obturações radiculares, capeamento pulpar, pulpotomia, apicificação e procedimentos endodônticos regenerativos, além de outras condições clínicas.

Does radiotherapy treatment alter the pulp condition in patients with head and neck cancer? A systematic review

Abstract The main purpose of this study was to answer the question: "Can radiotherapy cause changes in the dental pulp condition of patients treated with irradiation in the head and neck region?" Clinical observational studies in adults with head and neck cancer undergoing treatment with ionizing radiation, longitudinal or cross-sectional follow-up to measure oxygen saturation (SpO2), and/or pulp sensitivity test to cold stimulation, were considered eligible. A systematic literature search was performed in six different databases, including the gray literature, and in article references. Two independent evaluators selected the studies, extracted the data, recorded the data on electronic spreadsheets, and then evaluated the methodological quality using the Checklist for Quasi-Experimental Studies tool devised by JBI. The data were assessed qualitatively using the Synthesis Without Metanalysis (SWiM) guidelines. After removing the duplicate articles, carefully analyzing the titles and abstracts, and reading the papers in full, seven studies were included. Four of the studies evaluated applied the cold sensitivity test, two associated pulse oximetry and cold sensitivity, and only one used just pulse oximetry. Evaluation using the cold sensitivity test and pulse oximetry in the initial periods before radiotherapy showed a decrease in the sensitive response and in SpO2 levels during a maximum period of 1 year. However, analyses thereafter indicated a normal response in both tests from 5 to 6 years after the end of radiotherapy treatment. Radiotherapy causes changes in pulp behavior patterns in the short term; however, recovery and return to average values occurs after long periods.

Method to determine the root canal spatial geometry using an algorithm of the e-Vol DX CBCT software

Abstract This study evaluated a method to determine the spatial geometry of root canal preparation (RCP) using navigation dynamics and a specific algorithm from a new CBCT software (e-Vol DX). CBCT scans of 168 root canals of mandibular molars were acquired before and after RCP, using nickel-titanium (NiTi) instruments (ProTaper Next, BioRace, Reciproc Blue, and WaveOne Gold). The spatial geometry of the root canals and the operative risk of disproportional wear of dentinal walls after RCP were evaluated using a new CBCT software. A 3-point scoring system was used after the measuring of cementum/dentin thickness before and after RCP in all root thirds. The root thirds were distributed into three parts of similar sizes, and the scores were categorized at three levels: 1. mild risk (1/3), 2. moderate risk (2/3), 3. severe risk (3/3). These levels were proposed according to the risk of creating disproportionate shapes, thin walls, or perforations. The data were analyzed statistically by Fischer's exact test (α = 5%). There were no significant differences in operative risk among the NiTi engine-driven systems, for the distal or mesial walls of all the root canal thirds (p>0.05). The spatial geometry method to assess operative risk allows clinical planning for a predictable enlargement of the root canal in all root thirds. Based on using a map-reading strategy on root canals in CBCT scans, NiTi engine-driven instruments did not present an increased operative risk during RCPs.

Resumo Este estudo avaliou um método para determinar a geometria espacial do preparo do canal radicular (PCR) usando uma dinâmica de navegação e um algoritmo específico do software e-Vol DX. Imagens de tomografia computadorizada de feixe cônico (TCFC) de 168 molares inferiores foram adquiridas antes e depois do PCR, usando instrumentos de níquel-titânio (NiTi) (ProTaper Next, BioRace, Reciproc Blue e WaveOne Gold). A geometria espacial dos canais radiculares e o risco operatório de desgaste desproporcional das paredes dentinárias após o preparo foram avaliados usando o software de TCFC e-Vol DX. Um sistema de Score de 3 pontos foi usado após a mensuração da espessura cemento/dentina antes e depois do PCR, em toda extensão dos canais radiculares. Os terços radiculares foram distribuídos em três partes de tamanhos semelhantes, e os Scores foram categorizados em três níveis: 1. risco leve (1/3), 2. risco moderado (2/3), 3. risco severo (3/3). Esses níveis foram propostos de acordo com o risco de criar formas desproporcionais, paredes finas ou perfurações radiculares. Os dados foram analisados estatisticamente pelo teste exato de Fischer ((=5%). Não houve diferenças significativas no risco operatório entre os sistemas de NiTi acionados a motor, para as paredes distal ou mesial em todos os terços do canal radicular (p>0,05). O método de geometria espacial para avaliar o risco operatório permite o planejamento clínico para um alargamento previsível do canal radicular em todos os terços radiculares. Com base no uso de uma estratégia de navegação dinâmica de canais radiculares de molares inferiores analisados em imagens de TCFC, os instrumentos de NiTi acionados estudados não apresentaram um aumento do risco operatório durante o preparo dos canais radiculares.

Debris extrusion during root canal preparation with nickel-titanium instruments using liquid and gel formulations of sodium hypochlorite in vitro.

This study compared the amount of apically extruded debris during root canal preparation with three single-file systems using liquid and gel-based formulations of sodium hypochlorite (NaOCl) or distilled water. Seventy-two single-canalled roots were divided into three groups: HyFlex EDM (Coltene-Whaledent); Reciproc Blue (VDW); and F-One Blue (Shanghai Fanta) and then divided into three subgroups: NaOCl liquid (Imicrly), NaOCl gel (Cerkamed Medical) and distilled water. The amount of extruded debris was calculated by determining the dry weight of the debris collected. Data were analysed using Kruskal-Wallis test with Bonferroni correction. Debris extrusion occurred in all subgroups. Both the instrument and the irrigant had an impact. The F-One Blue tended to extrude the least debris, though no significant difference was observed in the pairwise comparisons between instruments. NaOCl liquid resulted in significantly more extruded debris than NaOCl gel or distilled water. The results lead us to conclude that the NaOCl gel reduced debris extrusion compared to NaOCl liquid.

Accuracy of periapical and panoramic radiography for detection of root morphologies: a comparative study

Abstract: Maxillary and mandibular incisors have increased risk for severe orthodontically induced inflammatory root resorption. A patient-related risk factor is aberrant root morphology. This study aimed to assess the frequency of detection of different root morphologies in anterior teeth using dental panoramic tomography (DPT) and long cone periapical radiographs (LCPAs). A retrospective cross-sectional design was used to assess a sample of 50 consecutive pre-treatment radiographic records of patients from a specialist orthodontic practice in Adelaide, Australia. A reference guide was developed that included three previously unreported morphologies: pipette and bent, bent and pointed, bent and blunt. Two trained and calibrated assessors examined each record against the inclusion criteria, then independently assessed each anterior tooth from DPTs and LCPAs to detect the type of root morphology present. Data were analysed using the chi-square statistical test. Radiographic records for 48 patients (48 DPTs and 161 LCPAs) were eligible, with 355 and 426 teeth on DPTs and LCPAs, respectively, included for assessment. Normal root morphology (119 teeth) was commonly observed in DPTs, while bent (154 teeth) was frequently observed using LCPAs. Mandibular incisors often had normal morphology in DPTs but bent in LCPAs. Bent was the most common morphology in maxillary lateral incisors using DPT and LCPAs, although maxillary centrals were mostly normal in DPTs but pointed in LCPAs. Differences using the two image acquisition methods were highly significant (p < 0.01). Aberrant root morphologies are more easily detected in anterior teeth using LCPAs compared to DPTs.

Retrograde peri-implantitis associated with residual cysts: 3 Case reports.

BACKGROUND AND OVERVIEW: The authors describe 3 cases of retrograde peri-implantitis associated with residual cysts and their successful surgical and regenerative management. Implants were originally placed with both immediate and delayed protocols. CASE DESCRIPTION: Three patients sought treatment at the authors' specialist private practices with the chief symptoms of pain and swelling in association with implant-retained restorations. Clinical, radiographic, and histopathologic findings supported the diagnoses of infected residual cysts. The lesions were enucleated in toto, the implant surfaces were decontaminated, and bone regeneration procedures were carried out. Long-term recall visits, ranging from 3 through 10 years, confirmed successful retention of all implants treated accordingly. CONCLUSIONS AND PRACTICAL IMPLICATIONS: The authors describe an unusual clinical manifestation and emphasize the role of local procedures during implant placement in areas compromised with infection, cysts, or both and the importance of long-term recall visits.

Post-operative instructions following minor oral surgery - the quality and level of evidence: a cross-sectional study.

Aims To assess the quality of information targeting lay people regarding post-operative instructions after minor oral surgery (MOS), and to determine the level of evidence of any scientific articles cited in the instructions.Design and setting A dynamic Internet-based cross-sectional study.Materials and methods An Internet search for professional organisations/specialist dental societies in ten English-speaking countries with a search of their websites was conducted to locate post-operative instructions. Where not readily available, these were requested from each respective organisation/society. Reliability and quality of the instructions were assessed using the DISCERN instrument. Evidence level of cited articles was analysed using the Joanna Briggs Institute Levels of Evidence.Results Of the 59 identified organisations/societies, 26 sets of instructions were assessed. Overall quality of information was low, represented by median scores of 45%, 42.9% and 42.7% for reliability, quality of information and total DISCERN score, respectively. Only two instructions cited articles to support their content; these were of moderate-low level evidence.Conclusion Post-operative instructions following MOS that target the lay public have low quality and cite articles of moderate-low level evidence to support their content. Peak organisations should ensure such content is easily locatable, of high quality and is supported by high-level evidence.

Comparative Histopathologic Analysis of Granulomatous Tissue of Endodontic and Periodontal Origin.

PURPOSE: The aim of this study was to compare the percentage of tissue types and assess the presence/absence of odontoblasts or preodontoblasts in granulation tissue harvested from lesions associated with teeth extracted due to endodontic and periodontal reasons. MATERIALS AND METHODS: Histologic reports of cases with a confirmed diagnosis (ie, endodontic or periodontal diseases) were included. These should include a semiquantitative analysis of the percentage of tissue types per sample (ie, epithelium, subepithelial connective tissue, bone or chronic inflammation/deep connective tissue). The overall percentage of tissue type per diagnosis was calculated. Quantitative variables were summarized with means and standard deviations. Normal distribution was tested by the D'Agostino-Pearson omnibus normality test. The level of P < .05 was adopted for statistical significance. Finally, an analysis of the salient findings was summarized. RESULTS: The reports from 19 patients were included, 9 of endodontic and 10 of periodontal origins. The granulomatous tissue of endodontic and periodontal disease origin was similar, and consisted mainly of chronic inflammation (endodontic 40%, periodontal 41.7%), followed by epithelium (endodontic 25.7%, periodontal 29.2%), subepithelial connective tissue (endodontic 18.6%, periodontal 20.8%), and bone (endodontic 15.7%, periodontal 8.3%). No significant differences were found when comparing the groups regarding the percentage of tissue types (P ≥ .05). No osteoblasts or preosteoblasts were reported. CONCLUSION: Within the limitations of the study, the granulomatous tissues associated with chronic infection of endodontic or periodontal origin are comparable and consist primarily of chronic inflammatory cells.

The Effect of Diode and Er,Cr:YSGG Lasers on the Bond Strength of Fiber Posts.

Background: Laser irradiation modifies the topography and composition of dentin surface aiming to increase the retention of bonded posts. Objective: To assess the effect of dentin irradiation with Er,Cr:YSGG or diode lasers on the bond strength of fiber posts using self-adhesive resin cement. Materials and methods: Sixty bovine root canals were root-canal treated, post spaces were prepared, and subsequently fiber posts were cemented. The samples were distributed according to the surface treatment: distilled water (control), Er,Cr:YSGG (1.5 W, 20 sec), or diode (1.5 W, 20 sec) lasers. Bond strengths were assessed by pull-out (n = 10) or push-out testing (n = 10). Pearson's correlation was calculated. Failure mode after testing and the depth of tags in the dentinal tubules were analyzed by confocal laser microscopy. Data were submitted to analysis of variance and Tukey's test. A p < 0.05 was considered significant. Results: In the push-out test, Er,Cr:YSGG laser had significantly different higher values (5.43 ± 0.10 MPa) compared to the control (4.79 ± 0.05 MPa). Diode laser values were not significantly different from the other groups (5.12 ± 0.27 MPa). In the pull-out test, there were no significant differences between Er,Cr:YSGG (6.86 ± 2.16 MPa) and diode (8.43 ± 1.77 MPa) lasers, and both had significant differences compared to the control (4.18 ± 1.29 MPa). No correlation was found. Adhesive failures were predominant in all groups, and no significant differences in tag penetration among the groups were found. Conclusions: The Er,Cr:YSGG laser increases the bond strength of resin cement and fiber post to dentin in both tests, compared to control group without laser treatment. Diode laser only enhanced bonding for pull-out test.

Cone-beam and micro-computed tomography for the assessment of root canal morphology: a systematic review

Abstract This study presents an overview of the accuracy of cone beam computed tomography (CBCT) compared with micro-computed tomography (μCT) in the assessment of root canal morphology of extracted human permanent teeth. A database search in PubMed, PubMed Central, Embase, Scopus, Opengrey, Scielo and Virtual Health Library was conducted which compared root canal morphology of extracted human permanent teeth on the accuracy of CBCT with μCT. In accordance with PRISMA statement guidelines, data were extracted on study characteristics, target mediators, sampling and assay techniques and the parameters associated with obtaining the image and ability to identify the root canal morphology. Amongst 2734 records, ten fulfilled the inclusion criteria. Four studies compared the accuracy of CBCT and μCT in the assessment of root canal morphology using Vertucci's classification, with at least one CBCT group or subgroup of each study presented high agreement compared to the μCT. Six studies assessed more detailed root canal morphology, including two articles that found a lack of agreement between these imaging systems. Risk of bias was deemed low in three studies, moderate in four and high in three. CBCT can be as accurate as μCT in the assessment of several morphological features of extracted human permanent teeth; however there are some exceptions related to the more detailed morphological aspects. Voxel size likely influences the ability to detect these features, though the different aspects of exposure setting used in studies components may be confounding factors. CBCT may be considered for the assessment of root canal morphology ex-vivo.

Limited evidence suggests benefits of single visit revascularization endodontic procedures - a systematic review

Abstract Revascularization endodontic procedures commonly require multiple treatment sessions. However, single visit procedures may be advantageous from the clinical and patient management standpoints. The purpose of this review was to evaluate the outcomes of single-visit revascularization endodontic procedures for the management of immature permanent teeth with non-vital pulp. Two electronic databases (Scopus and PubMed) were searched, from their inception to July 2018, for studies that assessed clinical and/or radiographic and/or histologic outcomes of single-visit revascularization endodontic procedures performed in immature permanent teeth with non-vital pulp. Case reports, animal studies and clinical trials were included. The quality of case reports was appraised by Joanna Briggs Institute Critical Appraisal Checklist for Case Reports. The quality of randomized clinical trials was assessed by the revised Cochrane risk of bias tool for randomized trials. The risk of bias for animal studies was assessed using SYRCLE's risk of bias tool. Tabulation followed by narrative synthesis was used to draw conclusions. Seven studies satisfied the selection criteria. Five were classified as case reports, one as a randomized clinical trial and one as animal study. The latter presented with a high risk of bias, whilst the remaining showed a low risk. The evidence supporting the potential use of single-visit revascularization endodontic procedures is scarce. Successful single-visit revascularization endodontic procedures commonly include the use of high concentrations of sodium hypochlorite and EDTA combined with the use of agitation systems. Further clinical trials with long term follow up are needed to confirm the results of the current review.

Resumo Os protocolos clínicos de procedimentos endodônticos de revascularização comumente requerem múltiplas sessões. Entretanto, procedimentos em única sessão podem apresentar vantagens clínicas relacionadas ao paciente. O objetivo desta revisão sistemática foi avaliar os resultados clínicos dos procedimentos endodônticos de revascularização para o manejo de dentes permanentes imaturos realizados em única visita. Duas bases de dados eletrônicas (Scopus e PubMed) foram utilizadas, do seu início à julho de 2018, buscando estudos que avaliaram resultados de procedimentos endodônticos clínicos e/ou radiográficos, e/ou histológicos da revascularização em sessão única realizados em dentes permanentes imaturos com necrose pulpar. Relatos de casos, estudos em animais e estudos clínicos foram incluídos e avaliados quanto à qualidade e risco de viés. A qualidade dos relatos de casos foi avaliada utilizando-se a ferramenta própria de análise crítica do Instituto Joanna Briggs. A qualidade dos estudos clínicos randomizados controlados foi analisada pela ferramenta de risco de viés da Cochrane. O risco de viés para os estudos em animais foi mensurado utilizando-se a ferramenta SYRCLE. Os dados foram tabulados e a síntese narrativa foi utilizada para análise dos mesmos. Sete estudos satisfizeram os critérios de inclusão. Cinco foram classificados como relatos de casos, um como ensaio clínico randomizado e um outro como estudo em modelo animal. Este último apresentou alto risco de viés, enquanto o restante dos estudos mostrou baixo risco. A evidência que apoia a utilização potencial de procedimentos endodônticos de revascularização em sessão única é escassa. Os procedimentos endodônticos de revascularização em sessão única geralmente incluem o uso de altas concentrações de hipoclorito de sódio e EDTA, combinadas com o uso de sistemas de agitação. Assim, estudos clínicos com longos períodos de acompanhamento são necessários para confirmação dos resultados do presente estudo.

Validation of self-reported history of root canal treatment in a southern Brazilian subpopulation

Abstract The aim of this study was to assess self-reported history of root canal treatment (SRHRCT) as a method for detecting the presence of root canal treatment (RCT) and apical periodontitis (AP) in a southern Brazilian subpopulation. In this cross-sectional study, 136 military police officers from the city of Porto Alegre, Brazil, were included. The participants were interviewed and full-mouth periapical radiographs were taken. A calibrated examiner determined the presence of RCT and AP by applying standardized criteria. The diagnostic accuracy of SRHRCT was calculated separately for RCT and AP. Accuracy, sensitivity, specificity, positive and negative predictive values (+PV and -PV), efficiency, and positive and negative likelihood ratios (+LR and -LR) were estimated. The mean age of the participants was 34.1 ± 10.4 years and 88.2% were males. Overall, SRHRCT demonstrated high sensitivity and specificity for RCT, but not for AP: sensitivity (RCT = 0.960, AP = 0.757) and specificity (RCT = 0.835, AP = 0.631). The estimated values for PV and LR were: +PV (RCT=0.777, AP=0.396), -PV (RCT = 0.972, AP = 0.890), +LR (RCT = 5.853, AP = 2.057), and -LR (RCT = 0.046, AP = 0.383). SRHRCT proved to be a good predictor of the presence of RCT, but a weak predictor of AP in this subpopulation.

Oximetria de pulso na avaliação da vitalidade pulpar: análise crítica / Pulse oximetry in evaluation of pulp vitality: critical analysis

O diagnóstico da condição pulpar é essencial para o estabelecimento do tratamento adequado, e continua sendo um desafio na prática clínica atual. Os testes pulpares térmicos e elétrico são os mais comumente utilizados, porém apresentam as limitações inerentes por avaliarem apenas a sensibilidade pulpar, através da aplicação de estímulos na superfície dentária. A vitalidade da polpa dentária está relacionada à sua vascularização, e testes que avaliam o fluxo sanguíneo pulpar têm sido desenvolvidos e estudados. A oximetria de pulso é amplamente utilizada na medicina para determinação dos níveis de saturação de oxigênio sanguíneos, e tem apresentado-se como recurso para determinação da vitalidade pulpar. Com a utilização de adaptadores, os níveis de saturação de oxigênio da polpa dentária têm sido determinados em diferentes condições clínicas, direcionando para um diagnóstico mais preciso. Resultados promissores obtidos em diversos estudos reforçam as vantagens do oxímetro de pulso em comparação aos testes de sensibilidade, por se tratar de um método mais acurado, objetivo, não invasivo e que não provoca dor e desconforto ao paciente. Nesta perspectiva, os avanços científicos e tecnológicos têm aprimorado o uso de métodos de diagnóstico pulpar inovadores, e o oxímetro de pulso é um potencial recurso para aplicação na rotina clínica dos cirurgiões-dentistas.

Dental pulp diagnosis is essential for the establishment of appropriate treatment and remains a challenge in current clinical practice. Thermal and electrical pulp tests are the most commonly used, but they have the inherent limitations of only evaluating the pulp sensitivity through the application of stimuli on the dental surface. The vitality of the dental pulp is related to its vascularization, and tests that evaluate pulp blood flow have been developed and studied. Pulse oximetry is widely used in medicine for determination of blood oxygen saturation levels and has been presented as a resource for pulp vitality determination. With use of adapters, the levels of oxygen saturation of the dental pulp have been determined in different clinical conditions, leading to a more accurate diagnosis. Promising results obtained in several studies reinforce the advantages of the pulse oximeter in comparison to the sensitivity tests, because it is a more accurate, objective, non-invasive method that does not cause pain and discomfort to the patient. In this perspective, scientific and technological advances have improved the use of innovative pulp diagnostic methods, and the pulse Oximeter is a potential resource for application in the clinical routine of dentists.

Ultrasonography in the diagnosis of bone lesions of the jaws: a systematic review.

The diagnostic use of ultrasonography in dentistry and maxillofacial surgery has previously been described in the literature. Considering that ultrasonography may be useful for the diagnosis of bone lesions of the jaws, a systematic review was carried out to examine the evidence. This review determined that ultrasonography has been used effectively for the diagnosis of infective and/or inflammatory lesions, cysts, nonodontogenic tumors, odontogenic tumors, and arteriovenous malformations and for the differential diagnosis of lesions of endodontic origin, compared with the gold standard of histologic analysis. Ultrasonography may be a viable adjunct to other special tests for the diagnosis of intraosseous lesions of the jaws, as it is noninvasive and does not involve ionizing radiation exposure of the patient.

Effect of an Alcohol-Based Caries Detector on the Surface Tension of Sodium Hypochlorite Preparations

The purpose of this study was to evaluate the effect of an alcohol-based caries detector (Kurakay) on the surface tension of a conventional sodium hypochlorite (NaOCl) preparation, and a product containing a surface-active agent (Chlor-XTRA). The surface tensions of the following solutions were tested: NaOCl, a mixture of NaOCl and Kurakay 9:1 w/w, Chlor-XTRA, a mixture of Chlor-XTRA and Kurakay 9:1 w/w. Ten measurements per test solution were made at 20 C, using an optical method called the "Pendant drop method", with a commercially available apparatus. The addition of Kurakay reduced the surface tension for NaOCl (p<0.05) whilst no significant difference was detected for Chlor-XTRA (p>0.05). Statistically significant differences between the NaOCl and Chlor-XTRA groups were found (p<0.05). The addition of an alcohol-based caries detector resulted in a reduction of the original surface tension values for NaOCl only. Taking into account the fact that mixtures of NaOCl and Kurakay have been used to assess the penetration of root canal irrigants in vitro, the related changes in surface tension are a possible source of bias.

O objetivo deste estudo foi avaliar o efeito de um detector de cárie com álcool (Kurakay) sobre a tensão superficial de um preparado convencional de hipoclorito de sódio (NaOCl) e um produto contendo um agente surfactante (Chlor-XTRA). Foram testadas as tensões superficiais das seguintes soluções: NaOCl, uma mistura de NaOCl e Kurakay na proporção de 9:1 em peso, Chlor-XTRA e um mistura de Chlor-XTRA e Kurakay na proporção de 9:1 em peso. Dez medidas foram feitas com cada solução, a 20 °C, utilizando um método óptico chamado "Método da gota pendente" (Pendant drop method) usando aparelhos disponíveis. Adição do Kurakay reduziu a tensão superficial do NaOCl (p<0,05), mas não houve diferença significante para Chlor-XTRA (p>0,05). Foram encontradas diferenças estatisticamente significantes entre os grupos NaOCl e Chlor-XTRA (p<0,05). Adição de um detector de cárie com álcool resultou na diminuição do valor original da tensão superficial apenas para NaOCl. Considerando que as misturas de NaOCl e Kurakay tem sido usadas para estudar a penetração in vitro dos irrigantes radiculares, as diferenças acima são uma possível fonte de desvio nos resultados.

Clinical importance of incidental findings reported on small-volume dental cone beam computed tomography scans focused on impacted maxillary canine teeth.

OBJECTIVE: To investigate the clinical importance of incidental findings reported for small-volume cone beam computed tomography (CBCT) scans of impacted maxillary canine teeth. STUDY DESIGN: Radiology reports of CBCT examinations performed as part of diagnosis and treatment planning for impacted or ectopically erupting maxillary canine teeth for 183 consecutive patients were assessed retrospectively. The scans were obtained with a small-volume unit (3 D Accuitomo 80) with a field of view that was either 40 × 40 or 60 × 60 mm. The findings were graded according to their clinical importance as low, intermediate, or high. RESULTS: Three hundred and forty incidental findings were reported. One of the incidental findings was of high importance (0.3%), 97 were of intermediate importance (28.5%), and 242 were of low importance or anatomic variant (71.1%). CONCLUSIONS: Incidental findings reported on small-dimension CBCT scans of impacted maxillary canine teeth rarely require immediate attention; nonetheless, 28.8% would require follow-up.