Zinc oxide-ozonated olive oil as a new root canal filling material in primary molars: a clinical randomized controlled trial.

OBJECTIVES: The complex root canal anatomy of primary teeth keeps it very tricky to attain appropriate cleansing by biomechanical instrumentation, so obtaining an obturating material with excellent antimicrobial properties is a challenge in current clinical pulpectomy practice. So, this study aimed to assess the clinical and radiographic performance of zinc oxide-ozonated olive oil as a primary root canal filling material. MATERIALS AND METHODS: Ninety non-vital primary molars in children ranging from 4 to 8 years were allocated into three groups in which root canals were filled with zinc oxide-ozonated olive oil, zinc oxide-olive oil, and zinc oxide-eugenol (ZOE) according to each group after pulpectomy procedure. Clinical and radiographic evaluations were done at 3-, 6-, and 12-month follow-up periods. Statistical analysis was performed for the collected data. RESULTS: All study groups showed a significant improvement regarding clinical signs and symptoms during follow-up periods. Ozonated-olive oil group revealed a significant increase in furcation radiodensity and a decrease in periodontal ligament space at 3-, 6-, and 12-month follow-up intervals compared to other groups. CONCLUSION: Zinc oxide-ozonated olive oil and zinc oxide-olive oil paste had shown good clinical and radiographic success for primary teeth pulpectomy. CLINICAL RELEVANCE: The intricate torturous primary root canal anatomy, in addition to the child's negative behavior, interferes with the complete debridement, so the long-lasting antibacterial effect of the primary root canal filling material aids in the pulpectomy success.

Concordância entre medida de comprimento de trabalho por radiografia e localizador eletrônico foraminal na dentição decídua: revisão integrativa / Agreement between work length measurement by radiography and electronic foraminal locator in the primary dentition: an integrative review

Introdução: O estabelecimento do comprimento de trabalho (CT) é uma etapa fundamental para o sucesso do tratamento endodôntico, principalmente na dentição decídua. O exame radiográfico é um dos principais meios de definir o CT. A mensuração desse comprimento também pode ser obtida por meio de dispositivos eletrônicos. Objetivo: Revisar a literatura acerca da concordância entre a medida de CT por radiografia e localizadores eletrônicos foraminais (LEFs) na dentição decídua. Metodologia: A busca bibliográfica foi realizada nas bases de dados PubMed, Cochrane Library e BVS, seguindo uma estratégia de combinação de palavras-chave, filtrando apenas pesquisas clínicas. A seleção dos artigos foi realizada em duas etapas: através da leitura dos títulos e resumos e, em seguida, por meio da obtenção e leitura dos artigos completos selecionados. Resultados: sete artigos foram selecionados, publicados entre 2011 e 2020. Todos foram analisados quanto à qualidade metodológica e à caracterização como tamanho da amostra, objetivo, metodologia, resultados e conclusão. Todos possuíam os dados necessários para contemplar o objetivo desta pesquisa. O uso dos LEFs mostrou-se tão preciso quanto o método radiográfico (n=6), e, em um estudo, o método eletrônico foi superior ao radiográfico para determinação do CT. Conclusão: O método eletrônico possui eficácia na determinação do CT durante o tratamento endodôntico de dentes decíduos sendo comparável ao radiográfico.

Introduction: To establish the working length (CT) is a fundamental step toward the suc-cess of endodontic treatment. Also, the radiographic examination is one of the most important means of determining CT. This length can also be measured by electronic devic-es. Objective: To review the literature on the agreement between the CT measurement by radiography and electronic foraminal locators (LEF) in the primary dentition. Methodology: A bibliographic search was performed on PubMed, Cochrane Library, and BVS, using a keyword combination strategy and filtering only clinical research. The selection of the articles occurred in two stages: by reading the titles and abstracts, and by obtaining and reading the selected full articles. Results: Seven articles, published between 2011 and 2020, were selected and analyzed for methodological quality and characterized for sample size, objectives, methodology, results, and conclusion. They had the essential data to contemplate the purpose of this research. The use of LEF proved to be as accurate as of the radiographic method (n=6), and in one study, the electronic method was superior to the radiographic method for determining TC. Conclusion: The electronic method is effective in determining the CT during the endodontic treatment of primary teeth and is comparable to the radiographic one.

Pasta de hidróxido de calcio/yodoformo en pulpectomías de dientes deciduos: Reporte de caso con seguimiento de seis meses / Calcium hydroxide/iodoform paste in primary teeth pulpectomies: a case report with six-month follow-up

Resumen Introducción: Las pastas de obturación a base de hidróxido de calcio/yodoformo han demostrado buenos resultados en pulpectomías de dientes primarios. Objetivos: describir el desempeño de una pasta de hidróxido de calcio/yodoformo (Calplus®) mediante la evaluación clínica y radiográfica en pulpectomias durante 6 meses. Metodología: Un paciente de sexo masculino de 2 años de edad acudió a la Clínica Odontológica de la Universidad Científica del Sur, Lima-Perú. Durante la evaluación clínica se diagnosticó caries de infancia temprana. Tratamientos preventivos y restauradores fueron realizados. Las pulpectomias fueron obturadas con (Calplus®). Para evaluar el desempeño, las pulpectomías fueron acompañadas durante 1, 3 y 6 meses mediante exámenes clínicos y radiográficos examinando dolor, movilidad patológica, alteraciones de tejido blando, rarefacción ósea, y reabsorción radicular patológica. Al tercer mes de seguimiento solo se observó contorno gingival alterado. Conclusiones: La pasta a base de hidróxido de calcio/yodoformo (Calplus®) demostró buen desempeño en pulpectomías de dientes primarios considerando aspectos clínicos y radiográficos después de 6 meses de seguimiento.

Abstract Introduction*: Calcium hydroxide/iodoform is a root canal filling material that have shown good results in pulpectomies of primary teeth. Objective: Describe the performance of a calcium hydroxide/iodoform (Calplus®) root canal filling material considering clinical and radiographic outcomes after 6 months follow-up. Methods: A 2-year-old male patient attended the Dental Clinic of Universidad Científica del Sur, Lima-Perú. Oral clinical examination showed early childhood caries. Preventive and restoration treatments were carried out. Pulpectomies were performed with Calplus®. To evaluate pulpectomies performance it was examined clinical and radiographic outcomes: pain, pathological mobility, soft tissue disorders, bone rarefaction and pathological root resorption. The clinical and radiographic findings at 1, 3, and 6 months were assessed. After three months, it was only observed altered gingival contour. Conclusion: Calcium hydroxide/ iodoform (Calplus®) root canal filling material showed good success rate in primary teeth pulpectomies considering clinical and radiographic outcomes after 6 months follow-up.

The effect of a chemomechanical protocol to eliminate microorganisms from pulpectomized primary teeth: three case reports

Introduction: Description of the bacterial community before and after chemomechanical preparation (CP) with the removal of a smear layer (SL) in pulpectomized primary teeth has been little reported. Objective: These case reports describe the presence of total microorganisms and Enterococcus faecalis in root canals of primary incisors before and after CP with SL removal. Case Reports: Microbiological samples were collected from the root canals of three children (3.66±0.58 years old) with necrosis (n=2) and irreversible pulpal inflammation (n=1) in maxillary primary incisors. After teeth isolation with a rubber dam and antisepsis of the operative field, the sample collections were performed with sterile absorbent paper cones before and after the CP, which included irrigation with 2.5% sodium hypochlorite followed by 6% citric acid to remove the SL. The collected samples were analysed immediately at the end of the clinical procedures. The plates were incubated anaerobically for 48 hours at 37°C. The results were expressed as colony forming units (CFU)/mL. Results: Two of the three teeth showed total microorganisms before the CP. One incisor had no microorganisms in the initial collection. No CFU was counted in the samples collected after CP. Moreover, E. faecalis was not observed any time, either before or after the CP. Conclusions: E. faecalis was not detected in any sample, yet two of the three root canals had microorganisms before CP. In cases where microorganisms were initially found, 100% elimination was observed after the applied protocol.

Introdução: A descrição da comunidade bacteriana antes e após o preparo químico-mecânico (PQM) com remoção da smear layer (SL) em dentes decíduos pulpectomizados tem sido pouco relatada. Objetivo: Esses relatos de casos descrevem a presença de microrganismos totais e Enterococcus faecalis em canais radiculares de incisivos decíduos antes e após PQM com remoção de SL. Relatos dos Casos: Amostras microbiológicas foram coletadas do canal radicular de três crianças (3,66 ± 0,58 anos) com necrose (n = 2) e inflamação pulpar irreversível (n= 1) em incisivos decíduos superiores. Após o isolamento dos dentes com dique de borracha e antissepsia do campo operatório, as coletas das amostras foram realizadas com cones de papel absorvente estéril antes e após o PQM, que incluiu irrigação com hipoclorito de sódio 2,5% seguido de ácido cítrico 6% para retirada do SL. As amostras coletadas foram analisadas imediatamente ao final dos procedimentos clínicos. As placas foram incubadas em anaerobiose durante 48 horas a 37°C. Os resultados foram expressos em unidades formadoras de colônias (UFC)/mL. Resultados: Dois dos três dentes apresentaram microrganismos totais antes do PQM. Um incisivo não apresentava microrganismos na coleta inicial. Nenhuma UFC foi contada nas amostras coletadas após o PQM. Além disso, o E. faecalis não foi observado nenhum momento, nem antes, nem depois do PQM. Conclusão: Não foi detectado E. faecalis em nenhuma amostra, porém dois dos três canais radiculares apresentavam microrganismos antes do PQM. Nos casos em que foram encontrados microrganismos inicialmente, observou-se 100% de eliminação após o protocolo aplicado.

Does Endodontic Re-Treatment in Primary Teeth Increase the Functional Tooth Retention? A Clinical, Retrospective, University-Based Study

Objective: To investigate the longevity of endodontic treatments and the survival of endodontic re-treatments performed in primary teeth. Material and Methods: The sample included endodontic treatments and re-treatments conducted in anterior and posterior primary teeth without sedation or general anesthesia among children attending a university dental service. Information collected retrospectively from clinical records was used for analyzing data. The Kaplan-Meier estimator test was used to analyze the longevity and survival of endodontic treatment and re-treatments, respectively. Results: A total of 73 patients with endodontic therapy in primary teeth were included in the study, and 116 teeth were analyzed. After one year, the longevity of endodontic treatments performed on primary teeth was 65.74% with an annual failure rate (AFR) of 34.2%. From 47 endodontic treatment failures, 14 teeth (29.8%) were endodontically re-treated. When the endodontic re-treatment was considered as survival, the longevity of treatments reached 68.06% with 31.9% of AFR after one year of follow-up. There was a significant increase in functional tooth retention in those patients that received an endodontic re-treatment (p<0.001). Retreatment provided an additional mean survival time of 8.3 months. Conclusion: Endodontic treatments performed in primary teeth presented a limited longevity. Endodontic re-treatment is a more conservative alternative for endodontically treated primary teeth that have failed and significantly increase tooth retention.

Graduate and Undergraduate Teaching of Primary Tooth Pulpectomy: A Comparison among Brazilian Dental Schools

Objective: To compare the teaching of the pulpectomy in primary teeth among graduate and undergraduate Brazilian dental schools. Material and Methods: From August 2015 to July 2016, an 11-question survey was sent to 44 graduate and 207 undergraduate dental schools. Data obtained were summarized using descriptive statistics. Results: The response rate was higher from graduate (56.8%) than undergraduate (41.1%) courses. Pulpectomy was taught by all participating schools. More than 90% of the undergraduate and graduate courses recommend the use of hand instruments for canals debridement, but the widening of root canals was advised in 69.4% of undergraduate and in 84% of graduate schools. Regarding the irrigatings, 1% sodium hypochlorite as a single irrigating solution was the most taught for both biopulpectomy and necropulpectomy. The iodoform-based Guedes-Pinto paste as the single indication was the preferred root canal filling material in undergraduate schools (30.6%), while the zinc oxidethickened calcium hydroxide paste as the single option was the most recommended in graduate courses (36%). Endodontic hand file associated with lentulo drill for filling root canals was recommended by most courses. Overall, biopulpectomy was performed in one session, while necropulpectomy led two sessions. Periapical radiograph for diagnosis and final obturation was the most adopted conduct by undergraduate (68.2%) and graduate (72%) schools. Gutta-percha and glass ionomer cement were preferred materials to seal the entrance of the pulp chamber. Conclusion: There was variability in the techniques and materials taught to perform pulpectomy in primary teeth among Brazilian graduate and undergraduate dental schools. Calcium hydroxide paste has been used in similar proportion to iodoform-based paste.

Iodoform Vs Calcium Hydroxide/Zinc Oxide based pastes: 12-month findings of a Randomized Controlled Trial

Abstract This study evaluated clinical and radiographic twelve-month outcomes of root canal treatments (CT) with smear layer removal, performed in primary teeth, using two different root canal filling materials. Pulpectomy was performed on 27 primary teeth with necrosis or irreversible pulpitis, caused by dental caries or trauma, in 23 children (2-7 years old). A single trained operator performed the CT in a single visit in cases without periapical or interradicular radiolucency (PIR) or in multiple visits in cases with PIR. Participants were selected based on specific inclusion and exclusion criteria, and randomly allocated into two groups: Group 1 (G1) - iodoform paste (iodoform + camphorated parachlorophenol + ointment comprising prednisolone acetate 5.0 mg and rifamycin 1.5 mg); Group 2 (G2) - Calen®/ZO paste. Treated teeth were restored with composite resin immediately after the root canal filling. The outcomes were evaluated clinically and radiographically according to specific criteria. Two blinded and standardized evaluators assessed the radiographic outcomes. We used descriptive analyses due to the small sample size. CTs were performed due to caries lesions in 70.4% of the cases and due to trauma in 29.6%. Only one tooth of G1 was unsuccessful; hence, pulpectomy performance in both groups was not influenced by the filling material, nor by any other analyzed variable. The level of the root canal filling was better in the Calen®/ZO group. The clinical and radiographic twelve-month outcomes indicated successful treatment, independently of the root filling material used.

Clinical, radiographic and histological evaluation of primary teeth pulpotomy using mta and ferric sulfate

Abstract The aim of this study was to evaluate the clinical, radiographic and histological outcomes of the dentin-pulp complex from primary molars after pulpotomy with mineral trioxide aggregate (MTA) and 15.5% ferric sulfate (FS). Thirty-one primary molars were randomly allocated into MTA or FS groups. Clinical and radiographic evaluations were recorded at 3-, 6-, 12- and 18-month follow-up. Teeth at the regular exfoliation period were extracted and processed for histological analysis. Clinical and radiographic data were tested by statistical analysis (p≤0.01). Histological outcomes were analyzed descriptively. All of the treated teeth presented clinical success over the experimental periods. Both groups exhibited 100% of radiographic success at 3, 6 and 12 months. At the 18-month follow-up, one tooth from FS group presented inter-radicular radiolucency (p>0.01). Histologically, the treated teeth presented pulp vitality and absence of inflammatory infiltrate into the connective tissue. Only MTA group showed hard tissue barrier surrounded by odontoblasts over the pulp stumps. Both MTA and 15.5% FS are effective for pulpotomies of primary teeth. Although MTA is considered the first-choice material, FS may be a suitable alternative when treatment cost is an issue.

Resumo O objetivo deste estudo foi avaliar os resultados clínicos, radiográficos e histológicos do complexo dentino-pulpar de molares decíduos após pulpotomia com agregado trióxido mineral (MTA) e sulfato férrico (SF) 15,5%. Trinta e um molares decíduos foram alocados aleatoriamente nos grupos MTA ou SF. As avaliações clínicas e radiográficas foram realizadas aos 3, 6, 12 e 18 meses de acompanhamento. Os dentes no período regular de esfoliação foram extraídos e processados ​​para análise histológica. Os dados clínicos e radiográficos foram analisados estatisticamente (p≤0,01). O resultados histológicos foram analisados ​​descritivamente. Todos os dentes tratados apresentaram sucesso clínico ao longo dos períodos experimentais. Ambos os grupos exibiram 100% de sucesso radiográfico aos 3, 6 e 12 meses. Aos 18 meses de acompanhamento, um dente do grupo SF apresentou radiolucidez interradicular (p>0,01). Histologicamente, os dentes tratados apresentaram vitalidade pulpar e ausência de infiltrado inflamatório no tecido conjuntivo. Somente o grupo MTA mostrou barreira de tecido duro rodeada por odontoblastos sobre os cotos pulpares. MTA e SF 15,5% são eficazes para pulpotomias de dentes decíduos. Embora o MTA seja considerado o material de primeira escolha, o SF pode ser uma alternativa adequada quando o custo do tratamento é um problema.

Assessment of alternative emergency treatments for symptomatic irreversible pulpitis: a randomized clinical trial.

AIM: To evaluate three emergency procedures for their ability to alleviate clinical symptoms associated with symptomatic teeth having signs of (at least) partial irreversible pulpitis. METHODOLOGY: Sixty-six maxillary and mandibular molars were randomly assigned to a total pulpectomy group (TP; n = 22), partial pulpectomy group (PP; n = 22) or pulpotomy group (P; n = 22). Procedure durations were recorded. Patients answered a questionnaire on daily analgesic requirements and about clinical symptoms (pain intensity, chewing sensitivity and thermal sensitivity) after the anaesthetic effect had disappeared (Day 0) and on Days 1, 3 and 7 post-treatment. RESULTS: The total pulpectomy group was associated with the longest procedures (median, 24 min), followed by the partial pulpectomy and pulpotomy groups (P < 0.001 for all). In all three groups, pain intensity, thermal sensitivity and chewing sensitivity decreased significantly from the preoperative time-point to Day 7 (P < 0.001 for all). The total pulpectomy group reported greater reductions in pain intensity than the pulpotomy group between Days 0 and 7, Days 1 and 3, and Days 1 and 7 (P < 0.001 for all). No other intergroup differences were noted regarding reductions in pain intensity, and none were observed with respect to changes in prevalence of thermal sensitivity and chewing sensitivity. There were also no significant intergroup differences regarding the analgesic requirements throughout the 7 days. CONCLUSION: As emergency treatments for teeth having signs of irreversible pulpitis, pulpotomy, partial pulpectomy and total pulpectomy were comparable with respect to relieving clinical symptoms. Pulpotomy may be preferred because it requires significantly less time and is a simple technique that relieves symptoms quickly and effectively.

Comparative evaluation of clinical and radiological success of zinc oxide-ozonated oil, modified 3mix-mp antibiotic paste, and vitapex as treatment options in primary molars requiring pulpectomy: An in vivo study.

OBJECTIVES: The aim of this study was to evaluate the clinical and radiographic success of zinc oxide-ozonated oil (ZnO-OO), modified 3Mix antibiotic paste, and Vitapex in treatment of primary molars requiring pulpectomy. METHODS: Sixty-four primary molars of forty three children aged between 4 and 8 years with pulpally involved primary molars requiring root canal procedures were treated with ZnO-OO, modified 3Mix-MP paste, and Vitapex. The subjects were followed up clinically at 1, 6, and 12 months whereas radiographically at 6 and 12 months, respectively. RESULTS: The results showed that the clinical and radiographic success rates of ZnO-OO and Vitapex over 12 months period of observation were 100% whereas, for modified 3Mix-MP paste, the results were 95.8% and 79.2%, respectively. CONCLUSION: On the basis of the overall success rates of all the three medicaments, following order of performance can be inferred clinical success and radiographical success:- ZnO-OO = Vitapex > modified 3MIX-MP paste.

O Tabagismo e suas implicações na saúde pulpar e periodontal / El tabaquismo y sus consecuencias para la pulpa y la salud periodontal / Smoking and its impact on pulp and periodontal health

Introdução: o tabagismo é considerado um dos maiores problemas de saúde pública do mundo segundo a Organização Mundial de Saúde. Sabe-se que o tabagismo interfere de diferentes maneiras na saúde dos tecidos da cavidade oral, estando diretamente relacionado aos problemas de saúde bucal. Objetivo: realizar uma revisão bibliográfica sobre o tema Tabagismo e suas implicações na saúde pulpar e periodontal. Métodos: realizou-se um estudo por revisão criteriosa da literatura em artigos científicos publicados nos últimos 5 anos (2012-2016) sobre temas relacionados às seguintes combinações de descritores: polpa dentária e pulpectomia e periodontia e tabaco; polpa dentária e pulpectomia e tabaco; pulpectomia e tabaco; periodontia e tabaco. As bases de dados utilizadas foram: Pubmed; Google Acadêmico; Science Direct; SciELO e Lilacs. Foram encontrados 36 estudos com os descritores instituídos. Análise e integração de informações: os estudos demostraram que o consumo do tabaco e seus derivados influenciam diretamente na saúde e homeostasia dos tecidos pulpar e periodontal, estando relacionado à perda dentária e a um incremento na necessidade de tratamento endodôntico. Conclusão: O Tabagismo possui importantes implicações na saúde pulpar e periodontal, influenciando na fisiologia, no metabolismo e em alterações teciduais nos tecidos conjuntivo pulpar e no tecido periodontal(AU)

Introducción: el tabaquismo es considerado uno de los mayores problemas de salud pública del mundo, según la Organización Mundial de la Salud. Se sabe que fumar interfiere en diferentes formas sobre la salud del tejido de la cavidade bucal, está directamente relacionado con problemas de salud bucal. Objetivo: realizar una revisión de la literatura sobre el tema Tabaquismo y sus consecuencias para la pulpa y la salud periodontal. Métodos: se realizó una cuidadosa revisión de la literatura en los artículos científicos publicados en los últimos cinco años (2012-2016) en temas relacionados con las siguientes combinaciones de descriptores: pulpa dental y pulpectomía y periodoncia y tabaco; pulpa dental y pulpectomía y Tabaco; Pulpectomía y tabaco; periodoncia y tabaco. Las bases de datos utilizadas fueron: Pubmed; Google Académico; Science Direct; SciELO y Lilacs. Se encontraron 36 estudios con descriptores establecidos. Análisis e integración de la información: los estudios demostraron que el consumo de tabaco y sus derivados influyen directamente en la salud y la homeostasis de la pulpa y de los tejidos periodontales y se relaciona con la pérdida de dientes y un aumento en la necesidad de un tratamiento de endodoncia. Conclusiones: El tabaco tiene implicaciones significativas en la pulpa y la salud periodontal, de manera que influye en las alteraciones de la fisiología, el metabolismo y el tejido conectivo de la pulpa y el tejido periodontal(AU)

Introduction: according to the World Health Organization, smoking is one of the greatest public health problems worldwide. It is a well known fact that smoking interferes in different ways with the health of oral tissue, and is directly related to oral health problems. Objective: conduct a bibliographic review on the topic Smoking and its impact on pulp and periodontal health. Methods: a careful review was conducted of scientific papers published in the last five years (2012-2016) about topics related to the following descriptor combinations: dental pulp and pulpectomy and periodontics and tobacco; dental pulp and pulpectomy and tobacco; pulpectomy and tobacco; periodontics and tobacco. The databases used were PubMed, Google Scholar, Science Direct, SciELO and Lilacs. 36 studies were found based on the above descriptors. Data analyse and integration: the studies showed that the use of tobacco and its by-products directly impact the health and homeostasis of the pulp and periodontal tissues, and is related to tooth loss and an increase in the need for endodontic treatment. Conclusions: tobacco use significantly impacts pulp and periodontal health, causing physiological and metabolic alterations, and affecting the pulp connective tissue and the periodontal tissue(AU)

Prevalência da terapia pulpar em dentes decíduos realizada na Clínica Escola de Odontologia do UNIPÊ / Prevalencia de la terapia pulpar en dientes temporales realizada en la Facultad de Odontología de Clínica de UNIPÊ / Prevalence of pulp therapy in deciduous teeth performed in UNIPÊ Clinical Dentistry School

Introdução: são vários os problemas que acometem o meio oral infantil, mas o principal deles é a cárie, devido à falta de conhecimento, negligencia com a saúde da criança, e informações inadequadas dos pais, a doença acaba progredindo e tomando proporções maiores. Objetivo: avaliar a prevalência da terapia pulpar em dentes decíduos realizados na Clínica Escola de Odontologia do Unipê. Métodos: foram analisados 600 prontuários clínicos de crianças na faixa etária de 3 a 10 anos, atendidos entre os anos de 2010 a 2013. Os prontuários foram analisados individualmente procurando obter dados referentes aos principais agentes etiológicos que acometem a dentição decídua, à identificação da faixa etária em que ocorre maior prevalência da terapia pulpar, quais os dentes mais acometidos, quais as técnicas de escolha de acordo com o material utilizado para dentes vitalizados e desvitalizados e qual a condição pulpar. Os dados foram analisados mediante estatística descritiva (frequências e valores percentuais) e inferencial. Resultados: os resultados mostraram que 11 por cento destas crianças, apresentavam pelo menos um dente que foi submetido à terapia pulpar, sendo maior a prevalência no sexo masculino com 56,1 por cento. O principal fator etiológico foi à cárie com 95,5 por cento. O índice de Higiene Bucal que prevaleceu foi o regular com 56,1 por cento. Os dentes mais acometidos foram o primeiro molar decíduo inferior direito, com 18,2 por cento e o segundo molar decíduo superior direito com 13,6 por cento. A pulpectomia foi o tratamento mais realizado, correspondendo a 51,5 por cento dos casos. Conclusão: conclui-se que a prevalência da terapia pulpar em dentes decíduos é maior no sexo masculino e tem como principal fator etiológico a cárie, sendo a pulpectomia o principal tratamento(AU)

Introduction: there are several problems that affect children's oral environment, but the main one is caries, due to lack of knowledge, neglect to the child's health, and inadequate information by the parents, the disease progresses and ends up taking larger proportions. Objective: to evaluate the prevalence of pulp therapy in primary teeth performed at the UNIPÊ Clinical School of Dentistry. Methods: we analyzed 600 medical records of children aged 3-10 years treated between the years 2010-2013. The records were analyzed individually seeking data to the main etiologic agents affecting the primary dentition, the identification of the age group in which there is greater prevalence of pulp therapy, which affected teeth most, which techniques of choice according to the material used for vital teeth and devitalized which the pulp and condition. Data were analyzed using descriptive statistics (frequencies and percentages) and inferential. Results: 11 percent of the children had at least one tooth that underwent pulp therapy, with a higher prevalence in males with 56.1 percent. The main cause was to decay to 95.5 percent. The oral hygiene index that prevailed was regular with 56.1 percent. The most affected teeth were the first deciduous molar bottom right, with 18.2 percent and the second primary molar upper right with 13.6 percent. The pulpectomy is most commonly performed treatment, corresponding to 51.5 percent of cases. Conclusions: the prevalence of pulp therapy in primary teeth is higher in males and its main etiological factor is decay, the pulpectomy being the main treatment.(AU)

Introducción: existen varios problemas que afectan al cavidad bucal de los niños, pero el principal es la lesión de caries, debido a la falta de conocimientos, el descuido de la salud del niño y la insuficiente información de los padres; la enfermedad progresa y termina con mayores afectaciones. Objetivo: evaluar la prevalencia de la terapia pulpar en dientes temporales realizada en la Escuela Clínica de Odontología UNIPÊ. Métodos: se revisaron 600 historias clínicas de los niños de 3 a 10 años tratados entre 2010-2013. Se analizaron los registros de búsqueda de datos individualmente a los principales agentes causales que afectan a la dentición primaria, la identificación del grupo de edad en el que hay una mayor prevalencia de la terapia de pulpa, los dientes más afectados, las técnicas de selección de acuerdo con el material utilizado para dientes vitales y desvitalizados, la pulpa y el estado. En el procesamiento de la información se empleó la estadística descriptiva (frecuencias y porcentajes) e inferencial. Resultados: el 11 por ciento de los niños tenían al menos un diente que se sometió a terapia pulpar, con una mayor prevalencia en los del sexo masculino, para el 56,1 por ciento. La causa principal fue la caries, con 95,5 por ciento. El índice de higiene oral que prevaleció fue regular con 56,1 por ciento. Los dientes más afectados fueron el primer molar temporal inferior derecho con el 18,2 por ciento y el segundo molar superior derecho primario con 13,6 por ciento. La pulpectomía fue el tratamiento más común, para el 51,5 por ciento de los casos. Conclusiones: la prevalencia de la terapia pulpar en dientes primarios es más alta en el sexo masculino y su principal factor causal resulta la caries; la pulpectomía constituye el principal tratamiento(AU)

Comparison of the Anesthetic Efficacy of Mepivacaine and Lidocaine in Patients with Irreversible Pulpitis: A Double-blind Randomized Clinical Trial.

INTRODUCTION: The objective of this study was to compare the anesthetic efficacy of 2% mepivacaine combined with 1:100,000 epinephrine with 2% lidocaine combined with 1:100,000 epinephrine during pulpectomy of mandibular posterior teeth in patients with irreversible pulpitis. METHODS: Forty-two patients with irreversible pulpitis who were admitted to the Emergency Center at the University of São Paulo School of Dentistry volunteered to take part in the study and were randomized to receive conventional inferior alveolar nerve block containing 1.8 or 3.6 mL of either 2% mepivacaine with 1:100,000 epinephrine or 2% lidocaine with 1:100,000 epinephrine. We recorded patients' subjective assessments of lip anesthesia, absence/presence of pulpal anesthesia tested by using electric pulp stimulation, and absence/presence of pain during the subsequent pulpectomy by using a verbal analogue scale. RESULTS: All patients tested reported lip anesthesia after application of either type of inferior alveolar nerve block. Pulpal anesthesia success rates measured by using the pulp tester were satisfactory for both solutions (86% for mepivacaine and 67% for lidocaine). Success rates according to patient report of no pain or mild pain during pulpectomy were higher for mepivacaine solution (55%) than for lidocaine solution (14%). The differences between mepivacaine and lidocaine were statistically significant. CONCLUSIONS: Mepivacaine resulted in effective pain control during irreversible pulpitis treatments. The success rates with either solution were not high enough to ensure complete pulpal anesthesia.

Systemically Transplanted Bone Marrow-derived Cells Contribute to Dental Pulp Regeneration in a Chimeric Mouse Model.

INTRODUCTION: Migratory cells via blood circulation or cells adjacent to the root apex may potentially participate in dental pulp tissue regeneration or renewal. This study investigated whether systemically transplanted bone marrow cells can contribute to pulp regeneration in a chimeric mouse model. METHODS: A chimeric mouse model was created through the injection of bone marrow cells from green fluorescent protein (GFP) transgenic C57BL/6 mice into the tail veins of recipient wild-type C57BL/6 mice that had been irradiated with a lethal dose of 8.5 Gy from a high-frequency linear accelerator. These mice were subjected to pulpectomy and pulp revascularization. At 1, 4, and 8 weeks after surgery, in vivo animal imaging and histologic analyses were conducted. RESULTS: In vivo animal imaging showed that the green biofluorescence signal from the transplanted GFP+ cells increased significantly and was maintained at a high level during the first 4 weeks after surgery. Immunofluorescence analyses of tooth specimens collected at 8 weeks postsurgery showed the presence of nestin+/GFP+, α smooth muscle actin (α-SMA)/GFP+, and NeuN/GFP+ cells within the regenerated pulplike tissue. CONCLUSIONS: These data confirm that transplanted bone marrow-derived cells can contribute to dental pulp regeneration.

Dor em urgência odontológica: uso de anti-inflamatórios, corticoides e analgésicos em casos de pulpite aguda irreversível / Pain in dental emergency: anti inflammatory use, steroids and painkillers in cases of irreversible acute pulpitis

O objetivo deste estudo foi avaliar o uso do cetorolaco de trometamina 10mg sublingual 30 minutos antes do procedimento de biopulpectomia em pacientes com pulpite irreversível com relação à dor antes do procedimento e nas 48 horas subsequentes, a quantidade de medicação consumida no pós-operatório e tempo esperado para sua utilização. Também foi avaliada a influência da anestesia intrapulpar, o uso da automedicação analgésica antes da procura pelo atendimento e diferença entre gêneros sobre os níveis de dor pré e pós-operatória. Propôs-se avaliar também a necessidade da presença do antibiótico na medicação intracanal, comparando o Otosporin® com hidrocortisona. Participaram da pesquisa 608 pacientes que procuraram o Setor de Urgência Odontológica da Faculdade de Odontologia de Bauru ou o Setor Odontológico do Pronto Socorro Central da Prefeitura Municipal de Bauru, sendo que 34 completaram de forma adequada o protocolo previsto. Foram divididos em 4 grupos que receberam cetorolaco ou placebo como medicação pré-operatória e Otosporin® ou hidrocortisona como medicação intracanal. Foram anotados os valores de intensidade de dor, em uma escala visual analógica, antes da medicação pré-operatória, antes do atendimento, após o atendimento, 1, 2, 4, 12, 24, 48 horas após e quando houve necessidade de medicação pós-operatória para alívio da dor. Também foi anotado se o paciente havia se automedicado e qual a droga utilizada, se houve necessidade de anestesia intrapulpar, a quantidade de medicação consumida pelo paciente no pós-operatório e o tempo esperado para seu consumo. Dos resultados observou-se que os pacientes que receberam cetorolaco como medicação pré-operatória tiveram uma redução significativa da dor em 30 minutos, quando comparado ao placebo. Foi observado que o tempo necessário para a ingestão de medicamentos pós-operatórios não demonstrou diferença significativa entre os grupos, assim como na quantidade de medicação ingerida. O tempo decorrido entre a primeira e a última dose de medicação pós-operatória também não demonstrou diferença estatística. Com relação a anestesia intrapulpar, 78% dos pacientes necessitaram desta técnica, mas devido ao pequeno tamanho da amostra obtida, não foi possível correlacionar o seu uso com a utilização da medicação pós-operatória. Para os pacientes que se automedicaram previamente, não houve diferença significativa em relação à dor inicial. Quando os gêneros foram comparados, não foi possível observar uma diferença estatística significante entre eles com relação aos parâmetros estudados. Também foram descritos no trabalho os motivos de não inclusão dos 574 pacientes que foram abordados durante a realização deste estudo. Com base nos resultados, conclui-se que o cetorolaco diminuiu expressivamente o nível de dor durante a espera pelo atendimento, porém com relação ao tempo esperado pelo paciente para tomar a primeira dose de medicação pós-operatória, a última dose, a quantidade de comprimidos e a frequência de ingestão não demonstrou a mesma diferença. Também não houve diferença no nível de dor inicial entre os pacientes que se automedicaram e os que não fizeram uso dessa prática. Devido ao pequeno número da amostra, não foi possível encontrar uma correlação entre o uso da técnica anestésica intrapulpar e medicação pós-operatória, sugerindo mais estudos futuros.(AU)

The aim of this study was to evaluate the use of ketorolac tromethamine (10mg sublingual taken 30 minutes before pulpectomy in patients with irreversible pulpitis) in pain reduction immediately before the procedure and the 48 subsequent hours, postoperative consumption of analgesic drugs and time for its use. The influence of intrapulpal anesthesia, the use of analgesic self-medication prior to the demand for care and gender difference on the levels of pre- and postoperative pain was also evaluated. It was also proposed assess the need for antibiotic presence in the intracanal medicament, comparing Otosporin® with hydrocortisone. A total of 608 patients who presented to Dental Urgency Sector from Dental School of Bauru (USP) or Emergency Dental Sector from Bauru City Hall were invited to participate, and 34 completed properly planned protocol. They were distributed in 4 groups that received either ketorolac or placebo as preoperative medication and Otosporin® or hydrocortisone as intracanal medication. The rates of pain intensity were recorded by means of a visual analogue scale before pretreatment medication, immediately before the appointment, 1, 2, 4, 12, 24, 48 hours after the appointment, and when there was taken post medication for postoperative pain relief. It was also recorded if the patient had self medicated and which the drug used and, if there was need intrapulpal anesthesia, amount of ketorolac and rescue medication (paracetamol 750mg) consumed by the patient postoperative time and the waitng time for consumption. The results showed that patients receiving Ketorolac as preoperative medication had a significant reduction of pain in 30 minutes compared to placebo. It was observed that the time required for the intake of postoperative drug showed no significant difference between groups, as well as the amount of medication intake. The time elapsed between the first and last dose of postoperative medication also showed no statistical difference. Concerning intrapulpal anesthesia, 78% of patients required for this technique, but because of the small sample size obtained it was impossible to correlate their use with the use of postoperative medication. For patients who practiced self medication previously, there was no significant difference with respect to initial pain. When genders were compared, it was not possible to observe a statistically significant difference between them regarding the parameters studied. Were also described in the study the reasons of non-inclusion of 574 patients that were addressed during this study. Based on the results, it is concluded that ketorolac significantly decreased the level of pain during the waiting time, but with respect to the time length for the patient to take the first dose of postoperative medication, the last dose, the number of tablets and taken frequency did not show the same difference. There was no difference in the initial level of pain among patients who practiced self medication and those who did not use this practice. Due to the small sample size, it was not possible to find a correlation between the use of the anesthetic technique intrapulpal and postoperative medication, suggesting more future studies.(AU)

Tratamientos pulpares en dientes primarios / Pulp therapies in primary teeth

El mantenimiento de las piezas dentarias para desempeñar sus funciones en la alimentación, en la expresión oral, en el mantenimiento de espacios en las arcadas dentarias, en el estímulo para el crecimiento y desarrollo de los maxilares, entre otras acciones, ha sido considerado esencial para el logro de un desarrollo armónico. Por otro lado, y a pesar de los avances en la materia, la caries dental es la causa más frecuente de las patologías pulpares en los dientes primarios y constituye el principal motivo de su deterioro y/o su pérdida. Las características histo-patológicas de la pulpa dental, la brevedad de su ciclo vital, el tamaño relativo de las cámaras pulpares, favorecen el rápido compromiso pulpar y propician que el proceso infeccioso progrese rápidamente a la necrosis. Ello ha determinado y determina el desarrollo de numerosas técnicas y tratamientos, diferentes ofertas terapéuticas de las cuales ninguna ha alcanzado el consenso universal. Como establecen las Guías de Odontología Pediátrica sobre tratamientos pulpares en dientes primarios, la literatura dental en esta área ofrece escasa y pobre evidencia para sustentar las diferentes técnicas y constantemente señalan la necesidad de nuevos y rigurosos estudios que la avalen.

Interradicular septum as guide for pilot drill in postextractive implantology: a technical note.

The extraction of teeth results in rapid bone resorption both vertically and horizontally in the first month. The loss of alveolar ridge reduces the chance of implant rehabilitation. The atraumatic extraction, implant placement in extraction socket, and an immediate prosthesis have been proposed as alternative therapies to maintain the volume and contours tissue and reduce time and cost of treatment. Thus, this paper aims to present a clinical case where the extraction was performed using interradicular septum as guide for pilot drill in postextractive implantology with implant placement and immediate provisionalization in a inferior molar. The advantages of this technique are to place the implant exactly in the center of the alveolar ridge, to mantain the edges of the alveolar ridge and reduce postextractive bone resorption, and has great advantages in final prosthetic rehabilitation.

Análise do efeito do fator de crescimento endotelial na angiogênese em canais de dentes de ratos com apicigênese completa / Analysis of the effect of vascular endothelial growth factor on angiogenesis of root canal in mature teeth of rats

A bioengenharia tecidual tem sido aplicada na Endodontia na busca de tratamentos mais biológicos. A revascularização pulpar tem sido observada em dentes com ápice aberto, porém há poucos estudos direcionados aos dentes com ápice formado. A angiogênese é primordial para a nutrição celular durante a regeneração tecidual. O objetivo deste estudo foi analisar o efeito do fator de crescimento endotelial (VEGF) na angiogênese após pulpectomia de canais radiculares de rato com apicigênese completa. A câmara pulpar dos primeiros molares superiores de 12 ratos machos Wistar com 13 semanas foi acessada. A polpa radicular do canal mésio vestibular foi removida e o canal instrumentado até a lima K25. Com uma lima K20, além do limite foraminal, foi induzido o sangramento periapical para o canal radicular. Os dentes do lado direito da arcada foram preenchidos com coágulo sanguíneo (GS), e nos dentes do lado esquerdo foi utilizado VEGF165 recombinante (Prospec, Israel) adicionado ao coágulo (GV). Os dentes foram selados com ionômero de vidro fotopolimerizável, e 60 dias depois os animais foram sacrificados.

A maxila foi dissecada, fixada, descalcificada e incluída em parafina. Cortes transversais seriados foram feitos e corados com hematoxilina-eosina para avaliação morfológica ou incubados com anticorpo de coelho anti-fator VIII (Bioss, EUA) para análise da angiogênese. A análise histológica demonstrou canais preenchidos por tecido conjuntivo sem presença de odontoblastos nos dois grupos. A imuno-histoquímica demonstrou positividade para o anticorpo no tecido neoformado em ambos os grupos. No grupo 1 foi predominante a marcação difusa, e no grupo 2 foi a marcação definida. Pode-se concluir que o uso de VEGF acelera a angiogênese que ocorre em canais pulpectomizados de molares com apicigênese completa.

The tissue engineering has been applied in Endodontics in search of more biological treatments. The pulp revascularization has been observed in immature teeth, but there are few studies directed to the closed-apex teeth. Angiogenesis is essential for cellular nutrition during tissue regeneration. The aim of this study was to analyze the effect of vascular endothelial growth factor (VEGF) in angiogenesis after pulp removal in rats with mature teeth. The pulp chamber of upper first molars of 12 male Wistar rats with 13-weeks-old was accessed. The pulp of the mesiobuccal root canal was removed, and the root canal was shaped up to 25K-file. Then, a 20K-file was introduced beyond the apex to induce bleeding. The teeth on the right side of the arch are filled using blood clot alone (GS) and the teeth on the left side was filled using blood clot + VEGF165 recombinant (Prospec, Israel) (GV). The teeth were coronally sealed using light-curing glass ionomer, and the animals were sacrificed after 60 days. The samples were dissected, fixed, decalcified and included in paraffin. Transverse serial sections were made, and stained using hematoxylin-eosin to morphological evaluation or expressed by immunostaining using anti-Factor VIII rabbit antibody (BIOSs, USA) to angiogenesis analysis. Morphological analysis showed root canals filled by connective tissue without the presence of odontoblasts in both groups. Immunohistochemistry showed positivity for the antibody in the new tissue in both groups, with marking defined in group 2. Diffuse marking was predominant in the group 1, and the well-maked type was predominant in the group 2. It can be concluded that the use of VEGF accelerates angiogenesis that occurs in root canal of closed-apex molars after pulpectomy.

Análise do efeito do fator de crescimento endotelial na angiogênese em canais de dentes de ratos com apicigênese completa / Analysis of the effect of vascular endothelial growth factor on angiogenesis of root canal in mature teeth of rats

A bioengenharia tecidual tem sido aplicada na Endodontia na busca de tratamentos mais biológicos. A revascularização pulpar tem sido observada em dentes com ápice aberto, porém há poucos estudos direcionados aos dentes com ápice formado. A angiogênese é primordial para a nutrição celular durante a regeneração tecidual. O objetivo deste estudo foi analisar o efeito do fator de crescimento endotelial (VEGF) na angiogênese após pulpectomia de canais radiculares de rato com apicigênese completa. A câmara pulpar dos primeiros molares superiores de 12 ratos machos Wistar com 13 semanas foi acessada. A polpa radicular do canal mésio vestibular foi removida e o canal instrumentado até a lima K25. Com uma lima K20, além do limite foraminal, foi induzido o sangramento periapical para o canal radicular. Os dentes do lado direito da arcada foram preenchidos com coágulo sanguíneo (GS), e nos dentes do lado esquerdo foi utilizado VEGF165 recombinante (Prospec, Israel) adicionado ao coágulo (GV). Os dentes foram selados com ionômero de vidro fotopolimerizável, e 60 dias depois os animais foram sacrificados. A maxila foi dissecada, fixada, descalcificada e incluída em parafina. Cortes transversais seriados foram feitos e corados com hematoxilina-eosina para avaliação morfológica ou incubados com anticorpo de coelho anti-fator VIII (Bioss, EUA) para análise da angiogênese. A análise histológica demonstrou canais preenchidos por tecido conjuntivo sem presença de odontoblastos nos dois grupos. A imuno-histoquímica demonstrou positividade para o anticorpo no tecido neoformado em ambos os grupos. No grupo 1 foi predominante a marcação difusa, e no grupo 2 foi a marcação definida. Pode-se concluir que o uso de VEGF acelera a angiogênese que ocorre em canais pulpectomizados de molares com apicigênese completa.

The tissue engineering has been applied in Endodontics in search of more biological treatments. The pulp revascularization has been observed in immature teeth, but there are few studies directed to the closed-apex teeth. Angiogenesis is essential for cellular nutrition during tissue regeneration. The aim of this study was to analyze the effect of vascular endothelial growth factor (VEGF) in angiogenesis after pulp removal in rats with mature teeth. The pulp chamber of upper first molars of 12 male Wistar rats with 13-weeks-old was accessed. The pulp of the mesiobuccal root canal was removed, and the root canal was shaped up to 25K-file. Then, a 20K-file was introduced beyond the apex to induce bleeding. The teeth on the right side of the arch are filled using blood clot alone (GS) and the teeth on the left side was filled using blood clot + VEGF165 recombinant (Prospec, Israel) (GV). The teeth were coronally sealed using light-curing glass ionomer, and the animals were sacrificed after 60 days. The samples were dissected, fixed, decalcified and included in paraffin. Transverse serial sections were made, and stained using hematoxylin-eosin to morphological evaluation or expressed by immunostaining using anti-Factor VIII rabbit antibody (BIOSs, USA) to angiogenesis analysis. Morphological analysis showed root canals filled by connective tissue without the presence of odontoblasts in both groups. Immunohistochemistry showed positivity for the antibody in the new tissue in both groups, with marking defined in group 2. Diffuse marking was predominant in the group 1, and the well-maked type was predominant in the group 2. It can be concluded that the use of VEGF accelerates angiogenesis that occurs in root canal of closed-apex molars after pulpectomy.