A 12-month Follow-Up Study of Pulp Oxygen Saturation in Deciduous Molars After Selective and Nonselective Carious-Tissue Removal: A Randomized Pilot Trial

ABSTRACT Objective: To compare the pulp vitality of deciduous molars before and after selective caries removal (SCR) or nonselective caries removal to hard dentin (NSCR) over one year, using oxygen saturation percentage (%SaO2). Material and Methods: Deciduous molars with deep occlusal/proximal-occlusal caries lesions were randomized to SCR (n=22) or NSCR groups (n=22). After the caries removal, the teeth were protected with calcium hydroxide cement and restored with composite resin (Filtek Z250). The pulp condition diagnosis was evaluated at baseline, immediately after caries removal, and follow-up (7 days, 1-, 6- and 12-months) by %SaO2. Pulp exposure and pulp necrosis were primary outcomes, and %SaO2 was secondary. Results: Intraoperative pulp exposure occurred in four teeth of the NSCR group (18.2%) and one tooth of the SCR group (4.5%) (p>0.05). Two cases of pulp necrosis occurred in the NSCR group (10%). No difference in %SaO2 pulp was observed in the inter-and intragroup comparison over time (p>0.05). Conclusion: Advantageously, the %SaO2 minimizes preoperatory pulp vitality diagnosis subjectivity before SCR/ NSCR treatments. Furthermore, the pilot study results suggest the pulp response of deciduous molars, when evaluated by clinical, radiographic, and pulp %SaO2 seems not to differ between teeth treated with SCR or NSCR.

Comparative evaluation of dental pulp tests in pulpal status diagnostics / Evaluación comparativa de pruebas de pulpa dental en el diagnóstico del estado pulpar

Introduction: The purpose of this study was to evaluate the effectiveness and compare the accuracy of pulp tests in the diagnosis of teeth pulpal health. Material and Methods: Traumatized (n=71) and non-traumatized (n=71) teeth from 42 patients were evaluated. Each tooth underwent cold, heat, electric and oximetry tests, followed by radiographic examination and calculation of the sensitivity, specificity, PPV, NPV and accuracy. Results: Clinical and radiographic examination showed no alteration for the 71 teeth from the intact contralateral group. From the traumatized group, 29 teeth presented complete endodontic treatment, 17 presented periapical alterations that required endodontic treatment and 25 teeth did not present conclusive radiographic alteration. The cold test showed a significantly higher proportion of correct results, while the electric test showed a significantly lower proportion. The data showed higher accuracy for the cold, followed by oximeter and heat tests, while the electric test presented the lowest accuracy. Cold and oximeter tests proved superior over the electric and heat tests, while the electric test showed better parameters when diagnosing diseased pulp. Conclusion: Combining two pulp tests seems reasonable for improving the pulp diagnoses using both oximeter and cold or oximeter and heat tests to detect healthy pulp; or cold and electric tests to define diseased pulp.

Introducción: El propósito de este estudio fue evaluar la efectividad y comparar la precisión de las pruebas pulpares en el diagnóstico de la salud pulpar de los dientes. Material y Métodos: Se evaluaron dientes traumatizados (n=71) y no traumatizados (n=71) de 42 pacientes. Cada diente se sometió a pruebas de frío, calor, eléctricas y de oximetría, seguidas de examen radiográfico y cálculo de la sensibilidad, especificidad, VPP, VPN y precisión. Resultados: El examen clínico y radiográfico no mostró alteración en los 71 dientes del grupo contralateral intacto. Del grupo traumatizado, 29 dientes presentaron tratamiento endodóntico completo, 17 presentaron alteraciones peri-apicales que requirieron tratamiento endodóntico y 25 dientes no presentaron alteración radiográfica concluyente. La prueba en frío mostró una proporción significativamente mayor de resultados correctos, mientras que la prueba eléctrica mostró una proporción significativamente menor. Los datos mostraron mayor precisión para la prueba de frío, seguida de las pruebas de oxímetro y calor, mientras que la prueba eléctrica presentó la menor precisión. Las pruebas de frío y oxímetro demostraron ser superiores a las pruebas eléctricas y de calor, mientras que la prueba eléctrica mostró mejores parámetros al momento de diagnosticar pulpa enferma. Conclusión: La combinación de dos pruebas pulpares parece razonable para mejorar los diagnósticos pulpares utilizando tanto el oxímetro como las pruebas de frío u oxímetro y calor para detectar una pulpa sana; o pruebas de frío y eléctricas para definir pulpa enferma.

In Vitro Cytotoxicity Analysis of Bioceramic Root Canal Sealers on Human Gingival Fibroblast Cells

ABSTRACT@#This study evaluated the cytotoxicity of four bioceramic root canal sealers (bioceramic sealers): GuttaFlow Bioseal (GB), MTA Fillapex, CeraSeal Bioceramic root canal sealer (CS), and iRoot SP root canal sealer (iRSP). The viability of human gingival fibroblast (HGF) cells was used to evaluate the cytotoxicity of these bioceramic sealers. HGF cells were cultured and exposed to bioceramic sealer extracts for 24 hours, 48 hours and 72 hours at 37°C in an incubator humidified with 5% CO2. The 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide or MTT assay was conducted to determine cell viability at each incubation period and compared among all bioceramic sealers. The Kruskal-Wallis test revealed statistically significant differences between the positive control group and MTA Fillapex, MTA Fillapex and GB, and between GB and iRSP with p < 0.05. However, no statistical differences were found in cell viability for each material across all the incubation periods. GB was the least cytotoxic bioceramic sealer with cell viability exceeding 90% throughout the 72-hour incubation followed by CS, iRSP, and MTA Fillapex with non-cytotoxicity after 72-hour incubation, mild cytotoxicity after 72-hour incubation, and mild cytotoxicity after 72-hour incubation, respectively. However, iRSP showed moderate cytotoxicity, and MTA Fillapex was severely cytotoxic (< 30% cell viability) after 24-hour incubation.

Oximetría de pulso y su eficacia para diagnosticar vitalidad pulpar / Pulse oximetry and its use in diagnosing pulp vitality

Objetivo: Identificar y analizar en la literatura científica reciente el uso de la oximetría de pulso como método diagnóstico de vitalidad pulpar. Metodología: En este trabajo se llevó a cabo una revisión de la literatura en las plataformas de PubMed y Google Académico, en la cual se analizó el uso de la oximetría de pulso en el diagnóstico y monitoreo odontológico del estado pulpar. Resultados: Después de una exhaustiva revisión, y de acuerdo con los criterios de inclusión y exclusión, se analizaron 21 artículos. La mayoría de los trabajos consideran la oximetría de pulso un método alternativo de diagnóstico indoloro, seguro y eficaz; sin embargo, la adaptación de un instrumento de uso exclusivo odontológico es necesaria para una medición exacta de la saturación de oxígeno en la pulpa dental. Los avances tecnológicos en el campo clínico de la odontología nos han llevado a la búsqueda de nuevas técnicas diagnósticas clínicas para mejorar la atención y los tratamientos de los pacientes que acuden día con día a recibir una consulta odontológica. Conclusiones: En los últimos años la oximetría de pulso ha demostrado ser una herramienta de diagnóstico eficaz para el diagnóstico de la vitalidad pulpar. El análisis de los artículos incluidos en esta revisión concluye que la oximetría de pulso es una técnica innovadora que puede ser utilizada como una herramienta diagnóstica adyuvante en el diagnóstico de la vitalidad pulpar (AU)

Objective: To identify and analyze in the recent scientific literature the use of pulse oximetry as a diagnostic method for pulp vitality. Methodology: In this work, a literature review was carried out on the PubMed and Google Scholar platforms in which the use of pulse oximetry in the dental diagnosis and monitoring of pulp status was analyzed. Results: After an exhaustive review and in accordance with the inclusion and exclusion criteria, 21 articles were analyzed. Most of the studies consider pulse oximetry an alternative method of painless, safe and effective diagnosis, however, the adaptation of an instrument for exclusive dental use is necessary for an exact measurement of the oxygen saturation in the dental pulp. Technological advances in the clinical field of dentistry have led us to search for new clinical diagnostic techniques to improve the care and treatment of patients who come every day to receive a dental consultation. Conclusions: In recent years, pulse oximetry has proven to be an effective diagnostic tool for the diagnosis of pulp vitality. The analysis of the articles included in this review concludes that pulse oximetry is an innovative technique that can be used as an adjunct diagnostic tool in the diagnosis of pulp vitality (AU)

Accuracy of the dental pulp sensibility test using cold spray for the diagnosis of pulp diseases: an observational clinical study

The dental pulp sensibility test is one of the main auxiliary resources for the diagnosis of pulp pathologies, and its accuracy is still debatable. This cross-sectional observational study evaluated the accuracy of the pulp sensibility test (PST) using cold spray (1,1,1,2-tetrafluoroethane) for the diagnosis of pulp diseases and determined the effect of individual and clinical variables on the reliability of this test. The paper was designed following the STROBE statement. Sixty patients with indications for primary endodontic treatment were selected and examined from August 2017 to July 2018. Data collection was performed through interviews, clinical/radiographic examinations and the PST. The results of the cold test, along with data on sex, age, the tooth type regarding the root number, and the presence of restorations and caries, as well as the recent consumption of analgesics, were recorded. The presence of bleeding within the pulp chamber was used as the gold standard to compare with the clinical diagnosis and to identify the true-positive, false-positive, true-negative, and false-negative responses. The accuracy of PST achieved in subgroups of individual and clinical variables was compared using the chi-square test with a significance level of 5% (p < 0.05). The PST with the use of cold spray showed a sensitivity of 0.88, a specificity of 1.00, a positive predictive value of 1.00, a negative predictive value of 0.86, and an accuracy of 0.93. The accuracy of the cold spray was not affected by individual or clinical variables. The PST with the use of cold spray is an accurate and reliable method for determining the diagnosis of pulp diseases, especially in cases of pulp vitality or irreversible pulpitis.

Expression of calcitonin gene-related peptide and pulp sensitivity tests in irreversible pulpitis

Abstract The aim of the present study was to identify the relationship between the expression of calcitonin gene-related peptide (CGRP) and the responses of pulp sensitivity tests in healthy pulps and irreversible pulps by performing a cross-sectional study on patients. Two hundred subjects were evaluated. A total of 75 subjects complied with the criteria. The participants were divided into two groups: a) Healthy pulp (subjects [n = 35] having posterior teeth with clinically normal pulp tissue), and b) Irreversible pulpitis (subjects [n = 40] having posterior teeth with irreversible pulpitis). All participants were evaluated using the following variables: a) medical and dental history, b) pulp sensitivity tests, c) expression of CGRP by the enzyme-linked immunosorbent assay (ELISA), and d) expression levels of mRNA CGRP and mRNA CGRP receptor genes. We determined that the responses of the cold test between 4 and ≥12 s presented a higher average of the expression of CGRP in the group having irreversible pulpitis (p = 0.0001). When we compared the groups with the value of the electrical impulse, we found statistically significant differences (p = 0.0001), observing positive responses to the test with electrical impulses of 7 to 10, with an average of 72.15 ng/mL of CGRP in the irreversible pulpitis group. High values of CGRP expression were observed in that group in the responses of pulp sensitivity.

Effect of at-home bleaching on oxygen saturation levels in the dental pulp of maxillary central incisors

Abstract The present study assessed oxygen saturation (SaO2) levels before, during, and after at-home bleaching treatment in the pulps of healthy maxillary central incisors. SaO2 levels were measured in 136 healthy maxillary central incisors using a pulse oximeter. The bleaching protocol consisted of 10% carbamide peroxide gel placed in individual trays and used for four hours daily for 14 days. SaO2 levels were assessed before bleaching (T0), immediately after the first session (T1), on the 7th day of treatment (T2), on the 15th day (the day following the last session) (T3), and 30 days after completion of the bleaching protocol (T4). Data were statistically analyzed using generalized estimating equations (GEE), Student's t test (p<0.05) and Pearson's correlation. Mean pulp SaO2 levels were 85.1% at T0, 84.9% at T1, 84.7% at T2, 84.3% at T3, and 85.0% at T4. Gradual reductions in SaO2 levels were observed, with significant differences (p<0.001) during the course of home bleaching treatment. However, 30 days after the end of the bleaching protocol, SaO2 levels returned to baseline levels. Home bleaching caused a reversible transient decrease in SaO2 levels in the pulps.

Resumo Este estudo verificou o grau de saturação de oxigênio (SaO2) pulpar antes, durante e após o clareamento dental caseiro em incisivos centrais superiores hígidos. O nível de SaO2 foi verificado em 136 incisivos centrais superiores hígidos usando oxímetro de pulso. A técnica de clareamento empregou peróxido de carbamida 10% em moldeira individual por quatro horas diárias durante 14 dias. Os níveis de SaO2 foram analisados antes do clareamento (T0), imediatamente após a primeira sessão (T1), no sétimo dia de tratamento (T2), no décimo quinto dia (um dia após a última sessão) (T3) e 30 dias após o término do clareamento dental (T4). A análise estatística utilizou o modelo de equações de estimações generalizadas (GEE), teste t de Student (p<0,05) e correlação de Pearson. Os níveis médios de SaO2 pulpar foram 85,1% em T0, 84,9% em T1, 84,7% em T2, 84,3% em T3 e 85,0% em T4. Foi observada uma redução gradual dos níveis de SaO2, com diferenças significantes (p<0,001) durante o clareamento dental caseiro. No entanto, 30 dias após o término do clareamento dental, houve retorno aos valores iniciais. O clareamento dental caseiro provocou uma diminuição transitória reversível no grau de SaO2 pulpar.

Eficácia de dois agentes térmicos antes e após a realização da terapia periodontal, em dentes humanos / In vivo evaluation of two cold tests before and after the periodontal therapy

A determinação ou pressuposição da vitalidade pulpar assume no dia-a-dia papel de capital importância no diagnóstico clínico com vistas à indicação ou não da terapia endodôntica. O objetivo do presente estudo foi avaliar a eficiência clínica de dois recursos térmicos, a saber: o bastão de gelo e o gás refrigerante, na deter¬minação da vitalidade pulpar em dentes humanos antes e após a realização de terapia periodontal, incluindo raspagem e aplainamento radicular e/ou procedimentos cirúrgicos periodontais. Para tanto, foram incluídos 60 pacientes de ambos os sexos e faixa etária entre 21 a 64 anos de idade num total de 411 dentes indica¬dos à terapia periodontal e analisados em dois tempos, a saber, na condição pré e pós-terapia periodontal. Realizaram-se o exame do paciente e o exame radiográfico periapical. Foi feita a aplicação dos dois agentes térmicos, o bastão de gelo e gás refrigerante, para obtenção da resposta dolorosa pulpar antes dos procedimen¬tos periodontais. Após uma semana os pacientes retornaram para nova aplicação dos testes de sensibilidade pulpar, valendo-se dos mesmos procedimentos de testes que foram executados na primeira sessão de exame do paciente. Para saber se houve diferença significativa entre as proporções, utilizou-se o teste não paramétrico Qui-quadrado (c2) em nível de 95% de confiança. Concluiu-se que ocorreu um número maior de respostas positivas após os procedimentos periodontais para os dois testes, exceção notada no dente pré-molar (p>0,05), indicando que não existe diferença na frequência de respostas positivas e negativas tanto antes como após a terapia periodontal

The determination or presumption of pulp vitality assumes a central role in clinical diagnosis for the indica¬tion of endodontic therapy or not. The aim of this study was to evaluate the clinical efficiency of two thermal resources: the ice stick and the refrigerant gas in determining pulp vitality in teeth before and after periodontal therapy including scaling and root planning and/or periodontal surgical procedures. For this, 60 patients of both genders and age between 21 and 64 years old were included. A total of 411 teeth indicated for periodontal therapy were analyzed in two times, namely in the pre and post periodontal therapy condition. The patient's examination and periapical radiographic examination were performed. The two thermal agents were applied to obtain the pulpal pain response before the periodontal procedures. After one week, the patients returned to a new application of the pulp sensitivity tests using the same test procedures that were performed in the first patient examination session. To determine if there was a significant difference among the proportions, the non-parametric Chi-square test was used at a 95% confidence level. It was concluded that there was a higher num¬ber of positive responses after the periodontal procedures for the two tests, exceptions noted in the premolar tooth (p> 0.05), indicating that there is no difference in the frequency of positive and negative responses both before and after periodontal therapy

Selective alveolar corticotomy to intrude overerupted maxillary first molars: analysis of pulp vitality / Corticotomía alveolar selectiva para la intrusión de los primeros molares superiores extruidos: análisis de la vitalidad pulpar

The excessive and prolonged orthodontic treatment might result in loss of pulp vitality. Selective alveolar corticotomy is an alternative to accelerate the orthodontic treatment in adults. This study aimed to evaluate the impact of selective alveolar corticotomy associated with orthodontic intrusion on pulp vitality of overerupted maxillary first molars. Six individuals with extruded maxillary first molars were randomly selected to undergo corticotomy as coadjuvant therapy for intrusion. Pulp vitality was evaluated with thermal (Endo-Ice and Heated gutta-percha) and electric tests before the surgical procedure and after intrusion (90 days). The intrusion of all teeth was obtained (mean 2.26 ± 0.52 mm), and all teeth responded positively to pulp vitality tests before and after intrusion. This suggests that selective alveolar corticotomy did not promote pulp damage, and can be considered an effective and safe auxiliary method to intrusion of overerupted maxillary molars.

El tratamiento de ortodoncia prolongado puede provocar la pérdida de la vitalidad pulpar. La corticotomía alveolar selectiva es una alternativa para acelerar el tratamiento de ortodoncia en adultos. El objetivo del presente estudio fue evaluar el impacto de corticotomía alveolar selectiva asociada a la intrusión dental con ortodoncia en la vitalidad pulpar de los primeros molares superiores extruidos. Seis individuos con primeros molares superiores extruidos fueron seleccionados al azar para someterse a corticotomía como terapia adyuvante para la intrusión dental. La vitalidad pulpar se evaluó en ensayos térmicos (Endo-ice y gutapercha climatizada) y eléctrica antes del procedimiento quirúrgico y después de la intrusión (90 días). Se obtuvo la intrusión de todos los dientes (media 2,26 ± 0,52 mm) y todos los primeros molares respondieron positivamente a las pruebas de vitalidad pulpar, antes y después de la intrusión. Los resultados sugieren que la corticotomía alveolar selectiva no promueve daño pulpar y se puede considerar un método eficaz y seguro para ayudar a la intrusión de molares extruidos.

Validez de pruebas diagnósticas endodónticas aplicadas por estudiantes de pregrado de una universidad chilena / Validity of applied endodontic diagnostic tests for undergraduate students of a Chilean university

Para el éxito de un tratamiento endodóntico es fundamental un correcto diagnóstico pulpar. Existen controversias con respecto a la validez de los métodos diagnósticos comúnmente utilizados en la práctica diaria por el odontólogo para determinar la condición del estado pulpar. El objetivo fue determinar la validez de dos de las pruebas pulpares (de frío y calor) más comúnmente usadas por estudiantes de pregrado en pacientes que acuden a una clínica de endodoncia. Se realizó un estudio de corte transversal, en 49 pacientes (54 dientes) que acudieron para atención de endodoncia, y que cumplían con los criterios de selección de este estudio. La sensibilidad para la prueba de frío y calor fue 75,9% y para la prueba combinada (frío y calor) fue 69% versus sangrado cameral. La especificidad para la prueba de frío fue 80%, para la prueba de calor 76% y para la prueba combinada 84%. La prueba de frío o del calor por sí sola tiene mayor sensibilidad que aplicada de manera combinada. En cambio, se consiguió una mayor especificidad al combinar ambas pruebas diagnósticas, que por sí solas.

For successful endodontic treatment a correct diagnosis for pulp diseases is essential. Controversy exists regarding the validity of diagnostic methods commonly used in daily practice by the dentist to determine the condition of the pulp state. The aim of this study was to determine the validity of two thermal tests (cold and heat stimuli) most commonly used by undergraduates students in patients in patients treated in endodontic dental clinic. Cross-sectional study was performed in 49 patients (54 teeth) who needed endodontics treatment, and meeting the criteria of this study. Sensitivity to cold and heat test was 75.9% and the combined test (hot and cold) was 69%. The specificity for the cold test was 80%, for the heat test was 76%, and for the combined test 84%. The cold or heat test alone, shows more sensitivity than the combination. However, higher specificity was achieved by combining both tests.

Estudio clínico prospectivo del dolor posoperatorio en pacientes, asociado al uso de la lima de pasaje / A prospective clinical study of postoperative pain in patients, associated with the use of an apical patency file

Objetivo: evaluar, en pacientes, el dolor posoperatorio asociado al uso de la lima de pasaje, en dientes con y sin vitalidad pulpar. Materiales y métodos: se analizaron 400 dientes (n=400) con indicación de tratamiento endodóntico, según el criterio de inclusión diseñado para este estudio. Fueron distribuidos en dos grupos de 200 cada uno. Sólo en uno de los grupos, se utilizó una lima de pasaje. Todos los tratamientos fueron realizados en una sesión operatoria. Previamente al tratamiento endodóntico, se evaluó la vitalidad pulpar. Posteriormente, se agregó a los 400 pacientes un cuestionario para evaluar la presencia o la ausencia de dolor posoperatorio, 326 de los cuales lo devolvieron correctamente respondido. Resultados: no hubo diferencias estadísticamente significativas entre los dos grupos en cuanto a la presencia de dolor posoperatorio y la vitalidad pulpar (p>0,05). Conclusión: el empleo de la lima de pasaje no incidiría en la presencia de dolor posoperatorio.

Avaliação da resposta ao teste de sensibilidade pulpar ao frio em dentes portadores de lesões cervicais não cariosas / Evaluation of response to pulp sensitivity test with cold in teeth with non-carious cervical lesion

Objetivo: avaliar a resposta do teste de sensibilidade ao frio em dentes que apresentam perda de estrutura por lesões cervicais não cariosas. Métodos: foram selecionados 18 pacientes atendidos nas disciplinas de Clínica Integrada da Faculdade de Odontologia da Universidade de Passo Fundo. Desses pacientes, foram analisados quarenta dentes monorradiculares (caninos e pré-molares) que preencheram os critérios de inclusão, sendo divididos em dois grupos: G1, composto por 20 dentes portadores de lesões cervicais não cariosas; G2 (controle), composto por 20 dentes sem perda de estrutura. Os pacientes foram orientados em relação ao nível de dor, seguindo uma escala visual analógica que classificava a resposta dolorosa em leve, moderada e severa. A partir das informações obtidas, os dados foram analisados estatisticamente pelo teste não-paramétrico de Kolmogorov-Smirnov ao nível de significância de 5%. Resultados: os resultados do presente estudo não demonstraram diferença estatisticamente significativa entre os dois grupos testados no que diz respeito à resposta aos testes de vitalidade pulpar (p < 0,05). Conclusão: de acordo com as limitações do presente estudo, foi concluído que os dentes com lesões cervicais não cariosas apresentaram diferentes níveis de respostas aos testes, o que sugere que dentes com perda de estrutura por essas lesões podem ou não apresentar sensibilidade pulpar.

Eficácia do gelo e gás na determinação da sensibilidade pulpar antes e após a restauracão / Reliability of ice and refrigerant gas before and after in restorative procedures

O objetivo do presente estudo foi comparar a frequência de respostas positivas e negativas, bem como a intensidade da dor do paciente frente à aplicação térmica em 625 dentes humanos cariados antes e após os procedimentos restauradores. A intensidade dolorosa foi medida por meio da Escala Analógica Visual representada por uma régua calibrada em milímetros de 1 a 10. Antes de fazer a restauração aplicou-se o bastão de gelo e depois o gás refrigerante, para obtenção da resposta pulpar. Após a restauração, nova aplicação dos testes e avaliação da intensidade dolorosa valendo-se da referida escala. Os dados relativos antes e após os procedimentos restauradores foram tabulados analisando-se a frequência e percentual de respostas positivas e negativas e a intensidade dolorosa em leve, moderada e intensa. Ao comparar o bastão de gelo e gás refrigerante ocorreu diferença percentual de repostas positivas e negativas com significado estatístico (p=O,ooool) o mesmo ocorrendo à intensidade da dor nos seus três níveis tanto antes como depois dos procedimentos restauradores. Concluiu-se que, o gás refrigerante comparado com o gelo, determinou maior número de frequências de respostas positivas tanto antes como depois dos procedimentos restauradores. O número de dentes com dor intensa antes dos procedimentos restauradores foi maior do que depois da restauração a aplicação do gelo como o gás refrigerante. Quanto à intensidade dolorosa moderada e leve verificou-se que antes de realizar a restauração os índices percentuais foram menores em relação à intensidade dolorosa depois dos procedimentos restauradores tanto a aplicação do gelo como o gás refrigerante.

The aim of this study was to compare the frequency of positive and negative responses and intensity of patient pain in the thermal application in 625 human caries teeth before and after the restorative procedures. Pain intensity was measured by Visual Analogue Scale represented bya calibrated rule 1-10 mm. Before making the restoration was applied the ice stick and then the refrigerant gas to obtain the pulp response. After the restoration were made the new application testing and evaluation of pain intensity availing himself of that scale. The data before and after the restorative procedures were tabulated by analyzing the frequency and percentage of positive and negative responses and pain intensity as mild, moderate and intense. By comparing the ice stick and refrigerant occurred percentage difference of positive and negative responses with statistical significance (p = 0.00001) occurring at the same intensity of pain at its three levels both before and after restorative procedures. it concluded that the refrigerant compared to the ice stick determined more positive response frequencies both before and after restoratives procedures. The number of teeth with pain before the restorative procedures was higher than after application of the restoration of ice stick as the refrigerantAs a moderate and mild pain intensity was found that before performing the restoration percentage rates were lower in relation to pain intensity after the restorative procedures both the application of ice and the refrigerant gas.

Root Dentine Sensitivity.

Background: Dentine hypersensitivity is one of the most painful, ubiquitous and least satisfactorily treated of all the chronic oral problems involving the teeth. Active Periodontal treatment appears to be one of the significant causes of hypersensitivity. Also, the role of plaque control in treatment of hypersensitivity is controversial. Thus the present study is aimed to study the degree to which a sample of patient developed Root Dentine Sensitivity (RDS) following nonsurgical periodontal treatment. Material & Methods: A total of 60 dental patients were evaluated for plaque scores and pain scoring using Scratch test and Air blast test. Visual Analogue Scale (VAS) was used for pain scoring. Oral hygiene instructions were given and non- surgical periodontal treatment was done quadrant wise over a period of 4 weeks. Results: The intensity of RDS given by VAS score and the percentage of teeth sensitive to both the test increased after scaling and root planing but gradually decreased when meticulous plaque control was maintained. Conclusion: Non- surgical periodontal treatment i.e. SRP and Oral hygiene maintenance may temporarily increase RDS, which reduces subsequently over a period of time with meticulous plaque control.

Laser Doppler em Endodontia: revisão da literatura / Laser Doppler in Endodontics: literature review

O propósito deste trabalho foi revisar e discutir a literatura acerca do uso da fluxometria Laser Doppler (FLD) como método de diagnóstico em Endodontia. Consultou-se o banco de dados da PubMed e do Portal de Periódicos Capes, selecionando-se artigos publicados desde1986 até 2010. Os testes elétrico e térmico são considerados testes de sensibilidade, pois avaliam apenas a função sensorial do dente. A capacidadede avaliar a circulação sanguínea é uma exigência para que o teste seja considerado de vitalidade e a FLD é um método não-invasivo que apresenta esse requisito. Porém, diversos fatores podem influenciar nas suas medições, tais como o comprimento de onda do laser, a banda Doppler, a distância entre as fibras ópticas que compõem a sonda e o isolamento do dente. O uso deste método tem sido bem documentado na literatura e tem se mostrado bastante eficaz para distinguir dentes vitais de não-vitais. Apesar de seu alto custo e a dificuldade de uso na prática clínica interferirem na sua utilização em larga escala, as pesquisas que comprovam a importância e eficácia da FLD poderão contribuir, a médio e a longo prazo, para a popularização e redução de custos deste método, considerando, principalmente, os casos de envolvimento pulpar de origem traumática a que a população está constantemente submetida.

The objective of this study was to review the periodics and scientific journals regarding the use of Laser Doppler Flowmetry (LDF) as a method of diagnosis in Endodontics. In order to obtain data, a literature search was performed in the Capes Journals and PubMed database.The review was based on articles published from 1986 to 2010. Electrical and thermal tests are considered sensitivity tests, because they only assess the sensory function of the tooth. A test must assess the blood flow inside the dental pulp to be considered a vitality test. The LDF is a noninvasive method, which assess pulpal blood flow. Several factors may have an influence in the LDF measurements, such as wavelength of the laser, Doppler bandwidth, probe's optical fibers distance, and tooth isolation. The use of this method has been well documented in the literature and it has been proven very effective in distinguishing between non-vital and vital teeth. Due to its high cost and difficulty to use, this method is not considered friendly to use in the clinical setting, which interpose a more wide-scale use. Current research that proves the importance and effectiveness of the LDF may lead to the popularization and cost reduction of this method, especially when we consider the potential improvement in diagnosis for cases of traumatic pulpal involvement that are common occurrences in our population.

Diagnostic and clinical factors associated with pulpal and periapical pain

A retrospective survey was designed to identify diagnostic subgroups and clinical factors associated with odontogenic pain and discomfort in dental urgency patients. A consecutive sample of 1,765 patients seeking treatment for dental pain at the Urgency Service of the Dental School of the Federal University of Goiás, Brazil, was selected. Inclusion criteria were pulpal or periapical pain that occurred before dental treatment (minimum 6 months after the last dental appointment), and the exclusion criteria were teeth with odontogenic developmental anomalies and missing information or incomplete records. Clinical and radiographic examinations were performed to assess clinical presentation of pain complaints including origin, duration, frequency and location of pain, palpation, percussion and vitality tests, radiographic features, endodontic diagnosis and characteristics of teeth. Chi-square test and multiple logistic regression were used to analyze association between pulpal and periapical pain and independent variables. The most frequent endodontic diagnosis of pulpal pain were symptomatic pulpitis (28.3 percent) and hyperreactive pulpalgia (14.4 percent), and the most frequent periapical pain was symptomatic apical periodontitis of infectious origin (26.4 percent). Regression analysis revealed that closed pulp chamber and caries were highly associated with pulpal pain and, conversely, open pulp chamber was associated with periapical pain (p<0.001). Endodontic diagnosis and local factors associated with pulpal and periapical pain suggest that the important clinical factor of pulpal pain was closed pulp chamber and caries, and of periapical pain was open pulp chamber.

Um estudo retrospectivo foi realizado para identificar fatores clínicos e de diagnóstico associado com a dor de origem odontogênica. Foram selecionados 1765 pacientes que buscaram tratamento para dor odontogênica no Serviço de Urgência da Faculdade de Odontologia da Universidade Federal de Goiás. Os critérios de inclusão foram dor de origem pulpar ou periapical antes do tratamento dentário (mínimo de 6 meses depois da última consulta odontológica), e os critérios de exclusão foram dentes com anomalias de desenvolvimento e falta de informações ou registros incompletos. Avaliações clínicas e radiográficas foram realizadas para se obter as características clínicas de dor, incluindo origem, duração, frequência e localização da dor, testes de palpação, percussão e vitalidade pulpar, aspectos radiográficos, diagnóstico endodôntico e características dos dentes. Os testes qui-quadrado e regressão logística múltipla foram utilizados para verificar a associação entre a dor de origem pulpar e periapical e variáveis independentes. O diagnóstico endodôntico de dor de origem pulpar mais frequente foi pulpite sintomática (28,3 por cento) seguido por pulpalgia hiper-reativa (14,4 por cento), e o mais frequente de dor de origem periapical foi periodontite apical sintomática infecciosa (26,4 por cento). Análise de regressão revelou que câmaras pulpares fechadas e cáries estavam altamente associadas à dor pulpar e, inversamente, câmara pulpar aberta estava associada à dor periapical (p<0,001). O diagnóstico endodôntico e fatores locais associados com dor de origem pulpar e periapical sugerem que os fatores clínicos importantes das dores pulpares foram câmaras pulpares fechadas e cáries, e de dor periapical foi câmara pulpar aberta.

A comparison of the clinical anesthetic efficacy of articaine infiltration and lidocaine blocking for microport extraction of impacted mandibular molar / 华西口腔医学杂志

<p><b>OBJECTIVE</b>To compare the clinical efficacy of the infiltration anesthesia with primacaine and the nerve blocking anesthesia with lidocaine for microport extraction of impacted lower third molar. METHODS; 104 chosen patients had both sides of impacted lower third molars extracted in this study. Patients were given local anesthesia with either primacaine or lidocaine randomly at each side, and then underwent microport extraction. Clinical factors including effective proportion (EP), effecting time point (ETP), visual analogue scale of pain (VASp), alteration of systolic pressures (ASP) and analgesia duration (AD) were evaluated statistically by means of paired t-test.</p><p><b>RESULTS</b>The EP of experimental group was higher than the control group (P = 0.024). The ETP of soft tissue and alveoli-dental pulp was (1.04 +/- 0.21), (2.44 +/- 2.60) min in the experimental group, and much earlier than that of the control group (P = 0.002, P = 0.032). The VASp and ASP of experimental group were lower than the control group (P = 0.041, P = 0.018). AD was (103.6 +/- 35.5) min, and higher than the control group (P = 0.04).</p><p><b>CONCLUSION</b>The infiltration anesthesia with primacaine has been proven to be a easier, reliable and quick-acting method. We suggest it an alternative method replacing the 2% lidocaine blocking during microport extraction of impacted lower third molar.</p>

Semiología de la pulpa: signos, síntomas y determinación del estado pulpar / Semiology of the pulp: signs, symptoms and pulp status determination

Es sabido que para toda intervención en medicina u odontología es imperativo proceder a realizar un correcto diagnóstico de la patología a tratgar; la operatoria dental no escapa a esta regla, debiendo el profesional realizar el diagnóstico de la lesión de los tejidos duros del diente pero además de su estado pulpar; y es precisamente aquí donde debe agudizar sus sentidos para observar la presencia de alguna patología y determinar en primera instancia el área de su incumbencia, o la derivación a la endodoncia. Es en este punto donde se cometen infinidad de errores ya que existe una sutil línea a partir de la cual la lesión pulpar pasa a un estadio irreversible. Es muy común intentar determinar el estado pulpar por la extensión de la lesión sin reparar en que existen grandes cavidades con tejido pulpar sano y pequeñas lesiones con patologías irreversibles. También es habitual que el profesional se guíe para la toma de decisiones por una radiografía, sin comprender que la misma no determina el estado pulpar. Por todo esto, es necesario conocer diferentes pruebas o tests que nos ayudan a diagnosticar con el menor margen de error posible, para encarar así un adecuado tratamiento.

Avaliação da escolha dos testes de sensibilidade pulpar por clínicos gerais da cidade de Taubaté / Evaluation of the choice of pulp sensitivity tests by practitioners of Taubaté city

Introdução: A proposta desta pesquisa é avaliar os recursos complementares de que os clínicos gerais da cidade de Taubaté lançam mão na determinação da sensibilidade pulpar. Método: Foram entrevistados ao acaso 106 cirurgiões-dentistas da cidade de Taubaté valendo-se de um questionário elaborado pelo autor. Tais profissionais eram de diferentes épocas de graduação, portadores de especialidade ou não e de diversas faculdades de Odontologia. Os questionários apresentavam uma lista de testes com a seguinte pergunta: ?Qual ou quais os recursos suplementares mais utilizados na avaliação da sensibilidade pulpar deque você lança mão durante o exame do paciente??. Os dados foram organizados de modo a facilitar sua subdivisão em teste pelo frio, calor, elétrico, cavidade, anestesia e outros, permitindo estabelecer percentuais de utilização destes em função do número de citações. Resultados: Como inferência estatística utilizou-se teste binomial para proporção, sendo o nível de significância de 5%.Na comparação entre a proporção de clínicos gerais que utilizam guta-percha (90,56%) e bastão de gelo (77,35%) o teste apresentou pvalor<0,05 indicando que a proporção de clínicos gerais que usam guta-percha aquecida é maior do que aqueles clínicos que usam bastão de gelo. Conclusão: De posse dos resultados obtidos, concluiu-se que a guta-percha aquecida foi o recurso auxiliar preferido pelos clínicos gerais (90,56%) seguido do bastão de gelo (77,35%), gases refrigerantes 64,15%), jato de ar (41,5%), teste de anestesia (38,67%), teste de cavidade (31,13%), água fria (24,52%), brunidor aquecido (4,71%), teste elétrico (1,88%) e algodão embebido em álcool (0,94%).

Introduction: The purpose of this study is to assess which methods that the general practitioners of the Taubaté city used to determine the pulpal sensitivity. Method: Were interviewed 106 randomly dentists of Taubaté city making use of a questionnaire prepared by the author. These professionals were from different times of graduation, expert or not and from various dentistry colleges. The questionnaires presented a list of tests with the following question: which additional resources do you prefer during the evaluation of pulpal sensitivity during of the patient exam??. The data were organized to facilitate their subdivision: cold test, heat test, electric test, anesthesia test and cavity test, to establish rates of use of these depending on the number of citations. Results: Because of statistical inference was used the binomial proportion with the significance level of 5%. The proportion of general practitioners using heat gutta-percha (90.56%) and ice stick (77.35%) tests presented pvalue<0.05 indicating that the proportion of general practitioners using heat gutta-percha is higher than those clinicians that using ice stick. Conclusion: It was concluded that heat gutta-percha were the test preferred by practitioners (90.56%) followed by ice stick (77.35%), refrigerants (64.15%), air jet (41.5%), test of anesthesia (38.67%) test cavity (31.13%), cold water (24.52%), heated burnisher (4.71%), electrical test (1.88%) and alcohol swab (0.94%).

Microbiological and microscopic analysis of the pulp of non-vital traumatized teeth with intact crowns

OBJECTIVE: This study evaluated the presence of microorganisms and analyzed microscopically the pulp of 20 traumatized human teeth with intact crowns and clinical diagnosis of pulp necrosis, based on the association of at least three of the clinical criteria: crown discoloration, negative response to thermal and electric pulp vitality tests, positive response to vertical and horizontal percussion, pain on palpation or mobility. MATERIAL AND METHODS: Microbiological collection was performed from the root canals to evaluate the presence of microorganisms. The pulp samples were stained with hematoxylin and eosin (H.E.) for histological evaluation of possible morphological alterations. RESULTS: Analysis of results was performed by statistical tests (linear regression test and diagnostic analysis) and subjective analysis of the sections stained with H.E. and revealed that only 15 percent of the sample did not exhibit microbial development. The time elapsed between dental trauma and onset of endodontic intervention ranged from 15 days to 31 months; the percussion test presented high sensitivity (80 percent) for detection of microorganisms in the root canal of traumatized teeth; 3 teeth (15 percent) did not present pulp tissue, being characterized as complete autolysis; analysis of pulp samples was performed on the other 17 cases, among which 3 (15 percent) exhibited partial necrosis without possibility of repair and 14 presented complete necrosis; none of the clinical criteria employed for the diagnosis of pulp necrosis in traumatized teeth was pathognomonic. CONCLUSIONS: The present results allowed the following conclusions: with regard to microbiological findings, 85 percent of teeth presented microorganisms in the root canal, despite the presence of an intact crown. Concerning the microscopic findings, 100 percent of traumatized teeth presented pulp necrosis; the pulp vitality tests based on pulp response to heat, cold and vertical percussion ...