Efficacy of clinical and radiological methods to identify second mesiobuccal canals in maxillary first molars.

INTRODUCTION: The success of endodontic treatment depends on the identification of all root canals. Technological advances have facilitated this process as well as the assessment of internal anatomical variations. The aim of this study was to compare the efficacy of clinical and radiological methods in locating second mesiobuccal canals (MB2) in maxillary first molars. METHODS: Fifty patients referred for analysis; access and clinical analysis; cone-beam endodontic treatment of their maxillary first molars were submitted to the following assessments: analysis; access and clinical analysis; cone-beam computed tomography (CBCT); post-CBCT clinical analysis; clinical analysis using an operating microscope; and clinical analysis after Start X ultrasonic inserts in teeth with negative results in all previous analyses. RESULTS: Periapical radiographic analysis revealed the presence of MB2 in four (8%) teeth, clinical analysis in 25 (50%), CBCT analysis in 27 (54%) and clinical analysis following CBCT and using an operating microscope in 27 (54%) and 29 (58%) teeth, respectively. The use of Start X ultrasonic inserts allowed one to detect two additional teeth with MB2 (62%). According to Vertucci's classification 48% of the mesiobuccal canals found were type I, 28% type II, 18% type IV and 6% type V. Statistical analysis showed no significant differences (p > 0.5) in the ability of CBCT to detect MB2 canals when compared with clinical assessment with or without an operating microscope. A significant difference (p < 0.001)was found only between periapical radiography and clinical/CBCT evaluations. CONCLUSION: Combined use of different methods increased the detection ofthe second canal in MB roots, but without statistical difference among CBCT, operating microscope, Start X and clinical analysis.

Fragmented adipose tissue graft for bone healing: histological and histometric study in rabbits' calvaria.

OBJECTIVE: The adipose tissue represents an important reservoir of stem cells. There are few studies in the literature with which to histologically evaluate whether or not the adipose tissue graft is really a safe option to achieve bone repair. This study histologically analyzed the effect of fragmented autogenous adipose tissue grafts on bone healing in surgically created, critical-size defects (CSD) in a rabbit's calvaria. STUDY DESIGN: Forty-two New Zealand rabbits were used in this study. CSD that were 15 mm in diameter were created in the calvarium of each animal. The defects were randomly divided into two groups: in Group C (control), the defect was filled only by a blood clot and, in Group FAT (i.e., fragmented adipose tissue), the defect was filled with fragmented autogenous adipose tissue grafts. The groups were divided into subgroups (n = 7) for euthanasia at 7, 15, and 40 days after the procedure had been conducted. Histologic and histometric analyses were performed. Data were statistically analysed with ANOVA and Tukey's tests (p < 0.05). RESULTS: The amount of bone formation did not show statistically significant differences seven days after the operation, which indicates that the groups had similar amounts of mineral deposition in the earlier period of the repair. Conversely, a significant of amount of bone matrix deposition was identified in the FAT group at 15 and 40 days following the operation, both on the border and in the body of the defect. Such an outcome was not found in the control group. CONCLUSION: In this study, an autologous adipose tissue graft may be considered as likely biomaterial for bone regeneration, since it positively affected the amount of bone formation in surgically created CSD in the rabbits' calvaria 40 days after the procedure had been performed. Further investigations with a longer time evaluation are warranted to determine the effectiveness of autologous adipose tissue graft in the bone healing.

Prosthetic rehabilitation and management of an MTA-treated maxillary central incisor with root perforation and severe internal resorption.

Root canal perforation and root resorption are challenging clinical conditions to correctly diagnose and treat, especially when they occur in anterior teeth. This clinical report describes the computed tomography findings, endodontic treatment, prosthetic rehabilitation, and clinical outcome of an iatrogenic root perforation and internal resorption in a maxillary central incisor. The case management consisted of endodontic retreatment, periodontal surgery, and prosthetic rehabilitation. Gray mineral trioxide aggregate (MTA) was used to fill the resorption space and seal the perforation. The prosthetic treatment was performed with glass fiber-reinforced dowels and all-ceramic crowns. No signs or symptoms, including discomfort, pain, or esthetic defects were observed in 30 months of follow-up.

Evaluation of Endo 10 mobile application as diagnostic tool in endodontics.

Background: Endodontic diagnosis can be compared to a puzzle, requiring the interpretation of a series of clinical and imaging data. Mobile health, especially mobile application (apps), can assist professionals in endodontic diagnosis. This work aims to evaluate an app - Endo 10 app, designed to assist pulpal and periapical diagnosis based on the patient's signs and symptoms and radiographic data. Material and Methods: A total of 41 dental students and dentists with different levels of expertise (10 multi-specialty clinic professors, 17 residents in endodontics and 14 dental students) were included. The System Usability Scale (SUS) was used to evaluate usability and the Davis' technology acceptance model was used to evaluate usefulness of Endo 10 app. The Mann-Whitney test was performed to compare SUS scores between professors and undergraduate dental students and to compare questions 6 and 7 of the utility test and verify whether participants who understood that the technology was useful also better understood the concepts of endodontic diagnosis. The agreement between professor's diagnosis with the app and professor without the app, and between professor and residents in endodontics with the app were evaluated. Results: The SUS score at the 50th percentile was 77.5, graded as acceptable. No significant difference was observed in the SUS scores when analyzing professors and dental students separately (p = 0.442). Usefulness test showed positive responses ranging between 72% - 100%. No statistically significant difference was observed between questions 6 and 7 of the utility test (p = 0.206), indicating that the group of participants who understood that the technology was useful in endodontic diagnosis was associated with the agreement that the application helped to better understand the concepts related. The diagnosis agreement between professor in the common diagnosis process and professor with app was 100% (31) of cases. The concordance between professor and residents in endodontics with the app was 71% (22) of cases. The differences were associated with resident's misinterpreting the patient's data. Conclusions: The Endo 10 app reached the usability and usefulness requirements. It proved accurate in diagnosing pulpal and periapical pathologies. Key words:Dental education, endodontics, diagnosis, smartphone, dental informatics.

Avaliação da usabilidade e utilidade de um aplicativo sobre traumatismos dentários para cirurgiões-dentistas e estudantes de Odontologia / Evaluación de usabilidad y utilidad de una aplicación para odontólogos y estudiantes de odontología en el manejo de traumatismos dentales / Usability and utility evaluation of an application for dentists and dental students to manage dental injuries

O objetivo deste estudo foi avaliar a usabilidade e a utilidade do aplicativo (app) Dental Trauma, disponível gratuitamente e em português nas lojas App Store e Play Store. Participaram do estudo estudantes de Odontologia e Cirurgiões-dentistas (CDs) (n =20). Utilizou-se o teste de Escala de Usabilidade do Sistema (System Usability Scale-SUS) para análise da usabilidade e o teste de Aceitação de Tecnologia (Technology Acceptance Model-TAM) adaptado ao contexto da pesquisa para a análise da utilidade. Foi aplicado o teste de Mann-Whitney para comparar o escore SUS entre estudantes e CDs e o teste de Spearman para correlacionar as questões da utilidade. A pontuação SUS no percentil 50 foi de 83,75. Valores acima de 68 são classificados como aceitáveis. O teste de Mann-Whitney não evidenciou diferença significativa na pontuação SUS ao analisar separadamente CDs e estudantes de Odontologia (p = 0,442). O app foi amplamente avaliado como útil (95% a 100%), sendo observadas correlações robustas, positivas e significas entre as respostas para cada questão. O app não contempla traumatismos em dentes decíduos, sendo uma oportunidade de atualização ou desenvolvimento de outros apps. O app Dental Trauma atendeu aos requisitos de usabilidade e utilidade, alcançando resultados classificados como "excelente". Os usuáriosreconheceram se tratar de uma tecnologia útil que pode auxiliar o profissional no diagnóstico e conduta e na compreensão dos conceitos relacionados ao traumatismo dentário (AU).

El objetivo de este estudio fue aplicar pruebas de usabilidad y utilidad a la aplicación (app) Dental Trauma, disponible de forma gratuita en portugués en App Store y Play Store. Participaron en el estudio estudiantes de odontología y Odontólogos(n = 20). Se utilizó la Escala de Usabilidad del Sistema (System Usability Scale-SUS) para el análisis de usabilidad y el Modelo de Aceptación de Tecnología (TAM), adaptado al contexto de la investigación, para el análisis de utilidad. Se aplicó la prueba de Mann-Whitney para comparar los puntajes SUS entre estudiantes y dentistas, y la prueba de Spearman para correlacionar preguntas de utilidad. El puntaje SUS en el percentil 50 fue de 83,75. Los puntajes por encima de 68 se clasifican como aceptables. La prueba de Mann-Whitney no mostró una diferencia significativa en el puntaje SUS al analizar por separado a los Odontólogosy estudiantes de odontología (p = 0,442). La aplicación fue ampliamente evaluada como útil (95% a 100%), observándose correlaciones robustas, positivas y significativas entre las respuestas a cada pregunta. Sin embargo, no aborda traumas en dientes deciduos, lo que representa una oportunidad para actualizar o desarrollar otras aplicaciones. La app Dental Trauma cumplió con los requisitos de usabilidad y utilidad, logrando resultados calificados como "excelentes". Los usuarios reconocieron que se trata de una tecnología útil que puede ayudar a los profesionales en el diagnóstico y manejo y en la comprensión de conceptos relacionados con el traumatismo dental (AU).

This study aimed to apply usability and utility tests to the Dental Trauma application (app), available for free in Portuguese on the App Store and Play Store. Students and dentists participated in the study (n = 20). The System Usability Scale (SUS) test was used for usability analysis, and the Technology Acceptance Model (TAM) test, adapted to the dental trauma context, was used for utility analysis. The Mann-Whitney test was applied to compare SUS scores between students and dentists, and the Spearman test was used to correlate utility questions. The SUS score at the 50th percentile was 83.75. Scores above 68 are classified as acceptable. The Mann-Whitney test did not show a significant difference in the SUS score when analyzing dentists and dental students separately (p = 0.442). The app was widely evaluated as useful (95% to 100%), with robust, positive, and significant correlations observed between responses to each question. However, it does not cover traumas in deciduous teeth, presenting an opportunity for updating or developing other apps. The Dental Trauma app fulfilled both usability and usefulness criteria, garnering an "excellent" rating in its outcomes. Users acknowledged its utility as a valuable technological tool aiding professionals in diagnosis, management, and comprehension of dental trauma-related concepts (AU).

Analysis of 115 mandibular angle fractures.

PURPOSE: This retrospective study reviewed cases of fractures of the mandibular angle to identify personal data, social traits, fracture characteristics, treatment modalities, and postoperative complications. PATIENTS AND METHODS: From April 1999 until July 2004, 114 patients were treated for 115 fractures of the mandibular angle by the Division of Oral and Maxillofacial Surgery at Piracicaba Dental School-Unicamp, in Brazil. RESULTS: More angle fractures were observed in Caucasian (55%) men (89%) with some kind of drug addiction (62%). Patient mean age was 27 years. The majority of fractures in this study were sustained in altercations, including gunshot wounds (43%), followed by vehicle accidents, including bicycles and being struck by a car (39%). Open fractures were the most frequent (90%), with prevalence of the left side (57%). Only 1 patient sustained bilateral angle fractures. Ninety-seven patients (85%) underwent open reduction. Complications occurred in 19 patients (17%); 10 (9%) were infections. Of the total number of complications, 3 underwent another surgical intervention for refixation. The factors that contributed to the development of postoperative complications were social risks that included alcohol abuse, smoking, and intravenous and nonintravenous drug abuse. CONCLUSIONS: Angle fracture management outcomes are affected by many factors beyond method of fixation.

Calcium hydroxide diffusion after agitation of endodontic irrigants: an ex vivo study

Aim: To compare the influence of two methods of agitation of endodontics irrigants, by diffusion of calcium hydroxide [Ca(OH)2] through the dentinal tubules, measuring the pH of the medium where they were kept. Methods: Twenty mandibular incisors were prepared using a WaveOne Gold Large file, in a reciprocating movement, and then divided into (n = 10): gutta-percha cone (GPC) or Easy Clean system (ECS) agitation of 1% sodium hypochlorite and 17% ethylenediaminetetraacetic acid. The specimens were filled with Ca(OH)2 paste, placed in flasks with 4 mL of deionized water, and stored in an incubator. The pH was read using a digital pH meter immediately after storage (T0), after 7 (T1), 14 (T2), 21 (T3), and 35 (T4) days. Results: Statistical difference between groups was observed regardless of the day pH was measured (p < 0.01). From T2 on, ECS presented higher pH values in comparison with GPC, with significant difference (p < 0.01). Conclusion: Agitation of endodontic irrigants with ECS enhances the Ca(OH)2 diffusion, providing higher pH values, from the 14th day on, when compared with GPC

Cerebrospinal fluid rhinorrhoea: diagnosis and management.

A cerebrospinal fluid (CSF) rhinorrhoea occurs when there is a fistula between the dura and the skull base and discharge of CSF from the nose. CSF rhinorrhea or liquorrhoea commonly occurs following head trauma (fronto-basal skull fractures), as a result of intracranial surgery, or destruction lesions. A spinal fluid leak from the intracranial space to the nasal respiratory tract is potentially very serious because of the risk of an ascending infection which could produce fulminant meningitis. This article reviewed the causes, diagnosis and treatment of CSF leakage. A PUBMED search of the National Library of Medicine was conducted. CSF leak most commonly occurs following trauma and the majority of cases presenting within the first three months. CSF rhinorrhoea have significantly greater incidence of periorbital haematoma. This suggests that patients with head injuries and features of periorbital haematoma are at greater risk of unobserved dural tear and delayed CSF leakage. In the presence of a skull base fracture on computed tomography and a clinical CSF leak, there is no need for a further confirmatory test. In cases where a confirmatory test is needed, the beta-2 transferrin assay is the test of choice because of its high sensitivity and specificity. A greater proportion of the CSF leaks in the patients resolved spontaneously. CSF fistulae persisting for > 7 days had a significantly increased risk of developing meningitis. Treatment decisions should be dictated by the severity of neurological decline during the emergency period and the presence/absence of associated intracranial lesions. The timing for surgery and CSF drainage procedures must be decided with great care and with a clear strategy.

Biomechanical aspects of external root resorption in orthodontic therapy.

External apical root resorption is a common phenomenon associated with orthodontic treatment. The factors relevant to root resorption can be divided into biological and mechanical factors. Some mechanical and biological factors might be associated with an increased or decreased risk of root resorption during orthodontic treatment. For mechanical factors, the extensive tooth movement, root torque and intrusive forces, movement type, orthodontic force magnitude, duration and type of force are involved. For biological factors, a genetic susceptibility, systemic disease, gender and medication intake have been demonstrated influence root resorption. Orthodontic therapy of patients with increased risk of root resorption should be carefully planned. Medical history, medication intake, family history, tooth agenesis, root morphology, oral health and habits must be considerate if we do not want jeopardize our patients by severe root resorption. To monitor apical root resorption the standard procedure is a radiographic examination after 6 months of treatment. In teeth with enhanced risk, a 3-month radiographic follow-up is recommended. The administration of anti-inflammatory drugs might suppress root resorption induced by orthodontic therapy, although none study was enough conclusive to indicate a protocol for patients with enhanced risk. In the event of multiple external root resorption, the diagnostic procedure should focus on the exclusion of the local factors and its associations (such as magnitude, duration and type of orthodontic force; periodontal disease; root form) that might lead to external root resorption. Systemic disorders associated with phosphorus-calcium metabolic alterations shall be suspected. This review searched the current knowledge of the mechanical and biological aspects of root resorption in orthodontic tooth movement.

Comparative analysis of death by suicide in Brazil and in the United States: descriptive, cross-sectional time series study.

CONTEXT AND OBJECTIVE:: The World Health Organization recognizes suicide as a public health priority. Increased knowledge of suicide risk factors is needed in order to be able to adopt effective prevention strategies. The aim of this study was to analyze and compare the association between the Gini coefficient (which is used to measure inequality) and suicide death rates over a 14-year period (2000-2013) in Brazil and in the United States (US). The hypothesis put forward was that reduction of income inequality is accompanied by reduction of suicide rates. DESIGN AND SETTING:: Descriptive cross-sectional time-series study in Brazil and in the US. METHODS:: Population, death and suicide death data were extracted from the DATASUS database in Brazil and from the National Center for Health Statistics in the US. Gini coefficient data were obtained from the World Development Indicators. Time series analysis was performed on Brazilian and American official data regarding the number of deaths caused by suicide between 2000 and 2013 and the Gini coefficients of the two countries. The suicide trends were examined and compared. RESULTS:: Brazil and the US present converging Gini coefficients, mainly due to reduction of inequality in Brazil over the last decade. However, suicide rates are not converging as hypothesized, but are in fact rising in both countries. CONCLUSION:: The hypothesis that reduction of income inequality is accompanied by reduction of suicide rates was not verified.