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1.
Int Endod J ; 53(7): 887-894, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32181902

RESUMO

AIM: To assess the prevalence of dental emergency visits (DEV) involving pain relief and their relationship with socio-economic and clinical factors in an Australian representative sample in the primary care setting. METHODOLOGY: Data on reason for visit and patient characteristics were collected from a representative random sample of Australian dentists in private practice surveyed in 2009-2010. Information regarding socio-economic (gender, age, health insurance) and clinical factors (number of teeth, number of decayed teeth, diagnosis and reason for visit [DEV, check-up, other reasons not involving pain relief]) were retrieved from compiled questionnaires. Descriptive statistics were reported, and Poisson regression models were used to assess the association between socio-economic and clinical factors and DEV. Prevalence ratio (PR) and 95% confidence interval (CI) were calculated. RESULTS: A total of 1148 dentists responded (67%), resulting in records from 6504 patients. The overall prevalence of DEV was 20.8%. The unadjusted analysis, according to the reason of visit, revealed the following predictors for DEV: male gender (PR = 1.18; 95% CI = 1.08-1.29), age 18-64 years (PR = 2.70; 95% CI = 2.19-3.33) and over 65 years (PR = 2.64, 95% CI = 2.10-3.32), uninsured patients (PR = 1.36; 95% CI = 1.24-1.49), patients with <20 teeth (PR = 1.19; 95% CI = 1.06-1.33), decayed teeth (PR = 1.64; 95% CI = 1.48-1.81). After adjustment for confounding factors (gender, age, insurance status, number of teeth and decayed teeth) apart from 'dental trauma' (PR = 1.37), all remaining diagnoses had lower PR ('other' PR = 0.19, 'decay' PR = 0.34, 'periodontal' PR = 0.51, 'failed restoration' PR = 0.45) compared with 'pulp/periapical disease'. CONCLUSIONS: In the primary care setting, the diagnoses 'pulp/periapical' and 'dental trauma' had a stronger association with DEV compared with visits not involving relief of pain. Both socio-economic (male gender, older age and uninsured individuals) and clinical factors (tooth loss, decayed teeth, endodontic diseases and dental trauma) were identified as independent risk indicators for DEV in this population. Future public health policies should include specific preventive strategies addressing these factors, aiming to reduce the need for DEV.


Assuntos
Doenças Periapicais , Idoso , Austrália , Serviço Hospitalar de Emergência , Humanos , Masculino , Dor , Prática Privada
2.
Int Endod J ; 53(5): 680-689, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31922612

RESUMO

AIM: To verify the diagnostic performance of an artificial intelligence system based on the deep convolutional neural network method to detect periapical pathosis on cone-beam computed tomography (CBCT) images. METHODOLOGY: images of 153 periapical lesions obtained from 109 patients were included. The specific area of the jaw and teeth associated with the periapical lesions were then determined by a human observer. Lesion volumes were calculated using the manual segmentation methods using Fujifilm-Synapse 3D software (Fujifilm Medical Systems, Tokyo, Japan). The neural network was then used to determine (i) whether the lesion could be detected; (ii) if the lesion was detected, where it was localized (maxilla, mandible or specific tooth); and (iii) lesion volume. Manual segmentation and artificial intelligence (AI) (Diagnocat Inc., San Francisco, CA, USA) methods were compared using Wilcoxon signed rank test and Bland-Altman analysis. RESULTS: The deep convolutional neural network system was successful in detecting teeth and numbering specific teeth. Only one tooth was incorrectly identified. The AI system was able to detect 142 of a total of 153 periapical lesions. The reliability of correctly detecting a periapical lesion was 92.8%. The deep convolutional neural network volumetric measurements of the lesions were similar to those with manual segmentation. There was no significant difference between the two measurement methods (P > 0.05). CONCLUSIONS: Volume measurements performed by humans and by AI systems were comparable to each other. AI systems based on deep learning methods can be useful for detecting periapical pathosis on CBCT images for clinical application.


Assuntos
Doenças Periapicais , Inteligência Artificial , Tomografia Computadorizada de Feixe Cônico , Humanos , Reprodutibilidade dos Testes , Raiz Dentária
3.
Quintessence Int ; 51(2): 100-107, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31942571

RESUMO

OBJECTIVE: The purpose of the present study was to assess the influence of type 2 diabetes mellitus (DM) on the evolution of pulpal and periapical pathology. METHOD AND MATERIALS: Two reviewers independently conducted a systematic search for articles published between 1 January 2001 and 31 December 2018 on MEDLINE/PubMed, ISI Web of Science, and Scopus databases. An additional manual search was also carried out. RESULTS: Ten studies fulfilling the inclusion criteria were included in the review (two longitudinal studies with 1-year follow-up comparing the success of primary root canal treatment between type 2 diabetic patients and non-diabetic patients, and eight cross-sectional studies). Analysis of the ten studies showed that inadequate control of type 2 DM may predispose and influence the inflammatory pulpal and periapical disease evolution. CONCLUSIONS: The present systematic review suggests that there are biologic bases to suggest that type 2 DM may act as a risk factor for developing an endodontic pathology, affecting the course of the disease in terms of susceptibility, prevalence, progression, and tissue healing capacity as a consequence of a disrupted immune response. However, more well-designed clinical investigations carrying out suitable research methodologies are needed to elucidate the influence of type 2 DM on the pulpal and periapical disease evolution.


Assuntos
Diabetes Mellitus Tipo 2 , Doenças Periapicais , Estudos Transversais , Humanos , Estudos Longitudinais , Tratamento do Canal Radicular
4.
Acta Odontol Scand ; 78(2): 81-86, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31322454

RESUMO

Objective: The tooth weakens due to removal of hard tissue during an endodontic procedure. Many dentists find it difficult to choose between different coronal restorations after root canal treatment (RCT). Studies show that the coronal restoration may affect the endodontic prognosis. This student-based study had three aims. (1) Examine the choice of coronal restoration of endodontically treated teeth at a Scandinavian dental school, (2) examine the survival of these restorations and (3) evaluate the influence of the coronal restoration on the outcome of the RCT. Material and methods: Radiographic and clinical examination was performed on 127 posterior teeth. The quality of the root canal treatment and the periapical status (PAI-index) were evaluated. Results: 43.8% of the teeth were restored with an indirect coronal restoration and 47.2% with a direct coronal restoration. The period from finished root canal treatment until placement of a permanent coronal restoration was significantly longer for an indirect restoration than a direct restoration. The teeth treated with a PAI score of 1 and 2 following pulpectomy, necrotic pulp treatment and endodontic retreatment was 93.8%, 82.6% and 69.4%, respectively.Conclusion: There was no significant association between choice of coronal restoration and PAI-score.


Assuntos
Restauração Dentária Permanente , Doenças Periapicais/etiologia , Tratamento do Canal Radicular , Dente não Vital/terapia , Distribuição de Qui-Quadrado , Humanos , Estudos Retrospectivos , Dente , Dente não Vital/diagnóstico por imagem , Resultado do Tratamento
5.
J Endod ; 45(12): 1489-1495, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31706622

RESUMO

INTRODUCTION: The aim of the present study was to evaluate the effects of calcium hydroxide (Ca[OH]2), Ca(OH)2 + ibuprofen, and Ca(OH)2 + ciprofloxacin in terms of receptor activator of nuclear factor kappa B ligand (RANKL) and osteoprotegerin (OPG) levels in asymptomatic periapical lesions. METHODS: Sixty-six patients were randomly divided into 3 groups using a Web program according to the medication selected: Ca(OH)2, Ca(OH)2 + ibuprofen, and Ca(OH)2 + ciprofloxacin. After removing gutta-percha from the root canals, the RANKL and OPG samples were taken from the interstitial fluid of the apical tissues using 3 paper points. At the second appointment, medicaments were removed, and second sampling was performed using the same method. The RANKL and OPG levels were measured by the enzyme-linked immunosorbent assay, and the RANKL/OPG ratio was calculated. RESULTS: According to the intragroup analysis, there were no statistically significant differences between the preoperative and postoperative levels of the RANKL/OPG ratio in any of the groups. Intergroup analyses showed that there were no statistically significant differences among the Ca(OH)2, Ca(OH)2 + ibuprofen, Ca(OH)2 + ciprofloxacin groups in terms of the percentage change in RANKL/OPG levels before and after treatment. CONCLUSIONS: Within the limitations of the present study, it can be concluded that addition of ibuprofen or ciprofloxacin to Ca(OH)2 paste does not provide any extra benefit in terms of lowering RANKL and OPG levels.


Assuntos
Anti-Inflamatórios não Esteroides , Hidróxido de Cálcio , Osteoprotegerina , Doenças Periapicais , Anti-Inflamatórios não Esteroides/uso terapêutico , Hidróxido de Cálcio/uso terapêutico , Ciprofloxacino , Humanos , Ibuprofeno/uso terapêutico , NF-kappa B/metabolismo , Osteoprotegerina/metabolismo , Doenças Periapicais/tratamento farmacológico , Ligante RANK
6.
J Pak Med Assoc ; 69(11): 1687-1692, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31740880

RESUMO

Wingless-Integrated/Beta-catenin (WNT/-catenin) signalling pathway is one of the principal intercellular signalling pathways in humans. It plays an intrinsic role in the cellular proliferation, differentiation and regeneration along with many other cellular functions. Epigenetic deoxyribonucleic acid methylations and silencing of WNT signalling pathway genes have a significant role in malignant transformation of oral lesions such as oral submucous fibrosis, oral leukoplakia, oral lichen planus and erythroplakia. The increase in WNT inhibitory proteins along with inflammatory factors cause bone loss in periapical lesions, such as chronic apical periodontitis. This review discusses the molecular genetics of potentially malignant oral lesions, sheds light on our understanding of WNT/-catenin signalling in bone loss pertaining to periapical lesions, and alteration of this pathway for therapeutic benefits.


Assuntos
Neoplasias Bucais , Via de Sinalização Wnt , Doenças Ósseas , Carcinogênese , Humanos , Doenças da Boca , Doenças Periapicais
7.
Biomed Res Int ; 2019: 1271492, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31662968

RESUMO

Objectives: This study aimed to assess the effect of zoledronic acid on an immunocompromised mice model with periapical disease. Materials and Methods: Thirty C57BL/6N mice were randomly divided into three groups (N = 10). All animals were subjected to bilateral ovariectomy (OVX) and then treated with saline (Veh), zoledronic acid (ZA), or concomitant zoledronic acid and dexamethasone (ZA/Dx) for 12 weeks. Eight weeks after starting drug administration, pulpal exposure was conducted on the lower left first molar. Four weeks after pulpal exposure, all mice were sacrificed and the mandibles were collected for radiological and histological examinations. Results: Microcomputed tomography (µ-CT) examination showed significantly reduced periapical bone resorption in the ZA/Dx group and decreased periodontal bone resorption in both ZA and ZA/Dx groups. Higher bone mineral density (BMD) and strengthened microstructure were found in ZA and ZA/Dx groups. More empty lacunae were found in ZA and ZA/Dx groups. Conclusions: Apical periodontitis aggravates MRONJ under immunocompromised circumstances. Concurrent use of ZA and steroids inhibits alveolar bone resorption but increases the risk of developing MRONJ.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Doenças Periapicais/tratamento farmacológico , Ácido Zoledrônico/uso terapêutico , Perda do Osso Alveolar/diagnóstico por imagem , Perda do Osso Alveolar/tratamento farmacológico , Perda do Osso Alveolar/patologia , Animais , Densidade Óssea/efeitos dos fármacos , Dexametasona/farmacologia , Modelos Animais de Doenças , Feminino , Mandíbula/efeitos dos fármacos , Camundongos , Camundongos Endogâmicos C57BL , Dente Molar/efeitos dos fármacos , Osteonecrose/tratamento farmacológico , Ovariectomia , Doenças Periapicais/diagnóstico por imagem , Doenças Periapicais/patologia , Microtomografia por Raio-X
8.
J Endod ; 45(11): 1307-1313, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31543274

RESUMO

INTRODUCTION: The objective of this long-term study was to evaluate radiographic healing in cone-beam computed tomographic (CBCT) scans taken 1 and 5 years after apical surgery. METHODS: In the context of a prospective clinical study, postsurgical CBCT scans were taken 1 and 5 years after apical surgery. Three calibrated observers independently assessed buccolingual CBCT images oriented along the longitudinal axis of the treated roots. Radiographic periapical healing was categorized as "fully, partially, or not healed" for each of the following study parameters: the resection plane, the cortical plate, the apical area, and the overall bone healing. The analysis included the interobserver agreement (Fleiss kappa values), the comparison of 5- and 1-year ratings, and the changes of healing categories from 1-5 years (McNemar-Bowker tests). Data were analyzed statistically for the detection of significant differences. RESULTS: CBCT images of 41 teeth (in 41 patients) with 47 treated roots were evaluated. At 5 years, all studied parameters had higher rates of fully healed cases compared with the rate at 1 year. The resection plane and apical area parameters each were judged in 72.3% as fully healed at 5 years, whereas the cortical plate and overall bone healing parameters showed clearly lower fully healed rates (42.6% and 38.3%, respectively). Fully healed cases at 1 year remained so at 5 years in 87.5%-100% depending on the study parameter. CONCLUSIONS: This 5-year CBCT follow-up study of apical surgery showed a marked improvement of radiographic healing from 1-5 years but to a varying degree regarding the different study parameters. Although new hard tissue formation at the resection plane and within the former apical defect was advanced in most cases at 5 years, the reestablishment of the cortical bone plate clearly lagged behind.


Assuntos
Tomografia Computadorizada de Feixe Cônico , Doenças Periapicais , Tomografia Computadorizada por Raios X , Ápice Dentário , Seguimentos , Humanos , Doenças Periapicais/cirurgia , Estudos Prospectivos , Ápice Dentário/cirurgia
9.
J Endod ; 45(9): 1114-1118, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31280911

RESUMO

INTRODUCTION: Acute and chronic apical abscesses are 2 dramatic ways that periradicular tissues may react to pulpal infection and necrosis. Although both of these clinical states are the response to pulpal infection, their clinical manifestations are significantly different. It is not clear why the body responds to root canal infection in one way or another. The objective of this study was to evaluate the size and pattern of bone loss in patients with acute apical abscess (AAA) and chronic apical abscess (CAA) using cone-beam computed tomographic images. METHODS: Twenty-three cone-beam computed tomographic images of cases with AAA and 25 cases with CAA were selected and evaluated. The presence and location of fenestration and the volume and pattern of the periradicular lesions were recorded and compared between the 2 groups using the Fisher exact and Mann-Whitney U tests. RESULTS: One hundred percent of cases with CAA had cortical fenestration, but only 47% of cases with AAA had cortical fenestration (P < .05). The median volume of the lesions was 233 mm3 in the CAA group and 109 mm3 in the AAA group (P > .05). CAA cases, in comparison with the AAA group, had a relatively larger cortical disruptions. CONCLUSIONS: Cortical fenestration is fundamental for the development of CAA. However, periradicular lesions without evident cortical fenestration can still cause AAA and fascial space involvement.


Assuntos
Abscesso , Doenças da Polpa Dentária , Doenças Periapicais , Periodontite Periapical , Abscesso/diagnóstico por imagem , Osso e Ossos , Tomografia Computadorizada de Feixe Cônico , Humanos , Periodontite Periapical/diagnóstico por imagem , Tratamento do Canal Radicular
10.
Br Dent J ; 227(2): 101-111, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31350492

RESUMO

Modern endodontic microsurgery has a high reported success rate of up to 93.5%, making it a viable treatment option in the management of periapical disease when orthograde root treatment is not possible or inappropriate. This high success rate is intimately related to advanced techniques that have allowed practitioners to overcome historical barriers to the success seen in traditional surgical endodontics. When comparing traditional root-end surgery and endodontic microsurgery there are key differences when considering the flap design, access armamentarium, size of osteotomy, instruments used and root-end material. This paper highlights such key differences and advises practitioners on the techniques and instruments used to achieve high success rates, firmly establishing non-surgical endodontic treatment as an important treatment option in well-selected cases.


Assuntos
Procedimentos Cirúrgicos Bucais , Doenças Periapicais , Humanos , Microcirurgia , Tratamento do Canal Radicular
11.
Int Endod J ; 52(12): 1789-1796, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31342526

RESUMO

AIM: To describe a case of autotransplantation nine weeks after the extraction of a hopeless tooth with a large periradicular lesion, which enabled the healing of the recipient site. SUMMARY: A 19-year-old male in generally good health was referred for evaluation of tooth 46. Clinically, there were class III mobility and sensitivity to percussion and palpation. There was a mesio-lingual swelling and a single narrow deep pocket of 15 mm at the disto-lingual aspect. CBCT imaging revealed a radiolucent area over 15 mm in diameter that extended from the mesial aspect of the mesial root of tooth 47 to the distal aspect of tooth 45. The radiolucent area was in proximity to the inferior alveolar canal and penetrated the buccal and the lingual cortical plates. The tooth was diagnosed with previously treated tooth, acute apical abscess and vertical root fracture. Tooth 46 was extracted, and a delicate curettage and drainage were performed. Nine weeks afterwards, a second surgery was performed: extraction of the impacted immature third molar (tooth 48). Immediately after the extraction, the tooth was replanted in the healing socket of tooth 46, and sufficient initial stability achieved. At a 1-year follow-up, the tooth had normal mobility, no sensitivity to palpation and percussion, and responded to thermal pulp testing. The soft tissue was normal, probing depths up to 3-mm, without swelling or sinus tract. Radiographically, periapical healing at the recipient site was observed. Compared to the post-operative periapical radiography immediately after the procedure, there was no change in the distal root dimensions. In the mesial root, development of the root length and a closed apex was demonstrated.


Assuntos
Doenças Periapicais , Dente Impactado , Adulto , Humanos , Masculino , Dente Serotino , Raiz Dentária , Transplante Autólogo , Adulto Jovem
12.
J Endod ; 45(2): 116-122, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30711166

RESUMO

INTRODUCTION: The aim of this study was to determine the prognostic factors of periapical healing of teeth after single-visit nonsurgical endodontic treatment under general anesthesia in special needs patients. METHODS: This retrospective study collected 448 teeth from 241 patients (mean age = 27.4 years, standard deviation = 13.9 years). A total of 271 teeth (60.5%) with clinical and radiographic follow-up records longer than 12 months (mean [standard deviation] = 56.1 [27.9]) were included in the outcome analysis. Demographic, systemic, and dental information about the cases were compared between the healed and nonhealed groups using the Pearson chi-square test. Factors contributing to periapical healing were determined with multivariate logistic regression analysis. RESULTS: Complete periapical healing without clinical signs was observed in 221 teeth (81.5%), uncertain healing with decreased size of the periapical lesion was shown in 43 teeth (15.9%), and no reduction in lesion size was observed in 7 cases (2.6%). In the multivariate analysis, diet type, oral hygiene maintenance, pulp vitality, and root filling length were detected as contributing factors for complete resolution of periapical lesions (P < .05). CONCLUSIONS: Successful outcomes of single-visit endodontic treatment under general anesthesia were shown in special needs patients. The prognoses were influenced by the clinical circumstances of the patients and the preoperative conditions of their teeth.


Assuntos
Anestesia Geral , Transtornos da Comunicação , Deficiência Intelectual , Doenças Periapicais/fisiopatologia , Doenças Periapicais/cirurgia , Tratamento do Canal Radicular , Ápice Dentário/fisiopatologia , Cicatrização , Adolescente , Adulto , Dieta , Feminino , Seguimentos , Humanos , Masculino , Higiene Bucal , Prognóstico , Estudos Retrospectivos , Inquéritos e Questionários , Fatores de Tempo , Adulto Jovem
13.
J Endod ; 45(2): 168-173, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30711173

RESUMO

INTRODUCTION: Nuclear factor kappa B (NF-κB) is an important transcriptional regulator of angiogenesis involving B-cell lymphoma 2 (Bcl-2) and Bcl-2-associated X protein (Bax) signaling pathways. Thus, inhibition of NF-κB may suppress the development of periapical lesions via blockage of angiogenesis. Accordingly, we examined the effects of NF-κB decoy oligodeoxynucleotide (ODN) treatment on experimentally induced periapical lesions. METHODS: Periapical lesions were induced in the mandibular first molars of 5-week-old male Wistar rats by the application of lipopolysaccharide to the pulp. NF-κB decoy ODN or NF-κB decoy scramble (control) was injected intraperitoneally every 7 days, starting 1 day before pulp exposure. After 28 days, the samples were retrieved, and digital radiographs were taken for radiomorphometry. Samples were processed for (1) immunohistochemistry of CD31, Bcl-2, and Bax; (2) laser capture microdissection to analyze Bcl-2, Bax, chemokine (C-X-C motif) ligand 1 (CXCL1), CXC receptor 2 (CXCR2), and vascular endothelial cell growth factor receptor 2 (VEGFR2) messenger RNA (mRNA) expression in CD31+ endothelial cells; (3) enzyme-linked immunosorbent assay to determine NF-κB/p65 activity; and (4) Western blotting for vascular endothelial growth factor expression. RESULTS: NF-κB decoy ODN treatment significantly reduced lesion size, NF-κB/p65 activity, and the density of CD31+ endothelial cells in the lesion. NF-κB decoy ODNs also down-regulated CXCL1, CXCR2, and VEGFR2 mRNAs and up-regulated Bax mRNA in endothelial cells but did not affect Bcl2 mRNA in endothelial cells. Vascular endothelial growth factor protein expression in the lesions was significantly decreased. CONCLUSIONS: The inhibition of NF-κB activity by decoy ODN treatment suppressed the development of experimentally induced periapical lesions with a concomitant reduction in angiogenic responses in endothelial cells.


Assuntos
NF-kappa B/antagonistas & inibidores , Oligodesoxirribonucleotídeos/administração & dosagem , Oligodesoxirribonucleotídeos/farmacologia , Doenças Periapicais/genética , Doenças Periapicais/prevenção & controle , Animais , Injeções Intraperitoneais , Lipopolissacarídeos/efeitos adversos , Masculino , NF-kappa B/metabolismo , Neovascularização Patológica/genética , Doenças Periapicais/induzido quimicamente , Ratos Wistar
14.
J Endod ; 45(2): 89-93, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30711183

RESUMO

INTRODUCTION: The aim of this study was to evaluate the efficacy of 2 hemostatic agents in periapical surgery and its relationship with patient- and tooth-dependent variables. METHODS: A prospective study was designed with 2 randomized parallel groups established according to the hemostatic agent used: aluminum chloride or electrocauterization. The surgeon and 2 independent blinded observers examined the initial and final bleeding and recorded it as 0 (no hemorrhage control), 1 (slight but apparent intermittent bleeding), or 2 (complete hemorrhage control). The following patient- and tooth-dependent variables were collected: sex, age, smoking habit, plaque index, and position. RESULTS: Sixty patients with a periapical lesion in the esthetic zone were enrolled in this study and divided into 2 groups of 30 patients. In the aluminum chloride group, complete hemorrhage control was achieved in 24 patients, and in the electrocauterization group, it was achieved in 18 patients (P < .05). A relationship between sex and the effectiveness of hemostasis was found; a female patient increases the possibility of achieving complete hemorrhage control. CONCLUSIONS: Hemorrhage control was better in the aluminum chloride group than in the electrocauterization group as well as in female patients compared with male patients.


Assuntos
Cloreto de Alumínio/administração & dosagem , Eletrocoagulação , Hemostasia Cirúrgica/métodos , Hemostáticos/administração & dosagem , Doenças Periapicais/cirurgia , Adulto , Endodontia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores Sexuais , Resultado do Tratamento
15.
J Endod ; 45(4): 402-405, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30770280

RESUMO

INTRODUCTION: Currently, the success of periapical microsurgery is determined by the restoration of the lamina dura and the elimination of symptoms. However, inadequate site preservation may prevent later implant placement. Although not possible before, the advent of cone-beam computed tomographic imaging and computer-aided registration allows for indirect and accurate 3-dimensional analysis of the surgical site over time. This study analyzed the volumetric healing pattern of the buccal plate after periapical microsurgery, with a specific focus on the buccolingual thickness of bone and the regression of the surface contour of the cortical plate. METHODS: Thirty-seven patients were scheduled for follow-up at least 1 year after periapical microsurgery (median = 25 months, total range = 12-31 months). Volumetric healing was analyzed by converting preoperative and postoperative cone-beam computed tomographic images into digital 3-dimensional models. The models were then registered to be able to analyze the changes in volume over time. Analysis was completed using Geomagic software (3D Systems, Rock Hill, SC), which allowed for registration of the volumes, calculation of volume change, and calculation of the margin of error. RESULTS: Twelve cases qualified for volumetric analysis. The median volumetric reduction of the cortical plate was -24.9 mm3 (interquartile range = -8.94 to -67 mm3), with an average linear error of 0.7 mm. This corresponded to an average loss in buccolingual dimension of 0.1-0.25 mm. Regression of the cortical plate was within the margin of error in all cases. CONCLUSIONS: After periapical microsurgery, and in the absence of grafting materials or membranes, healing occurs with little to no regression of the buccal cortical plate.


Assuntos
Tomografia Computadorizada de Feixe Cônico/métodos , Imageamento Tridimensional/métodos , Maxila/diagnóstico por imagem , Microcirurgia/métodos , Doenças Periapicais/diagnóstico por imagem , Doenças Periapicais/cirurgia , Radiografia Dentária/métodos , Cicatrização , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Maxila/anatomia & histologia , Maxila/fisiopatologia , Pessoa de Meia-Idade , Doenças Periapicais/fisiopatologia , Fatores de Tempo , Adulto Jovem
16.
Compend Contin Educ Dent ; 40(1): 27-31; quiz 32, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30601019

RESUMO

Maintaining dental pulp vitality should be among the clinical goals of any restorative treatment. By obtaining a pretreatment pulpal and periradicular diagnosis before performing restorative treatment, the clinician will be better able to proceed with treatment of the pulp, especially if it is exposed during caries excavation. A pretreatment pulpal and periapical diagnosis may be effectively attained by performing five objective clinical tests: pulp sensibility, percussion (which may include bite testing), palpation, periodontal probing/ tooth mobility, and updated radiography. This article provides a description of these five clinical tests and gives an overview of current terminologies used when obtaining a pulpal and periradicular diagnosis.


Assuntos
Doenças da Polpa Dentária/diagnóstico , Doenças Periapicais/diagnóstico , Restauração Dentária Permanente , Humanos
17.
Acta Odontol Scand ; 77(1): 49-54, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30156125

RESUMO

OBJECTIVE: The standard imaging techniques used in dentistry consist of two-dimensional radiographic techniques like intraoral periapical (PA) radiographs, bitewings or extraoral panoramic X-rays. Three-dimensional methods, such as cone beam computed tomography (CBCT), are not standard procedures. In several fields of dentistry, such as oral surgery or implantology, dental magnetic resonance imaging (DMRI), a technique without radiation exposure, has already been introduced as a new promising diagnostic tool. The aim of this study was to compare the agreement of DMRI and PA radiographs in measuring residual periodontal bone support. MATERIAL AND METHODS: In this study, the residual periodontal bone support of 21 teeth was investigated and compared with DMRI and PA radiographs by two independent raters. Intra-class correlation coefficients (ICCs) were calculated using the software R to identify the intra-rater and inter-rater agreement of the two modalities. Bland-Altman plots were created to directly compare the two methods. RESULTS: Overall, all calculated ICC values showed an excellent intra-rater and inter-rater agreement (>0.9) for DMRI, as well as PA radiographs. Bland-Altman analysis also showed a strong agreement between both diagnostic methods in this study. CONCLUSIONS: In conclusion, there was a strong agreement between DMRI and PA. Thus, DMRI proved to be a comparable method to PA radiographs for evaluating the proportion of residual periodontal bone support.


Assuntos
Radiografia Dentária Digital/métodos , Doenças Dentárias/diagnóstico por imagem , Tomografia Computadorizada de Feixe Cônico/métodos , Cárie Dentária/diagnóstico por imagem , Humanos , Arcada Osseodentária/diagnóstico por imagem , Imagem por Ressonância Magnética , Doenças Periapicais/diagnóstico por imagem , Radiografia Panorâmica/métodos
18.
Int Endod J ; 52(4): 484-490, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30341803

RESUMO

AIM: To determine the prevalence of cholesterol crystals in periapical biopsies and to evaluate the correlation between cholesterol crystals in periapical biopsies and age, gender, location of the periapical lesion, pathologic diagnosis and lesion size. METHODOLOGY: The biopsy report database (Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand) during 2005-2014 was reviewed. The prevalence of cholesterol crystals in the periapical lesions of root filled teeth was determined. Pathological diagnosis, patients' age, gender and the location (maxilla or mandible) of the periapical lesion were obtained from treatment records. The area of the lesion from the periapical radiograph before surgery was calculated using ImageJ software. Univariate and multivariate logistic regression analyses were used to determine the association between independent variables and the presence of cholesterol crystals. RESULTS: The overall prevalence of cholesterol crystals was 20.31%. The periapical biopsies >100 mm2 in size on periapical films had a significantly greater prevalence of cholesterol crystals than those <100 mm2 (P = 0.005). The biopsies diagnosed as radicular cysts had a significantly greater prevalence of cholesterol crystals than the biopsies with other diagnoses (P < 0.001). A pathological diagnosis of radicular cyst was the variable with the strongest association with the presence of cholesterol crystals (P < 0.001; adjusted OR, 12.39). CONCLUSIONS: Presence of cholesterol crystals was associated with periapical lesion diagnosed as a radicular cyst and lesion >100 mm2 in area. Age, gender and location of the lesion did not influence the presence of cholesterol crystals.


Assuntos
Doenças Periapicais , Cisto Radicular , Colesterol , Humanos , Obturação do Canal Radicular , Tailândia
19.
Pharmacol Rep ; 71(1): 24-31, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30366345

RESUMO

BACKGROUND: A periodontal lesion is a consequence of chronic inflammatory processes, itself triggered by a bacterial infection of the pulpal and endodontic microenvironment. Evidence suggests that periodontal lesion induction could alter inflammatory cytokines leading to behavior changes. These effects in the context of anxiety and depressive behavior have been not full investigated. We aimed to observe anxiety- and depressive-like behavioral in rodent subjected to periapical dental lesions. METHODS: Pro-inflammatory cytokines levels also were investigated in the frontal cortex and hippocampus. Parameters related to hypothalamic-pituitary-adrenal (HPA) axis activation also were evaluated. Wistar rats were divided in groups: control/saline; control/imipramine; periapical lesion/saline; and periapical lesion/imipramine. Three weeks after induction of the periapical dental lesion, they were subjected to behavioral tests. RESULTS: In the periapical lesion group was demonstrated anhedonic behavior and depressive-like behavior. In the elevated plus-maze test the periapical lesion group had an increase in the number of entries and spent more time in the closed arms. Imipramine treatment was able to reverse depressive- and anxiety-like behaviors. In the hippocampus and frontal cortex tumor necrosis factor-α (TNF-α), interleukin-1ß (IL-1ß), IL-6, and serum adrenocorticotropic hormone (ACTH) levels were higher in the periapical lesion group. However, rats treated with imipramine had lower IL-1ß and ACTH levels. CONCLUSIONS: Our results revealed depressive- and anxiety-like behaviors following induction of a specific dental lesion. These effects could be associated to higher levels of brain pro-inflammatory cytokines and HPA axis changes. Antidepressants treatments could be an alternative to treat comorbidities associated to periodontal lesions.


Assuntos
Hormônio Adrenocorticotrópico/metabolismo , Antidepressivos Tricíclicos/farmacologia , Ansiedade/tratamento farmacológico , Comportamento Animal/efeitos dos fármacos , Encéfalo/efeitos dos fármacos , Depressão/tratamento farmacológico , Imipramina/farmacologia , Mediadores da Inflamação/metabolismo , Interleucina-1beta/metabolismo , Doenças Periapicais/complicações , Animais , Ansiedade/etiologia , Ansiedade/metabolismo , Ansiedade/psicologia , Encéfalo/metabolismo , Encéfalo/fisiopatologia , Depressão/etiologia , Depressão/metabolismo , Depressão/psicologia , Modelos Animais de Doenças , Comportamento Alimentar/efeitos dos fármacos , Masculino , Aprendizagem em Labirinto/efeitos dos fármacos , Atividade Motora/efeitos dos fármacos , Doenças Periapicais/metabolismo , Ratos Wistar
20.
J Oral Maxillofac Surg ; 77(1): 71-86, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30218655

RESUMO

PURPOSE: Medication-related osteonecrosis of the jaw (MRONJ) is a rare but severe side effect of antiresorptive medications. Most animal models use tooth extraction as an instigating local factor to induce MRONJ, with varied results. However, these teeth are healthy and absent of dental disease, a rare finding that does not reflect clinical practices. The authors hypothesized that extraction of teeth with periapical inflammation would lead to MRONJ in rats treated with high-dose bisphosphonates. MATERIALS AND METHODS: Rats were pretreated with zoledronic acid (ZA) for 1 week. Pulp exposure (PE) was established by exposing the pulpal chamber of the first and second molars. Experimental periapical disease (EPD) was induced by PE and bacterial inoculation into pulp chambers of the first and second mandibular molars. The mandibular molars were extracted 4 weeks after PE or EPD, and animals were euthanized 4 weeks after tooth extraction. Extraction sockets were assessed clinically, radiographically, and histologically. RESULTS: Clinically, radiographically, and histologically, socket healing was observed in all vehicle-treated animals and in ZA-treated animals after extraction of healthy teeth or teeth with PE. In contrast, bone exposure, lack of socket healing, and osteonecrosis were present in most ZA-treated animals after extraction of teeth with EPD. Bacterial presence was noted in areas of osteonecrotic alveolar bone. CONCLUSION: These data support a synergistic contribution of severe dental disease and tooth extraction to MRONJ pathogenesis. Importantly, this model is amenable to manipulation of methodologic conditions for the dissection of parameters involved in MRONJ pathogenesis.


Assuntos
Osteonecrose da Arcada Osseodentária Associada a Difosfonatos , Doenças Periapicais , Animais , Conservadores da Densidade Óssea , Difosfonatos , Masculino , Ratos , Ratos Wistar , Extração Dentária
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