The extended finite element method in endodontics: A scoping review and future directions for cyclic fatigue testing of nickel-titanium instruments.

OBJECTIVES: The present study reviews the current literature regarding the utilization of the extended finite element method (XFEM) in clinical and experimental endodontic studies and the suitability of XFEM in the assessment of cyclic fatigue in rotary endodontic nickel-titanium (NiTi) instruments. MATERIAL AND METHODS: An electronic literature search was conducted using the appropriate search terms, and the titles and abstracts were screened for relevance. The search yielded 13 hits after duplicates were removed, and four studies met the inclusion criteria for review. RESULTS: No studies to date have utilized XFEM to study cyclic fatigue or crack propagation in rotary endodontic NiTi instruments. Challenges such as modelling material inputs and fatigue criteria could explain the lack of utilization of XFEM in the analysis of mechanical behavior in NiTi instruments. CONCLUSIONS: The review showed that XFEM was seldom employed in endodontic literature. Recent work suggests potential promise in using XFEM for modelling NiTi structures.

Microrobotics in endodontics: A perspective.

Microorganisms are the primary aetiological factor of apical periodontitis. The goal of endodontic treatment is to prevent and eliminate the infection by removing the microorganisms. However, microbial biofilms and the complex root canal anatomy impair the disinfection process. Effective and precise endodontic therapy could potentially be achieved using advanced multifunctional technologies that have the ability to access hard-to-reach surfaces and perform simultaneous biofilm killing, removal, and detection of microorganisms. Advances in microrobotics are providing novel therapeutic and diagnostic opportunities with high precision and efficacy to address current biofilm-related challenges in biomedicine. Concurrently, multifunctional magnetic microrobots have been developed to overcome the disinfection challenges of current approaches to disrupt, kill, and retrieve biofilms with the goal of enhancing the efficacy and precision of endodontic therapy. This article reviews the recent advances of microrobotics in healthcare and particularly advances to overcome disinfection challenges in endodontics, and provides perspectives for future research in the field.

Tratamento endodôntico em dente permanente traumatizado com rizogênese incompleta: relato de caso / Endodontic treatment in permanent traumatised tooth with incomplete rhizoganis: case report / Tratamiento endodóntico en diente permanente traumatizado con rizoganis incompleta: presentación de un caso

Os traumatismos dentários representam um problema de saúde pública devido à alta prevalência e impacto psicossocial, sendo muito frequentes em crianças podendo resultar em necrose pulpar e culminar na rizogênese incompleta de dentes permanentes. Nestes casos de traumatismos em dentes permanentes com rizogênese incompleta e necrose pulpar, o tratamento mais indicado pela literatura é a apicificação, sendo um tratamento complexo e longo. Considerando a importância deste tema, o objetivo deste trabalho é relatar o caso de um paciente com traumatismo dental e necrose pulpar, que acarretou a interrupção do desenvolvimento completo e adequado do ápice dentário, sendo necessária a intervenção por meio da técnica de apicificação e o acompanhamento a longo prazo. O caso trata-se de uma menina em que um traumatismo dentário acarretou fratura de um incisivo central superior com formação radicular incompleta, comprometendo tanto a estética quanto a vitalidade do dente. Foi realizado o tratamento endodôntico com apicificação e posteriormente ao plug apical de MTA. O dente foi restaurado definitivamente com resina composta e realizado acompanhamento do paciente. Nas consultas de acompanhamento houve ausência de sintomatologia dolorosa e satisfação da paciente com a aparência atual. Sendo assim, a apicificação apresenta-se como uma ótima alternativa para dentes com rizogênese incompleta e necrose pulpar, embora longo houve uma melhora estética e satisfação do paciente.

Dental trauma represents a public health problem due to its high prevalence and psychosocial impact, being very frequent in children and can result in pulp necrosis and culminate in incomplete root formation of permanent teeth. In these cases of trauma to permanent teeth with incomplete root formation and pulp necrosis, the most indicated treatment in the literature is apexification, which is a complex and long treatment. Considering the importance of this topic, the objective of this work is to report the case of a patient with dental trauma and pulp necrosis, which caused the interruption of the complete and adequate development of the dental apex, requiring intervention through the apexification technique and follow-up. long-term. The case is about a girl in which a dental trauma resulted in a fracture of a maxillary central incisor with incomplete root formation, compromising both the esthetics and the vitality of the tooth. Endodontic treatment was performed with apexification and then apical MTA plug. The tooth was definitively restored with composite resin and the patient was followed up. In the follow- up consultations, there was no painful symptomatology and the patient was satisfied with her current appearance. Thus, the apexification presents itself as a great alternative for teeth with incomplete root formation and pulp necrosis, although in the long run there was an aesthetic improvement and patient satisfaction.

Los traumatismos dentales representan un problema de salud pública debido a su alta prevalencia e impacto psicosocial, siendo muy frecuentes en niños y pudiendo dar lugar a necrosis pulpar y culminar en la formación incompleta de la raíz de los dientes permanentes. En estos casos de traumatismos en dientes permanentes con formación radicular incompleta y necrosis pulpar, el tratamiento más indicado en la literatura es la apexificación, que es un tratamiento complejo y largo. Considerando la importancia de este tema, el objetivo de este trabajo es relatar el caso de una paciente con traumatismo dentario y necrosis pulpar, que causó la interrupción del desarrollo completo y adecuado del ápice dentario, requiriendo intervención a través de la técnica de apexificación y seguimiento. a largo plazo. Se trata de una niña en la que un traumatismo dental provocó la fractura de un incisivo central maxilar con formación radicular incompleta, comprometiendo tanto la estética como la vitalidad del diente. Se realizó tratamiento endodóntico con apexificación y posterior taponamiento apical con MTA. El diente fue restaurado definitivamente con resina compuesta y el paciente fue sometido a seguimiento. En las consultas de seguimiento, no había sintomatología dolorosa y la paciente estaba satisfecha con su aspecto actual. Así, la apexificación se presenta como una gran alternativa para dientes con formación radicular incompleta y necrosis pulpar, aunque a la larga se produjo una mejoría estética y satisfacción de la paciente.

Mechanical properties and metallurgical features of two similar endodontic rotary instruments with different heat treatments (FireWire™ and Gold).

The aim of this study was to explain the mechanical differences between EdgeTaper Platinum (ETP) and ProTaper Gold (PTG) determining the transition temperatures and the composition of the alloy of ETP, since no data are present in literature. A total of 130 instruments were selected: 65 ETP F2 and 65 PTG F2. 20 instruments per type were submitted to each mechanical tests. The cyclic fatigue and torsional tests were performed at a pre-set temperature of 35 °C ± 1 °C. During the cyclic fatigue test, Time to fracture, number of cycles to fracture (NCF) and the fragment length (FL) were recorded. During the static torsional, Torque to Fracture (TtF) and FL were recorded. The fracture surface of 5 randomly selected fragments from each test was examined through a Scanning Electron Microscopy (SEM) and an EDX analysis was performed. 20 instruments per type were submitted to a bending test The force generated (grams) to bend each was recorded. Recorded data of mechanical and metallurgical tests were statistically analyzed using a one-way analysis of variance (ANOVA) test with significance set to a 95% confidence level. ETP F2 showed a higher cyclic fatigue resistance and bending ability than PTG F2, with a statistically significant difference (p < 0.05). PTG showed a higher torsional resistance with a statistically significant difference (p < 0.05). DSC analysis of 5 samples for each instrument type pointed out that the austenite finish temperature of PTG was higher than the ETP, respectively of 49.99 ± 3.31 (°C) and 38.92 ± 1.75 (°C). EDX analysis confirmed the near-equiatomic composition of the Ni-Ti alloys, with a presence of a third component recognized as rubidium in the ETP samples. ETP showed higher flexibility in comparison with PTG, despite the latter is characterized by a more martensitic characterization. since its Af temperature is higher than the ETP.

Brazilian advanced specialty programs in endodontics: characteristicsand distribution / Cursos de especialização em endodontia no Brasil: características e distribuição

The existence of several Endodontics specialty programs in Brazil is known. However, there was no precise information regarding their geographic distribution, duration, workloadandthe profiles of the program's directors. There was also no meanstodetermineif the requirements defined by the country's legal bodies were fulfilled by the institutions.The present cross-sectionalstudy was conductedto bring together characteristics and peculiarities of all Brazilian endodontics advanced specialty programs, searching for information on the regulatory-agencies webpages and other venues. We searched the Ministry of Education'swebsite to locateinformation such as geographical location, duration (months), number of hours, and program director professional degreeprofile.Program's homepages were searched to collect additional information­frequency, periodicity, costs, number of faculties. The searcheswere made between August 2019 and October 2019,identifying 505 registered programs and 117specific program's websites. It was observed that 39% of the programsare in the Southeast regionand 61.2% have a duration of 24 months. Additionally, a majority of the program's directorswere male, accounting for 69.1% of the sample. The most common highest qualification held by themwas a Masters' degree(45.1%).Regarding the 117programs that had specific websites,they presented insufficient information, for instance:the frequency was only reported in 81 programs/websites, the number of teachersonlyin 51,andtotal feesonlyin 65. It wasconcluded that there arevarious Endodontic specialization programs in Brazil, benefiting the different students' profiles. Also, there is alack of clear information on some programs (AU).

Sabe-se da existência de diversos cursos de especialização em Endodontia no Brasil. Porém, não havia informações precisas acerca da distribuição geográfica, duração, carga horária e perfil dos diretores dos cursos. Também não havia formas de determinar se as exigências definidas pelos órgãos legais do país estavam sendo cumpridas. O presente estudo transversal foi conduzido para reunir características e peculiaridades de todos os cursos de especialização em Endodontia no Brasil, buscando informações nos sitesdas agências reguladoras e em outras fontes. Buscou-se o site do Ministério de Educação para encontrar informações quanto à localização geográfica, duração (em meses), número de horas e perfil profissional do(a) coordenador(a) do curso. Os sites dos cursos foram pesquisados para coleta de informações adicionais ­frequência, periodicidade, custos, número de professores. As buscas ocorreram entre agosto e outubro de 2019, identificando 505 cursos registrados e 117 sitesespecíficos desses cursos. Observou-se que 39% dos cursos localizam-se na região Sudeste e 61,2% têm uma duração de 24 meses. Ainda, a maioria dos coordenadores são do sexo masculino, somando 69,1% da amostra. A maior qualificação entre eles foi o título de Mestre (45,1%). Em relação aos 117 cursos que possuíam sitesespecíficos, as informações apresentadas foram insuficientes: a frequência foi informada apenas em 81 programas/sites, o número de professores apenas em 51 e o total de mensalidades apenas em 65. Conclui-se que há uma grande quantidade de cursos de Endodontia no Brasil, beneficiando os diferentes perfis dos estudantes. Ainda, há uma falta de informação clara sobre alguns cursos (AU).

An Appraisal on Newer Endodontic File Systems: A Narrative Review.

AIM: This narrative review aims to explore and elicit the newer endodontic file systems used for root canal treatments. BACKGROUND: The primary goals of endodontic therapy continue to be the mechanical enlargement and shaping of the intricate endodontic root canal systems to aid in disinfection. Nowadays endodontists have access to a wide range of endodontic file systems for root canal preparations with various design characteristics and benefits. REVIEW RESULTS: ProTaper Ultimate (PTU) files' tip have a triangular convex cross-section, an offset mass of rotating design, a maximum flute diameter of 1.0 mm, and are constructed of gold wire, hence, commonly applied in conditions with restricted accessibility or an extremely curved canal. TruNatomyhas advantages over other cutting-edge file systems like maximum flute diameter of the corona, reduced distance between active cutting flutes, and shorter handles in comparison to SX instruments. In comparison to PTU files, ProTaper Gold (PTG) files are noticeably more elastic and fatigue-resistant. Compared to files in the F1-F3 range, size S1 and S2 files have a significantly longer fatigue life. MicroMega One RECI is more resistant to cyclic fatigue because of its heat treatment and reciprocating action and the C-wire heat treatment of the former gives it flexibility and controlled memory, enabling the prebending of the file. The RECIPROC blue demonstrated enhanced flexibility, increased fatigue resistance, and lower microhardness while maintaining the same surface qualities. CONCLUSION: As per the necessity and requirement on case to case basis, every endodontic file system has advantages and disadvantages as mentioned in this narrative review. According to the need, an endodontist can select the file system which is required specifically. Although several studies are comparing these various systems in the literature, this narrative review aims to give the clinician a summary of some recently launched endodontic rotary file systems available in the market and their clinical uses. CLINICAL SIGNIFICANCE: As per the priority and need of the case, whether removal and extrusion of debris, reduction of micro-organisms, keeping canal anatomy, and cutting efficiency, a specific required file system can be utilized.

Tempo e resultados biomecânicos da instrumentação endodôntica rotatória comparada a manual em protótipos de molares decíduos: estudo in vitro / Time and biomechanical results of rotary endodontic instrumentation compared to manual in deciduous molar prototypes: in vitro study

Objetivou-se elaborar um e-book aos cirurgiões-dentistas sobre as opções de sistema de instrumentação endodôntica para dentes decíduos e comparar os resultados biomecânicos de diferentes sistemas e seu tempo de preparo em protótipos de dentes decíduos por meio de uma análise em micro-CT. Para isso, foram realizados dois estudos. No primeiro, realizou-se uma busca bibliográfica em seis bases de dados por estudos laboratoriais e clínicos sobre protocolos de pulpectomia utilizando pelo menos uma técnica de instrumentação. Dados a respeito das características, cinemática, benefícios e orientações à cerca da utilização de acordo com as instruções dos fabricantes foram extraídos para elaboração do conteúdo teórico e diagramação do layout do e-book, confeccionado no programa Canva. Após finalizado, o mesmo foi avaliado por três pós-graduandos da Disciplina de Odontopediatria da FOUFRJ e as sugestões foram incorporadas. Elaborou-se o material intitulado ''Guia ilustrado de instrumentação endodôntica para dentes decíduos'' contendo 43 páginas, abordando 13 sistemas de instrumentação, com sequências ilustradas de protocolos para utilização. Para o segundo estudo foram utilizados 60 protótipos padronizados de segundos molares decíduos inferiores confeccionados em polímero transparente para avaliar os resultados biomecânicos da instrumentação com diferentes sistemas de limas. Foram utilizados os sistemas manual k-file e mecanizados ProTaper Nextâ (PTN), XP- Endoâ Shaper (XPS), XP- Endoâ Finisher (XPF), XP­Clean (XPC) e Sequence Baby file (SBF) (n= 10/cada). A instrumentação foi realizada por um único operador treinado e o tempo de utilização de cada sistema foi cronometrado. Realizouse a irrigação com um total de 16mL de soro fisiológico à 0,9% para cada canal instrumentado, associada a aspiração simultânea. Os protótipos foram escaneados antes e após da instrumentação através do micro-CT. A reconstrução foi padronizada os conjuntos de imagens iniciais e instrumentados foram registrados entre si. Alterações no volume do canal radicular, área não instrumentada, debris acumulados, volume de dentina removido e transporte do canal foram quantificados. Os dados foram tabulados no programa JAMOVI versão 1.6 e analisados através do teste Shapiro-Wilk para verificar a distribuição dos dados. Para distribuição normal foram realizados testes paramétricos e para aqueles que não seguiram a normalidade, testes não paramétricos foram utilizados, todos com um nível de significância de 5% (p<0,05). A instrumentação com sistemas mecanizados resultou em menos tempo de instrumentação (p< 0,001) do que com a k-file. A porcentagem de áreas não instrumentadas foi semelhante para todos os sistemas. O acúmulo de debris foi maior para K-file e XPS ao longo de todo o canal (p<0,05). Todos os grupos apresentaram aumento do volume do canal radicular após a instrumentação (p= 0,003) com valores mais elevados na lima K-file (p<0,05). A análise 3D revelou maior transporte da lima K-file. SBF e K-file apresentaram, respectivamente, o menor (0,01 ± 0,01 e 0,03 ± 0,04) e o maior (0,04 ± 0,05 e 0,32 ± 0,94) valor de transporte do canal nos protótipos. Diante das metodologias utilizadas, conclui-se que um material relevante e prático ficará disponível nas plataformas digitais da Disciplina de Odontopediatria da UFRJ, para livre acesso e ampla divulgação aos cirurgiões-dentistas. Além disso, com relação aos resultados de instrumentação mecânica, o SBF e o XPC resultaram em uma abordagem mais conservadora. A instrumentação mecânica pode levar à algum grau de transporte do canal e deixar partes das paredes do canal infectadas sem preparo mecânico. (AU)

The objective was to elaborate an e-book to dentists about the options of endodontic instrumentation system for primary teeth and to compare the biomechanical outcomes of the different systems and their instrumentation time in prototypes of primary teeth through micro-CT analysis. To this end, two studies were carried out. In developing the first, a bibliographic search was carried out in six databases. Laboratory and clinical studies with a pulpectomy protocol using at least one instrumentation technique were included. Data about features, kinematics, benefits, and guidelines on use according to the manufacturer's instructions were extracted to prepare the theoretical content and layout diagramming of the e-book using Canva software. Afterwards, it was evaluated by 3 postgraduate students of the Pediatric Dentistry Discipline-FOUFRJ and the suggestions for changes were incorporated. The product entitled 'Guia ilustrado de instrumentação endodôntica para dentes decíduos' contains 43 pages covering 13 instrumentation systems and illustrated sequence of protocols use for each. The second consists of 60 standardized prototype teeth of mandibular second primary molars made with transparent polymer to evaluate the outcomes of biomechanical instrumentation of different systems. Manual k-file, ProTaper Nextâ (PTN), XP-Endoâ Shaper (XPS), XP-Endoâ Finisher (XPF), XP ­ Clean (XPC) and Sequence Baby file (SBF) (n= 10/each) were used. The specimen instrumentation was performed by a single trained and the time spend was recorded. Irrigation was performed with a total of 16mL of 0.9% saline solution for each instrumented canal and simultaneous aspiration. The prototypes were scanned before and after the instrumentation using micro-CT. In addition, the reconstruction was standardized and initial and instrumented image sets were registered with each other. Next, changes in root canal volume, noninstrumented areas, accumulated debris, removed dentin volume and canal transportation were quantified. Data were tabulated in the JAMOVI program version 1.6 and analyzed using the Shapiro-Wilk test to verify the data distribution. For normal distribution, parametric tests were performed and that did not follow normality, nonnormal tests were used, all with a significance level of 5% (p<0.05). Instrumentation with rotary files resulted in less time-consuming (p <0.001) than manual k-file. The percentage of non-instrument areas were similar for all systems. Accumulated debris was higher for K-file and XPS along the entire canal. All groups showed an increase in root canal volume after instrumentation (p= 0.003) with higher values in K-file (p <0.05). 3D analysis revealed greater transportation in K-file. SBF and K-file showed, respectively, the lowest (0.01± 0.01 and 0.03 ± 0.04) and highest (0.04 ± 0.05 and 0.32 ± 0.94) canal transportation value in the prototypes. Given the methodology applied, it was concluded that: the didactic material will be available on the digital platforms of Pediatric Dentistry at UFRJ for free access and widespread. From the overall mechanical instrumentation outcomes, the SBF and XPC resulted in a more conservative approach. Mechanical instrumentation may lead transportation and leave preparation. (AU)

Introduction of nickel titanium rotary instruments to undergraduate students: afour-yearclinical experience / Introdução de instrumentos rotários de níquel titânio para alunos de graduação: quatro anos de experiência clínica

Many studies address the quality of root canal treatments, but few refer to endodontics usingrotatory techniques performed by noviceoperators. This study evaluatedthe performance of undergraduates in their first contact with rotary root canal instrumentation concerningthe findings of the final periapical radiograph, and thepostendodontic treatment pain.A longitudinal observational studywas performed on periapical radiographs of 491teethfrom 450 patientssubmitted toroot canal treatmentby undergraduate students from 2015 to 2018. The analysis of the length of root canal filling followed the criteria: (i) acceptable, ifperiapical radiograph presentsroot filling ending 0 -1 mm short of radiographic apex; (ii) over, if periapical radiograph presentsroot filling ending beyond the radiographic apex; and (iii) under, ifperiapical radiograph presentsroot filling ending > 1 mm short of radiographic apex. Evaluation of postendodontic treatment painwas categorized into either absence or presenceof pain. Adequate length root canal filling was observed in 65.9% of the cases (324 teeth). Periapical lesions presenceand dimensions did not interfere to the obturation quality.Statistical relation was found between the pulp condition and postendodontic treatment pain. Thepresence of pain was observed in 4.7% of the vital teeth and 0.3% of non-vital teeth. The presence of periapical lesion did not influence postoperative pain.AdequatelengthrootcanalfillingwasobservedinmostcasesandNitTi rotary instrumentation hadapplicability in undergraduate programs, even with novice operators. Besides that, pulp condition had an effect on post endodontic pain (AU).

Muitos estudos abordam a qualidade dos tratamentos de canal radicular, mas poucos se referem à endodontia por meio de técnicas rotatórias realizada por operadores novatos. Este estudo avaliou o desempenho de graduandos no primeiro contato com a instrumentação endodôntica em relação aos achados da radiografia periapical final e à dor pós-tratamento endodôntico. Um estudo observacional longitudinal foi realizado em radiografias periapicais de 491 dentes de 450pacientes submetidos a tratamento endodôntico por estudantes de graduação no período de 2015 a 2018. A análise do comprimento da obturação de canais radiculares obedeceu aos critérios: (i) aceitável, se a radiografia periapical apresentasse término de obturação 0 -1 mm aquém do ápice radiográfico; (ii) acima, se a radiografia periapical apresentasse obturação que termina além do ápice radiográfico; e (iii) abaixo, se a radiografia periapicalapresentasse obturação, terminando > 1 mm aquém do ápice radiográfico. A avaliação da dor pós-operatória foi categorizada em ausência ou presença de dor. A obturação de canais radiculares de comprimento adequado foi observada em 65,9% dos casos (324 dentes). A presença e as dimensões das lesões periapicais não interferiram na qualidade da obturação. Foi encontrada relação estatística entre a condição pulpar e a dor pós-tratamento endodôntico. Presença de dor foi observada em 4,7% dos dentes vitais e 0,3% dos não vitais. A presença de lesão periapical não influenciou na dor pós-operatória. O comprimento de trabalho adequado foi observado na maioria dos casos e a instrumentação rotatória NitTi teve aplicabilidade em programas de graduação, mesmo com operadores iniciantes. Além disso, a condição pulpar afetou a dor pós-operatória (AU).

Instrumentação foraminal: repercussões locais e sistêmicas / Foraminal enlargement: Local and systemic repercussions

Introdução: A infecção endodôntica pode alcançar a saída foraminal e, inclusive, ir além dela. Logo, a determinação da constrição apical como o limite ideal para instrumentação e obturação tem sido questionada. A instrumentação foraminal intencional é realizada com o intuito de diminuir o contingente microbiano a níveis mais favoráveis ao reparo. Entretanto, repercussões locais e sistêmicas estão associadas à sua execução. Objetivo: Realizar uma revisão crítica da literatura sobre repercussões locais e sistêmicas relativas à instrumentação foraminal intencional. Métodos: Em março de 2018, uma busca eletrônica realizada na base de dados PUBMED utilizando os termos "foraminal enlargement" OR "foraminal widening" OR "apical limit" AND "endodontics" identificou 74 artigos científicos. Esses artigos, a análise de suas referências bibliográficas e a utilização de mais 5 artigos base resultaram nos 111 estudos consultados para a realização dessa pesquisa. Resultados: A ampliação foraminal intencional nem sempre pode ser praticada em virtude de razões anatômicas e morfológicas. Quanto maior a ampliação do forame apical, maior a possibilidade de extravasamento de substâncias e/ou materiais utilizados para a realização do tratamento endodôntico. A instrumentação foraminal intencional parece ser contraindicada em pacientes que fazem ou fizeram uso de bisfosfonatos recentemente, com distúrbios de coagulação e/ou sob uso crônico de anticoagulantes e com alto risco de bacteremia. Conclusões: Os impactos da instrumentação foraminal intencional sobre o sucesso do tratamento endodôntico devem ser investigados. Contudo, os delineamentos metodológicos dos estudos clínicos devem ser cuidadosos, principalmente no tocante às condições sistêmicas dos pacientes que farão parte do universo amostral (AU).

Introduction: endodontic infection can reach and even go beyond the apical foramen. Therefore, determining apical constriction as the ideal limit for instrumentation and obturation has been questioned. Intentional foraminal enlargement is performed for the purpose of reducing the microbial contingent to levels more favorable to repair. However, local and systemic repercussions have been associated with this approach. Objectives: to critically review the literature on local and systemic repercussions relative to intentional foraminal enlargement. Methods: in March 2018, an electronic search performed on the PUBMED database using the terms "foraminal enlargement" OR "foraminal widening" OR "apical limit" AND "endodontics" identified 74 scientific articles. These articles, analysis of their references and use of another 5 base articles resulted in the 115 studies used for performing this research. Results: intentional foraminal enlargement cannot always be performed due to the anatomical and morphological conditions. The greater the apical foramen enlargement, the greater the possibility of extrusion of substances and/or materials used to perform endodontic treatment. Intentional foraminal enlargement seems to be contraindicated in patients who are taking or have recently used bisphosphonates, those with coagulation disorders and/ or under chronic use of anticoagulants and at high risk for bacteremia. Conclusions: the impacts of intentional foraminal enlargement on the success of endodontic treatment should be investigated. However, the methodological procedures of clinical studies should be carefully designed, especially taking into consideration the systemic conditions of patients who will be part of the sample (AU).

Instrumentación rotatoria comparado con instrumentación manual para tratamiento endodóntico en dientes permanentes / Rotary instrumentation compared to manual instrumentation for endodontic treatment in permanent teeth

RESUMEN: Introducción: El éxito del tratamiento endodóntico requiere de la desinfección completa del sistema de canales radiculares. Convencionalmente este procedimiento se realiza a través de maniobras de instrumentación rotatoria o manual e irrigación química. Dentro de las diferentes técnicas de instrumentación, la de tipo rotatoria ha surgido como una alternativa a la instrumentación manual, cuyos beneficios en comparación a ésta aún deben ser dilucidados. Métodos: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. Resultados y conclusiones: Identificamos cinco revisiones sistemáticas que en conjunto incluyeron 15 estudios primarios, de los cuales, 10 corresponden a ensayos aleatorizados. Concluimos que el uso de instrumentación rotatoria en comparación a instrumentación manual probablemente disminuye la incidencia del dolor postoperatorio. Además, la instrumentación rotatoria podría disminuir el uso de analgésicos post tratamiento endodóntico. Sin embargo, podría resultar en poca o nula diferencia en la intensidad del dolor, pero la certeza de la evidencia es baja. Además, no es posible establecer con claridad si el uso de instrumentación rotatoria en comparación a la instrumentación manual aumenta la reparación apical debido a que la certeza de la evidencia existente ha sido evaluada como muy baja.

ABSTRACT: Introduction: Successful root canal therapy (endodontic treatment) requires complete disinfection of the root canal system. Traditionally, disinfection of the root canal system involves rotary or manual instrumentation and chemical irrigation. Various rotary instrumentation techniques have emerged as an alternative to manual instrumentation, but its benefits against manual techniques need to be clarified. Methods: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. Results and conclusions: We identified five systematic reviews that together included 15 primary studies, of which 10 correspond to randomized trials. We conclude that the use of rotary instrumentation compared to manual instrumentation probably reduces the incidence of pain. Also, rotatory instrumentation may reduce the use of postoperative analgesics. However, it could result in little or no difference in pain intensity, but the certainty of the evidence is low. Furthermore, it is not possible to clearly establish whether the use of rotary instrumentation increases apical repair as the certainty of the evidence has been assessed as very low.

Antibióticos potencializam a ação antimicrobiana de cimentos endodônticos, em diferentes períodos, após a presa / Antibiotics increase the antimicrobial action of endodontic seal-ers, in different periods, after setting time

O objetivo do presenteestudo foi avaliar a atividade antibacteriana dos cimentos endodôn-ticos MTA Fillapex, Sealapex, Sealer 26 e Endofill puros e acrescidos de amoxicilina e ci-profloxacina frente a duas linhagens ATCC de Enterococcus faecalis (ATCC 29212 e ATCC 4083). Os testes foram realizados pela técnica de difusão radial dos cimentos aplicados di-retamente no ágar e impregnados em discos de papel e pelo teste de contato direto. Para a análise estatística, utilizaram-se os testes de ANOVA e Tukey com nível de significância de 5%. Os resultados mostraram que pela técnica da difusão radial, considerando os cimentos puros, o Sealapex foi o único que apresentou halos de inibição frente às duas linhagens. Já quando da associação de amoxicilina e ciprofloxacina, o MTA Fillapex revelou os melhores halos de inibição para as duas linhagens. Todos os cimentos tiveram a ação potencializada pela adição dos antibióticos (p<0,05). Pela técnica de difusão dos cimentos impregnados em discos de papel, o cimento Sealapex puro fresco demonstrou atividade antimicrobiana em todas as variáveis de tempo. Quando acrescidos dos antibióticos, todos os cimentos ti-veram a ação antimicrobiana potencializada pelas drogas, em todas as variáveis de tempo. Esse mesmo resultado foi observado na técnica do contato direto dos cimentos com ambas as linhagens. A atividade antibacteriana, frente ao E. faecalis, dos cimentos MTA Fillapex, Endofill, Sealer e Sealapex, acrescidos dos antibióticos amoxicilina e ciprofloxacina, foi potencializada mesmo após um longo período da presa dos cimentos.

The objective of this study was to evaluate the antibacterial activity of different endodon-tic cements (MTA Fillapex, Sealapex, Sealer 26, and Endofill), both pure and mixed with 5% of amoxicillin or ciprofloxacin, against two strains of Enterococcus faecalis (ATCC 29212 and ATCC 4083). Bacterial susceptibility testing was conducted by radial diffusion methods and direct contact test after different periods. Data were subjected to ANO-VA and Tukey test with a significance level of 5%. Sealapex was the only pure sealer to promote the inhibition of bacterial growth against both strains in different experimental periods. However, all cements present an increase in antibacterial activity by the addition of antibiotics (p<0.05). MTA Fillapex and Sealapex associated with amoxicillin promoted increased values for bacterial growth against ATCC 29212 and ATCC 4083 in comparison to other groups (p<0.001), including extended periods after setting time. The association of antibiotic agents increased the antibacterial effect of the evaluated sealers against the strains of E. faecalis.

Avaliação das características superficiais dos instrumentos Reciproc, Reciproc Blue e Xp-Endo Shaper / Evaluation of the surface characteristics of the Reciproc, Reciproc Blue and Xp-Endo Shaper instruments

Introdução: o controle da qualidade no processo de fabricação dos instrumentos endodônticos é importante uma vez que defeitos e falhas superficiais podem comprometer o preparo dos canais. Objetivo: avaliar a presença de defeitos e falhas do processo de fabricação na superfície de instrumentos Reciproc (R25), Reciproc Blue (RB25) e XP-endo shaper (XP), por meio de microscopia eletrônica de varredura (MEV). Materiais e Métodos: Ao total, foram avaliados 60 instrumentos de níquel titânio, sendo 20 por grupo: R25, RB25 e XP, em três regiões: 0mm (ponta do instrumento), 4mm e 7mm da ponta, no MEV, com aumento de 100x. As imagens foram avaliadas quanto ao número de falhas de fabricação (bordo irregular, ranhura, microcavidade e rebarba) e por um sistema de escores de 1 a 4, sendo 1, nenhuma área com defeito e 4, mais de cinco áreas com defeitos na superfície. Os dados foram submetidos à análise estatística utilizando o teste de Dunn (p<0,05). Resultados: Sobre a análise por regiões, foram identificadas diferenças significativas em grande parte dos instrumentos. Comparando os diferentes instrumentos, não foi observada diferença significativa para microcavidade (p=0,76), bordo irregular (p=0,98) e rebarba (p=0,40). O instrumento R25 mostrou maior número de ranhuras em comparação aos demais (p=0,0000*). RB25 mostrou maiores valores de escores que os instrumentos R25 (p= 0,0002) eXP (p=0,01). Conclusão: Todos os instrumentos avaliados apresentaram defeitos/falhas superficiais do processo de fabricação.

Introduction: The quality control of endodontic instruments is extremely importantsince defects and failures on their surface, during their manufacturing process, can compromise the preparation of root canal. Objective: this study evaluated the presence of defects and failures in the manufacturing process on the surface of Reciproc (R25), Reciproc Blue (RB25) and XP endo-shaper (XP) instruments by means of scanning electron microscopy (SEM). Materials and Methods: In total, sixty nickel titanium instruments (n=20): R25, RB25 and XP were evaluated in the scanning electron microscope in three regions: 0mm (tip of the instrument), 4mmand 7mm of the tip, with a magnification of 100x. The images were evaluated in relation to the number of manufacturing faults (irregular border, groove, microcavity and burr) and by a system of scores, from 1 to 4, where 1 is no defective area and 4, more than five areas with defects on the surface. The data were submitted to statistical analysis using Kruskal-Wallis and Mann-Whitney tests (p<0.05). Results: Regarding the analysis by regions, significant differences were identified in most of the instruments. Comparing the different instruments, no significant difference was observed for microcavity (p=0.76), irregular border (p=0.98) and burr (p=0.40). The R25 instrument showed a greater number of grooves compared to the others (p=0.0000*). RB25 showed higher scores than the R25(p=0.0002) and XP (p=0.01) instruments. Conclusion: All evaluated instruments showed defects/failures in the manufacturing process.Introduction: The quality control of endodontic instruments is extremely importantsince defects and failures on their surface, during their manufacturing process, can compromise the preparation of root canal. Objective: this study evaluated the presence of defects and failures in the manufacturing process on the surface of Reciproc (R25), Reciproc Blue (RB25) and XP endo-shaper (XP) instruments by means of scanning electron microscopy (SEM). Materials and Methods: In total, sixty nickel titanium instruments (n=20): R25, RB25 and XP were evaluated in the scanning electron microscope in three regions: 0mm (tip of the instrument), 4mmand 7mm of the tip, with a magnification of 100x. The images were evaluated in relation to the number of manufacturing faults (irregular border, groove, microcavity and burr) and by a system of scores, from 1 to 4, where 1 is no defective area and 4, more than five areas with defects on the surface. The data were submitted to statistical analysis using Kruskal-Wallis and Mann-Whitney tests (p<0.05). Results: Regarding the analysis by regions, significant differences were identified in most of the instruments. Comparing the different instruments, no significant difference was observed for microcavity (p=0.76), irregular border (p=0.98) and burr (p=0.40). The R25 instrument showed a greater number of grooves compared to the others (p=0.0000*). RB25 showed higher scores than the R25(p=0.0002) and XP (p=0.01) instruments. Conclusion: All evaluated instruments showed defects/failures in the manufacturing process.

Fractographic analysis of separated endodontic file designs.

Endodontic rotary files are cutting instruments used to perform root canal procedures within a tooth interior. Focusing on quantitative fractographic analysis increases necessary, clinical performance understanding of file separation failure. This research employed controlled, dynamic testing to failure of commercial rotary files, analyzing the fractographic, forensic characteristics in relation to Weibull reliability determination, considering: (1) design analysis; (2) stress concentrations; (3) times to failure; (4) number of cycles to failure (NCF). Ex vivo testing included three file designs, each having constant tip size (0.035 mm), taper (0.06 mm/mm), and length (25 mm). Files were individually tested using an electric, torque-controlled handpiece, rotating within a standardized, simulated canal until fracture separation occurred. Fractographic analysis, including critical measurements, was conducted using the scanning electron microscope (SEM) (PhenomProX, PhenomWorld, NL). Weibull statistical analysis established reliability factors per design group. Fractographic analysis identified separation fractures, processing inclusions, flexural-fatigue striations, and stress concentrations at flute pitches. Calculated NCF median values (1277-EE; 899-VB; 713-PI) demonstrated significant statistical differences among groups (p < 0.001). Separated apical fragments yielded statistically significant differences (p ≤ 0.05) for varying file design groups. Weibull moduli among groups were statistically equivalent. Fractographic analysis exposed a presence of multiple failure factors in addition to defect distribution, governing cyclic fatigue failure originating at stress concentration points irrespective of file design. Fractographic analysis indicated that a change in file design, specifically at the working edges, in addition to improved surface finish, has the potential of reducing failures by lowering points of stress concentration and reducing fracture initiating surface cracks.

Simultaneous Perio-endo Surgery with ER:YAG Laser and Bone Xenograft. A Case Report.

Periodontally affected teeth with periapical lesion indicated for periapical surgery have a poor prognosis. Using Er:YAG lasers to perform simultaneous surgery on both defects may increase their survival rate. Preparing a retrograde cavity on affected teeth and obturating it is still a matter of debate among clinicians. The purpose of this case report was to describe the simultaneous use of Erbium-doped Yttrium Aluminium Garnet Er:YAG (2,940 nm) laser in the treatment of periapical granuloma and infraossal defect and the achieved results. The Er:YAG laser was used to perform flap dissection, granulation tissue removal, osteotomy and root-end resection except for initial flap incision and reflection. The cystic cavity was filled with Bio-Oss Collagen® xenograft. Results were followed up for 18 months with the help of radiographic orthopantomographic images. The outcome of this clinical case indicates that the use of Er:YAG laser could be considered a suitable method to perform simultaneous periodontal and endodontic surgery.

Filling ability of three variants of the single-cone technique with bioceramic sealer: a micro-computed tomography study.

The present study evaluated the quality of single-cone root canal fillings with bioceramic (BC) sealer using three different techniques by means of micro-computed tomography (micro-CT). The canals of 30 extracted single-rooted permanent teeth were shaped with R40 Reciproc blue files and filled with the single-cone technique (SCT). BioRoot RCS BC sealer was placed inside the canals with one of the following master cones: R40 cone to working length (RWL, n = 10); R40 cone trimmed 1 mm short of working length (RWL-1, n = 10); non-standardized gutta-percha cone to working length (NSWL, n = 10). A quantitative and qualitative micro-CT analysis assessed the filling quality and internal/external voids formation. Collected data underwent statistical analysis by multivariate one-way analysis of variance (α = 0.05). In all groups, the voids were minimal and prevalently external. The NSWL and RWL-1 groups had increased sealer ratios in the whole canal and the apical canal portion, respectively. The lowest amounts of voids were found in the RWL group; the void volumes were slightly greater in the RWL-1 mm and NSWL groups, especially at the apical level. Two alternative SCTs showed satisfactory filling ability, uniform distribution of the BC sealer, and a minimally increased voids formation compared to the standard SCT with dedicated cone. The two tested alternative SCTs could take advantage of the beneficial characteristics of the BC sealer, which evenly filled the endodontic space, ideally sealing both the major and the accessory communications with the periodontium.

Efeito da sequência de processamento durante a fabricação de instrumentos endodônticos Niti em suas propriedades mecânicas / Effect of the processing sequence during the manufacture of niti endodontic instruments on their mechanical properties

As características geométricas e técnicas de fabricação das limas endodônticas afetam o desempenho clínico e sua resistência à fratura, flexibilidade e outras propriedades. Um parâmetro muito explorado na Endodontia é a utilização de tratamentos térmicos, que promovem um aumento na resistência à fadiga e flexibilidade destes materiais. Neste estudo pretendeu-se avaliar o efeito de diferentes processos de tratamento térmico/usinagem nas propriedades físicas, flexibilidade, resistência torcional e à fadiga flexural dos instrumentos Prodesign Logic (PDL), verificando se a sequência de processamento dos instrumentos levaria a comportamentos mecânicos diferentes. Este sistema é fabricado a partir de um método inovador que envolve a realização do tratamento térmico para obtenção de memória de forma no fio NiTi anteriormente à usinagem. A hipótese nula a ser testada é que o momento de aplicação dos procedimentos de tratamento térmico e usinagem não afetariam as propriedades físicas e mecânicas de instrumentos endodônticos de NiTi. Para grupos de comparação, foram utilizados protótipos de instrumentos com as mesmas características geométricas e dimensionais, sendo um grupo de instrumentos sem tratamento térmico aplicado (SEP) e outro com o tratamento térmico realizado de forma convencional, após a usinagem do instrumento (HTP). Foram realizadas caracterização física e microestrutural com ensaios de calorimetria exploratória diferencial (DSC) e testes de difratometria de Raios-X (DRX), além de ensaios mecânicos divididos em testes de torção, dobramento em 45 e resistência à fadiga flexural. Os resultados mostraram que macroscopicamente não houve nenhuma alteração importante nas características dos três grupos de instrumentos, exceto mudanças de cor devido a diferentes sequências de processamento. Os resultados de DSC mostraram que à temperatura ambiente a liga é principalmente austenítica no grupo SEP e que após o tratamento térmico realizado nos grupos PDL e HTP, houve uma mudança nas temperaturas de transformação, com um aumento da temperatura de Af e predominância da liga NiTi em fase R. Os resultados de XDR confirmaram os achados do DSC. As diferenças nos parâmetros medidos entre diferentes tipos de instrumentos nos ensaios de resistência torcional, dobramento a 45º e fadiga flexural foi sempre considerada com um nível de significância de 95%. Os resultados para os ensaios de flexão mostraram que o grupo HTP mostrou-se o mais flexível, com os mais baixos valores de momento de dobramento, seguido por PDL e SEP. Nos resultados dos ensaios de torção foi possível observar que SEP apresentou valores mais altos de torque seguido por PDL e HTP (p<.05). Os ensaios de resistência à fadiga mostraram valores médios de NCF maiores para HTP, seguido por PDL e SEP. Entretanto, um pior comportamento do PDL só seria evidenciado clinicamente se os instrumentos fossem usados um número de vezes maior do que o recomendado pelo fabricante. Pode-se concluir que alterar o processo de fabricação dos instrumentos endodônticos, invertendo-se as etapas de usinagem e tratamento térmico, levou, de fato, a uma mudança no comportamento mecânico de instrumentos Prodesign Logic em relação aos prótótipos.

The geometric characteristics and manufacturing techniques of endodontic instruments affect clinical performance, fracture resistance, flexibility and other properties. A parameter widely explored in Endodontics is the use of heat treatments, which promote an increase in the resistance to fatigue and flexibility of these materials. This study aimed to evaluate the effect of different heat treatment / machining processes on the physical properties, flexibility, torsional strength and flexural fatigue of Prodesign Logic (PDL) instruments, verifying whether the processing sequence of the instruments would lead to different mechanical behaviors. This system is manufactured using an innovative method that involves performing thermal treatment to obtain shape memory in the NiTi wire prior to machining. The null hypothesis to be tested is that the moment of application of the heat treatment and machining procedures would not affect the physical and mechanical properties of NiTi endodontic instruments. For comparison groups, instrument prototypes with the same geometric and dimensional characteristics were used, being one group of instruments without thermal treatment applied (SEP) and another with thermal treatment carried out in a conventional manner, after machining the instrument (HTP). Physical and microstructural characterization were performed with differential scanning calorimetry (DSC) tests and X-ray diffractometry (XRD) tests, in addition to mechanical tests divided into torsion tests, 45° bending and resistance to flexural fatigue. The results showed that macroscopically there were no major change in the characteristics of the three groups of instruments, except for color changes due to different processing sequences. The DSC results showed that at room temperature the alloy is mainly austenitic in the SEP group and that after the heat treatment carried out in the PDL and HTP groups, there was a change in the transformation temperatures, with an increase in the Af temperature and predominance of the NiTi alloy in phase R. The XRD results confirmed the DSC findings. Differences in the parameters measured between different types of instruments in the tests of torsional resistance, bending at 45º and flexural fatigue were always considered with a significance level of 95%. The results for the flexibility tests showed that the HTP group proved to be the most flexible, with the lowest values, followed by PDL and SEP. In the results of the torsion tests it was possible to observe that SEP presented higher values of torque followed by PDL and HTP (p <.05). Fatigue resistance tests showed higher mean NCF values for HTP, followed by PDL and SEP. However, a worse behavior of the PDL would only be evidenced clinically if the instruments were used several times greater than that recommended by the manufacturer. It can be concluded that changing the manufacturing process of endodontic instruments, inverting the machining and heat treatment steps, led, in fact, to a change in the mechanical behavior of Prodesign Logic instruments in relation to the prototypes.

Avaliação de dentes monorradiculares artificiais utilizados para treinamento endodôntico / Evaluation of artificial monoradicular teeth used for endodontic training

Introdução: É desafio do ensino pré-clínico em Endodontia fornecer aos alunos dentes artificiais que reproduzam a morfologia dos dentes humanos. Objetivo: Comparar a morfologia interna e externa de dentes artificiais monorradiculares com dados da literatura sobre dentes humanos. Material e método: Os dentes artificiais foram doados pelos fabricantes: Fábrica de Sorrisos, empresa A, (n=20), e IM do Brasil Ltda., empresa B, (n=20). Foi realizada mensuração do comprimento total do dente e da raiz, da altura, das dimensões vestibulopalatina e mesiodistal da coroa, com paquímetro digital. A descrição morfológica das raízes, coroas e câmaras pulpares foi realizada. A localização topográfica do forame apical principal foi avaliada após exploração dos canais com instrumento endodôntico tipo K #15 até este atingir visualmente o ápice radicular. Os dados foram dispostos em uma planilha de cálculo e realizou-se a análise estatística [ANOVA e pós-teste de Tukey (α=5%)]. Resultado: A amostra de caninos superiores da empresa B apresentou todas as variáveis dentro dos padrões morfométricos descritos na literatura. Em relação às morfologias interna e externa, a amostra de incisivos laterais superiores da empresa A foi a única a apresentar todas as variáveis dentro dos padrões descritos na literatura. Em relação à localização topográfica foraminal, os dentes da empresa A, assim como o canino inferior da empresa B, apresentaram tendência à posição distalizada e centralizada, vindo ao encontro da literatura. Conclusão: Nenhum dente artificial estudado apresentou total similaridade morfológica e morfométrica com a literatura analisada, diferindo em pelo menos uma das variáveis, sendo indicada aos fabricantes uma revisão dos seus modelos.

Introduction: It is a challenge of pre-clinical teaching in Endodontics to provide students with artificial teeth that reproduce the internal and external morphology of human teeth. Objective: To compare the internal and external morphology of single-rooted artificial teeth with data from the literature on human teeth. Material and method: The artificial teeth were donated from two companies: Fábrica de Sorrisos, company A, (n=20) and IM do Brasil Ltda, company B (n=20). Measurement of total tooth length, root, height, buccal-palatal and mesio-distal crown dimensions with digital caliper was performed. The morphological description of the roots, crown and pulp chamber was performed, the last one only after access. The topographic location of the main apical foramen was evaluated after canal exploration with a K #15 endodontic instrument until it visually reached the root apex. The data were arranged in a spreadsheet and statistical analysis was performed (ANOVA, followed by the Tukey post-test (α=5%)). Result: Regarding the morphometric parameters, the upper canine sample from company B presented all variables within the standards described in the literature. Regarding internal and external morphology, the sample of upper lateral incisors from Company A was the only one to present all variables within the standards described in the literature. Regarding the foraminal topographic location, the teeth of Company A, as well as the lower canine of company B, showed a tendency to the distalized and centralized position, in line with the literature. Conclusion: none of the artificial teeth studied showed total morphological and morphometric similarity with the control, differing in at least one of the variables, and a review of their models is indicated to the manufacturers.

Torsional Resistance of Two New Heat Treated Nickel Titanium Rotary Instruments: An in Vitro Evaluation

Abstract Objective: To evaluate the difference in torsional resistance, angular deflection and fragment length between two new rotary instruments: AF Blue S4 and S-One. These files share all features except cross-sectional design. Material and Methods: A total of 40 new Nickel-Titanium instruments of 25 mm in length were tested in this study and divided in two groups: 20 AF Blue S4, tip 25 and constant 6% taper and 20 AF-Blue S4 tip 25 and constant 6% taper. The torsional test was performed by the use of a torque recording endodontic motor (KaVo, Biberac, Germany). Torque to Fracture (TtF), Angular Deflection (AD) and Fragment Length (FL) was recorded for each instrument. To ensure an immovable block at 3mm of the instrument tip, an auto-polymerizing resin (DuraLay; Reliance Dental Mfg Co, Worth, IL) was used. Each file was rotated clockwise at a speed of 300 rpm until fracture occurred. Results: Group A (AF Blue S4) showed higher TtF and AD than Group B (S-One), and statistical analysis found significant differences between the two instruments (p<0.05). The mean values for FL showed no significant differences (p>0.05) between the two instruments. Conclusion: The AF Blue S4 seems to have a higher resistance to torsional stress in vitro. Clinically, the use of AF Blue S4 could be safer in narrow canals.

The Comparison of Different Irrigation Systems to Remove Calcium Hydroxide from the Root Canal: A Systematic Review and Meta-Analysis

Abstract Objective: To examine the effect of a variety of irrigation systems on the removal of root canal Ca (OH)2 residues through meta-analysis and systematic review. Material and Methods: A search of relevant articles was systematically performed on databases of Medline, PubMed, Cochrane Library, Embase, ISI, and Google Scholar published from 2013 to 2019. Electronic title management was carried out by EndNote X9 software. Searches were based on the main keywords of "Irrigation Systems", "Calcium Hydroxide"," Root Canal", "Self-adjusting File OR SAF", "Conventional Irrigation", "EndoVac System", "Ultrasonic Irrigation" and "YAG Laser". Results: The studies investigated were found to lack any standardization concerning the irrigation method used or the measurement of outcomes; for instance, different studies used 5 or 10 mL of 2.5% NaOCl, or 5 mL of 5.25% NaOCl, or 0.5 mL, 3 mL and 10 mL of 17% EDTA. Conclusion: The effective techniques for the removal of root canal Ca(OH)2 were PUI, and SAF approaches.

Tratamentos endodônticos realizados em uma clínica de graduação: características dos casos, prevalência de fraturas de instrumentos e percepção dos alunos / Endodontic treatments performed in a graduation clinic: characteristics of the cases, prevalence of Instrument fracture and student's perceptions

O estudo avaliou os tratamentos endodônticos realizados nas clínicas de Endodontia da Faculdade de Odontologia da UFMG. Trata-se de um estudo transversal que analisou os procedimentos de urgência prévios e finalização dos casos, à prevalência de fraturas de instrumentos endodônticos e às percepções dos alunos frente a essa ocorrência e a prática endodôntica. Os dados foram obtidos nos prontuários clínicos e no acompanhamento dos atendimentos, durante dezoito meses, entre os anos de 2017 e 2018. As percepções dos estudantes foram levantadas através da aplicação de um questionário. Os dados foram analisados descritivamente por meio de frequência absoluta e relativa e análise bivariada realizada utilizando o teste Qui-Quadrado de Pearson com correção de Bonferroni considerando um nível de confiança de 95%, e probabilidade de significância de 5% (p≤0,05) no SPSS v. 22. Os molares (p>0.0001) e os dentes diagnosticados com necrose pulpar (p<0.0001) foram os mais relacionados a procedimentos de urgência prévios. A maioria dos tratamentos endodônticos foram finalizados (85,9%). A taxa de finalização foi menor entre adolescentes comparados com jovens (p = 0,006) e adultos mais velhos (p = 0,003), em dentes molares comparados com dentes anteriores (p = 0,005) e pré-molares (p = 0,003), em dentes que passaram por urgência prévia (p = 0,002) e em pacientes que faltaram às consultas (p = 0,014). Ocorreram fraturas de limas rotatórias em 3,9% dos casos em canais curvos de molares (66,7%). Fragmentos localizados no terço coronário/médio (61,3%), medindo mais de três milímetros (72,2%) e foram removidos ou ultrapassados em metade das ocorrências. A maioria dos estudantes relatou controlar o número de usos (88,9%) e em 66,7% dos casos a fratura ocorreu até o terceiro uso. Os alunos relataram dificuldades (98,0%), a maioria relacionada à procedimentos técnicos (54,1%) e a morfologia e localização dos dentes (26,8%). Para os estudantes que não relataram a ocorrência de fraturas, a maioria relatou que seu interesse (88,2%) e confiança (83,9%) não seriam influenciados caso esse incidente ocorresse. Já os alunos que de fato tiveram a experiência de fratura, observou-se uma diminuição desse percentual para 44,5% e 33,3%, respectivamente. O estudo evidenciou um número satisfatório de tratamentos concluídos demandando poucas sessões. A não finalização foi associada à complexidade anatômica dos molares, à baixa idade dos pacientes e ao absenteísmo. A prevalência de fraturas de instrumentos endodônticos foi baixa. Os aspectos relacionados a elas sugerem sobrecarga torcional como a causa mais provável. As dificuldades mais relatadas estão relacionadas a falta de habilidades técnicas ou a complexidade anatômica dos molares. A percepção sobre a própria confiança e interesse na especialidade parece ser diretamente afetada pela ocorrência de fratura de instrumentos.

The study evaluated the endodontic treatments performed in the Endodontic clinics of UFMG School of Dentistry. This is a cross-sectional study that analyzed the previous urgent procedures, the completion of the cases, the prevalence of fractures of endodontic instruments and the perceptions of students regarding such occurrence and endodontic practice. Data were obtained through clinical records and during clinical practice during eighteen months between the years of 2017 and 2018. Students' perceptions were raised through the application of a questionnaire. Data were analyzed in a descriptive way by absolute and relative frequency and bivariate analysis performed using the Pearson's ChiSquare test with Bonferroni correction considering a 95% confidence level and 5% significance probability (p≤0, 05) in SPSS v. 22. The molars (p> 0.0001) and the teeth diagnosed with pulp necrosis (p <0.0001) were the most related to previous emergency procedures. 85.9% of endodontic treatments were completed. Treatments were less finalized in adolescents compared with young people (p = 0.006) and older adults (p = 0.003), in molar teeth compared with anterior teeth (p = 0.005) and premolars (p = 0.003), in teeth that had previous emergency treatments (p = 0.002) and in patients who missed appointments (p = 0.014). Instrument fractures occurred in 3.9% of cases in curved canals of molar teeth (66.7%). Fragments were located in the coronal/middle third (61.3%), measuring more than three millimeters (72.2%) and removed or exceeded in half of the occurrences. Most students reported controlling the number of uses (88.9%) and in 66.7% of fractured occurred in up to the third use. Students reported difficulties (98.0%), most technical procedures (54.1%) and to the morphology and location of teeth (26.8%). For students who did not report the occurrence of fractures, the majority reported that their interest (88.2%) and confidence (83.9%) would not be influenced in case of a fracture. Among the students who had the fracture experience, a decrease in this percentage was observed, 44.5% and 33.3% respectively. The study showed a satisfactory number of completed treatments requiring few sessions. The conclusion was associated with the anatomical complexity of the molars, the low age of the patients and absenteeism. The prevalence of fractures of endodontic instruments was low. The aspects related to them suggest torsional overload as the most likely cause. The most related difficulties are the lack of technical skills or the anatomical complexity of the molars. The perception of their own confidence and interest in the specialty seems to be directly affected by the occurrence of instrument fractures.