Tooth- and Patient-Related Conditions May Influence Root Canal Treatment Indication.

AIM: To investigate predisposing aspects related to the indication for root canal treatment (RCT) at Dental Schools of Brazil. METHODS: Data of 207 patients referred to endodontic treatment at undergraduate Dental Schools of Brazil were collected over a period of 8 months. Patient-related data included age, gender, first dental visit, tooth brushing frequency, number of remaining teeth, and previous endodontic treatment, and tooth-related information regarding number, type, and location in the mouth of teeth that need RCT, waiting time for the endodontic treatment, endodontic diagnosis, pain report, and dental crown condition was collected for each participant. Bivariate analysis (Chi-square test; p < 0.05) associated gender and tooth/patient-related conditions. Poisson regression analysis compared multiple endodontic need and exposure variables. RESULTS: Patients were mainly comprised of women (65.2%), aged 18-39 years (69.6%). Previous RCT was significantly more prevalent in women when compared to men (p=0.005). First dental visit at later moment (after 20 years of age) demonstrated 400% greater prevalence of multiple RCT demand when compared to patients that attended the dental office at age below seven years (p=0.032). Most of the patients presented only one tooth needing RCT (80.2%), mainly premolars (44.9%). Interestingly, women underwent more RCT in maxillary teeth (p=0.016) and significantly contributed with their report to the diagnosis process when compared to men (p=0.014). Regarding dental crown condition, 45.4% of all teeth registered unsatisfactory restorations, which were more pronounced in female patients (p=0.018). Unsatisfactory restorations or dental caries had 75% and 82%, respectively, less prevalence of multiple RCT indication when compared to sound dental crown (p=0.001). CONCLUSIONS: RCT was undertaken more frequently in young female adults' premolars presenting unsatisfactory restorations. First dental visit, number of teeth with previous endodontic treatment, tooth group, and dental crown condition were significantly associated with the necessity of multiple endodontic treatments.

Outcomes of traumatised immature teeth treated with apexification or regenerative endodontic procedure: a retrospective study.

This study compares the clinical success rate and continued radiographic root development of apexification and regenerative endodontic procedure in traumatised immature permanent teeth, and proposes a method to evaluate apical convergence, namely apical angle. Clinical and radiological data were collected from 44 treated teeth (22 with apexification and 22 with regenerative endodontic procedure). The preoperative and follow-up periapical radiographs were analysed to calculate the percentage changes in root length, root width, apical diameter and apical angle. The success rates for complete healing with apexification and regenerative endodontic procedure were 86.36% and 95.45%, respectively. Radiographically, regenerative endodontic procedure showed significantly greater percentage changes in root width only (P < 0.05). Apexification and regenerative endodontic procedure provide satisfactory outcomes concerning clinical success rates. Continued root development in regenerative endodontic procedure was similar to apexification, except for root width. Apical angle allowed us to assess the convergence of the root canal walls.

Pré-molar com três raízes tratado por meio de Endodontia convencional: relato de caso com acompanhamento de 24 meses / Three-rooted premolar treated with conventional endodontics: 24-month follow-up case report

O completo conhecimento da anatomia dentária interna representa um dos fatores determinantes para o sucesso do tratamento endodôntico. A presença de três raízes em segundos pré-molares superiores refere-se a uma ocorrência rara durante os tratamentos endodônticos convencionais, tornando-se relevante sua descrição detalhada na literatura. Objetivo: O presente trabalho objetiva descrever o tratamento endodôntico de um segundo pré-molar superior apresentando três raízes separadas. Relato de caso: O paciente atendido compareceu para atendimento relatando dor contínua e exacerbada ao frio, em seu segundo pré-molar superior direito. O exame radiográfico sugeriu a presença de três raízes separadas no referido pré-molar, o que foi confirmado durante a abertura coronária, que foi realizada de forma cuidadosa. Os canais foram instrumentados por meio da técnica manual de pre- paro químico-mecânico e obturados por meio da técnica de compactação lateral. Os controles aos 12 e 24 meses não demonstraram alteração clínica e radiográfica. Conclusão: A presença de três canais radiculares em segundos pré-molares superiores pode comprometer o sucesso do tratamento endodôntico. Entretanto, o conhecimento adequado da anatomia e do diagnóstico pode possibilitar o tratamento de variações anatômicas por um clínico geral sem o emprego de recursos tecnológicos (AU).

Introduction: The thorough knowledge of the internal anatomy of tooth is one of the determining factors for the success of endodontic treatment. Three-rooted second maxillary premolars represent a rare occurrence during endodontic treatment, making its description in the literature an important contribution. This paper describes the endodontic treatment of maxillary second premolar with three separated root canals. Case report: The patient exhibited a right maxillary second premolar affected by continuous pain that was exacerbated by cold testing. Periapical radiograph analysis suggested the presence of three separated roots, which was confirmed during the careful access to the pulp chamber. The tooth was treated with manual instrumentation technique and filled through lateral condensation technique. One and two-years follow-up visits revealed absence of clinical and radiographic signals. Conclusion: The presence of three root canals in second maxillary premolars may compromise endodontic treatment success. Meanwhile, a conscious knowledge of anatomy and a careful diagnosis do not exclude the treatment of anatomic variations by a general dentist without the use of technological resources (AU).

Endodontic Tendencies in a Very-Low-Income Population Area of Northeastern Brazil.

AIM: To gather information regarding endodontic treatment protocols and continuing education attendance of dentists in some cities located in Northeastern Brazil (Sergipe and Bahia States), a region that comprises a very-low-income population. METHODS: A questionnaire containing different questions (e.g., routine treatment protocols, the use of new technologies, time required to conclude the treatment, and attendance in an endodontic continuing education) was distributed to 250 dentists. The collected data were analyzed through descriptive statistics and Poisson regression (p < 0.05). RESULTS: A total of 199 dentists practicing endodontic treatment in the cities of Aracaju (n = 58), Salvador (n = 83), and towns of Estância (n = 8), Itabaiana (n = 16), Itabaianinha (n = 5), Lagarto (n = 10), Ribeirópolis (n = 3), Simão Dias (n = 6), and Tobias Barreto (n = 10) participated in this research. Most of the respondents have concluded their graduation in Dentistry in less than 10 years (62.3%), with nearly 75.4% of the sample having attended postgraduation education in the field. Regarding treatment protocols, the frequency for using rotary/reciprocating systems and for always using rubber dam isolation during root canal treatment (RCT) was 78% and 62%, respectively, which was also more prevalent among dentists who attended a continuous education program (p < 0.05). Lastly, the professionals who attended (p < 0.05) to a continuous education program in Endodontics were more frequently associated to performing incisors and molars RCT in one clinical appointment (p < 0.05). CONCLUSIONS: The results of this survey indicated that even in an area where most of the population has low-income conditions, the professionals are seeking for knowledge by attending to postgraduation programs, following the new tendencies in Endodontics with most of the professionals having employed technological resources.

Dental trauma education intervention as a positive influence among undergraduate students.

OBJECTIVE: To investigate the effect of dental trauma educational intervention among undergraduate students of a Federal University in Brazil. MATERIALS AND METHODS: Students (n = 125) enrolled in the dentistry (n = 70), nursing (n = 33), and speech therapy (n = 22) courses were invited to attend a dental trauma lecture and also to answer a questionnaire about their confidence in managing crown fracture and tooth avulsion, before (T0) and immediately after (T1) the lecture. McNemar's test (P < 0.05) with logistic regression compared the answers between the courses. RESULTS: Female gender (78.4%) aged from 18 to 22 years (73.6%) predominated among all the participants. Dentistry students scored higher correct answers (54.3%) in T0 when compared to nursing (12%) and speech therapy (9%) students, concerning the storage medium for tooth fragment transportation. Likewise, few dentistry students (22.9%) and no nursing and speech therapy students knew about the ideal storage medium for an avulsed tooth when immediate replantation was unviable. After educational intervention, a significant improvement was found between T0 and T1 (P < 0.001) for all courses, mainly regarding tooth avulsion with almost 100% of correct answers. Furthermore, logistic regression demonstrated that dentistry students had three times more knowledge absorption than nursing and speech therapy ones. CONCLUSIONS: The educational intervention demonstrated a significant positive impact regarding the knowledge of dental trauma emergency management among health students. Accordingly, it is essential to spread this information among health professionals to save teeth, especially in cases of avulsion.

Singlet oxygen production by combining erythrosine and halogen light for photodynamic inactivation of Streptococcus mutans.

BACKGROUND: Photodynamic inactivation of microorganisms is based on a photosensitizing substance which, in the presence of light and molecular oxygen, produces singlet oxygen, a toxic agent to microorganisms and tumor cells. This study aimed to evaluate singlet oxygen quantum yield of erythrosine solutions illuminated with a halogen light source in comparison to a LED array (control), and the photodynamic effect of erythrosine dye in association with the halogen light source on Streptococcus mutans. METHODS: Singlet oxygen quantum yield of erythrosine solutions was quantified using uric acid as a chemical-probe in an aqueous solution. The in vitro effect of the photodynamic antimicrobial activity of erythrosine in association with the halogen photopolimerizing light on Streptococcus mutans (UA 159) was assessed during one minute. Bacterial cultures treated with erythrosine alone served as negative control. RESULTS: Singlet oxygen with 24% and 2.8% degradation of uric acid in one minute and a quantum yield of 0.59 and 0.63 was obtained for the erythrosine samples illuminated with the halogen light and the LED array, respectively. The bacterial cultures with erythrosine illuminated with the halogen light presented a decreased number of CFU mL(-1) in comparison with the negative control, with minimal inhibitory concentrations between 0.312 and 0.156mgmL(-1). CONCLUSIONS: The photodynamic response of erythrosine induced by the halogen light was capable of killing S. mutans. Clinical trials should be conducted to better ascertain the use of erythrosine in association with halogen light source for the treatment of dental caries.

Fracture resistance of weakened bovine teeth after long-term use of calcium hydroxide.

BACKGROUND/AIM: In some parts of the world, revascularization may not be the most feasible treatment option for necrotic immature teeth. Therefore, apexification remains the most widely utilized treatment option for these cases. This study aimed to evaluate the fracture resistance of weakened bovine tooth roots treated with various irrigant solutions as well as long-term application of calcium hydroxide intracanal medication (ICM). MATERIAL AND METHODS: One hundred seventy bovine teeth were randomly divided into three experimental groups (n = 50) and two control groups (n = 10). Group SS was irrigated with physiologic solution; group CHX was treated with 2% chlorhexidine gel and group NaOCl was irrigated with 1% sodium hypochlorite. After instrumentation, root canals were dressed with calcium hydroxide and evaluated at different periods (15, 60, 90, 180, and 360 days). The specimens were loaded at a 45° angle to measure fracture resistance through the use of an EMIC test machine. RESULTS: A decrease in fracture resistance was observed during the time of ICM dressing. The highest values of fracture resistance were observed in group SS with 15 days of ICM, not differing from the control group. Irrigation with NaOCl associated with ICM for 15 days presented the lowest fracture resistance; however, a statistically significant difference was not observed when compared with SS and CHX in the same time period. In longer periods of exposure to ICM (180 and 360 days), root canals irrigated with NaOCl and CHX showed significantly lower fracture resistance than SS (P < 0.05). CONCLUSION: Apexification with periodic changes of calcium hydroxide medicament leads to weakness of the teeth independent of the irrigation solution used.

Post-traumatic complications of severe luxations and replanted teeth.

AIM: The aim of this study was to evaluate the main post-traumatic complications of severe luxation and replanted teeth using clinical and radiographic analyses. MATERIALS AND METHODS: Eighty-three patients aged between 7 and 55 years old presenting 180 traumatized teeth that suffered extrusive luxation (n=67), lateral luxation (n=69), intrusive luxation (n=10) and tooth avulsion (n=34) followed by replantation were evaluated. The follow-up period was 24 months. The complications examined were: pulp canal obliteration, pulp necrosis and root resorption (infammatory and replacement). Furthermore, the relationship between time elapsed before receiving dental attendance and development of infammatory resorption was observed. RESULTS: Pulp necrosis was the main complication, occurring in 147 teeth (82.7%). All of the teeth that suffered intrusive luxation and tooth avulsion were diagnosed with pulp necrosis, with significant difference in comparison with another traumas (p<0.001/Fisher's exact test). Infammatory root resorption was observed in 20.5% of the cases and replacement resorption was more related to tooth replantation (94.1%), showing significant prevalence among tooth luxations (p<0.001/Fisher's exact test). In addition, it was noted that patients who seek treatment 9 weeks after the trauma episode presented 10 times more chance of developing infammatory resorption when compared with patients who seek treatment soon after dental trauma (Odds ratio test). CONCLUSION: It may be concluded that pulp necrosis was the main post-traumatic complication observed in traumatized teeth and that delay in seeking treatment may damage the prognosis of severe luxation and replanted teeth. CLINICAL SIGNIFICANCE: Clinical studies describing the main complications that may affect traumatized teeth present great relevance to make the population aware of the importance of seeking immediate treatment and to alert the professional to the need for follow-up. When traumatic injuries are diagnosed and treated early, post-traumatic complications may be controlled, allowing conservation of the tooth in oral cavity.

Pulp revascularization: an alternative treatment to the apexification of immature teeth / Revascularização pulpar: tratamento alternativo à apicificação de dentes jovens com rizogênese incompleta

Pulp revascularization can be considered as a current alternative treatment to apexification, recommended for immature teeth cases, requiring endodontic treatment. Apexification involves long-term periodic exchanges of a calcium hydroxide paste into the root canal to induce the formation of a calcified barrier. Despite being the most classically therapy employed for these cases, the permanence of calcium hydroxide for long periods of time and also the successive changes may lead to a weakening of the root due to its hygroscopic properties and the proteolytic activities of calcium hydroxide, increasing the risk of fractures and contamination of the pulp space. Thus, a constant search for new treatment alternatives that provide the end of root development have been done to avoid the risk of future root fractures. So, revascularization has emerged as a new treatment option for cases of undeveloped teeth, that provides not only apical closure, as apexification, but also increase the dentin walls thickness. In the literature, there is an assortment of treatment protocols employing pulp revascularization procedure in attempt to attain the best way to achieve success. Assuming the diversity of protocols for revascularization treatment, it is important to go deep in the literature to collect, describe and discuss these protocols guiding new researches in this field and also conducting the clinicians. Therefore, this review aims to assess the literature on the different revascularization protocols.

A revascularização pulpar pode ser considerada atualmente como um tratamento alternativo à apicificação e é indicado para dentes com rizogênese incompleta e necessidade de tratamento endodôntico. A apicificação envolve a realização de trocas periódicas em longo prazo de uma pasta de hidróxido de cálcio com o objetivo de formar uma barreira calcificada. Apesar de ser a terapia mais empregada, a permanência desta medicação por longos períodos e as trocas sucessivas, podem levar à fragilização da raiz devido às propriedades higroscópicas e proteolíticas do hidróxido de cálcio, aumentando o risco de fraturas e contaminação do espaço pulpar. Desta forma, tem-se buscado novas alternativas de tratamento que possibilitem o fechamento do forame apical dos dentes imaturos sem que ocorra a fragilização dos mesmos. A revascularização pulpar tem surgido como uma nova opção de tratamento para estimular o término do desenvolvimento radicular e não apenas o fechamento apical. Há na literatura uma variedade de protocolos utilizando esta técnica, buscando sempre alcançar o sucesso no tratamento. Diante dessa variedade, é de grande importância a realização de uma revisão de literatura sobre revascularização pulpar visando reunir, descrever e discutir os diferentes protocolos, para que possam direcionar novas pesquisas e ser empregada de forma adequada pelo clínico. O objetivo desse trabalho é revisar na literatura os diferentes protocolos de revascularização pulpar.

Sugestão de um novo protocolo terapêutico para dentes permanentes com ápices não completamente formados, acometidos por luxação lateral / Suggestion of a new therapeutic protocol for permanent teeth with fully formed apices not, affected by dislocation

O presente estudo tem por finalidade apresentar o relato de um caso clínico de um dente permanente, com rizogênese incompleta, acometido por luxação lateral, tratado endodonticamente por meio de: protocolo terapêutico que associa hidróxido de cálcio, clorexidina gel a 2% e óxido de zinco (na proporção de 2:1:2) como medicação intracanal, sem necessidade de substituições. A medicação normalmente utilizada no tratamento convencional de apicificação prevê trocas frequentes da pasta de hidróxido de cálcio agregado a um veículo aquoso, viscoso ou oleoso. Para a medicação proposta neste artigo, a renovação da pasta não se fez necessária. Os autores concluíram que este protocolo é eficaz para tratamento de dente permanente com ápice aberto, pois obteve-se a manutenção do elemento dentário na cavidade bucal, cumprindo suas funções estéticas e mastigatórias, com uma diminuição no custo do tratamento e nas etapas do atendimento

Traumatized immature teeth treated with 2 protocols of pulp revascularization.

INTRODUCTION: Pulp revascularization may be considered a promising alternative for traumatized necrotic immature teeth. The aim of this study was to evaluate traumatized immature teeth treated with 2 protocols of pulp revascularization. METHODS: Twenty-three teeth of young patients (7-17 years old) with necrotic upper incisors caused by dental trauma were divided into 2 groups; one group was treated with triple antibiotic paste (metronidazole, ciprofloxacin, and minocycline) (TAP) (n = 12), and the other was medicated with combination of calcium hydroxide and 2% chlorhexidine gel (CHP) (n = 11). Patients were treated and followed up for a period from 9-19 months in 2 dental institutions for evaluation of clinical and radiographic data. RESULTS: Most of the teeth were affected by lateral luxation (47.8%). Clinical evaluation in group TAP showed significant reduction in spontaneous pain (P = .01), pain on horizontal percussion (P = .007), and pain on palpation (P = .03), whereas group CHP showed significant reduction in pain on vertical percussion (P = .03). Crown discoloration was observed significantly more in teeth of group TAP (83.3%) (P < .002). On radiographic exam, periapical repair was found in all TAP-treated teeth (P = .03). Similarly, the same findings were found for all teeth treated with CHP with exception of 1 tooth (P = .21). Apical closure was significantly observed in both groups (P < .05). Increase in root length was demonstrated in 5 teeth (41.7%) and 3 teeth (27.3%) of groups TAP and CHP, respectively. Thickening of lateral dentinal walls was observed in 5 teeth of each group. CONCLUSIONS: Revascularization outcomes for traumatized patients treated with the tested protocols presented similar clinical and radiographic data. However, TAP caused esthetic problem leading to tooth discoloration, which can be considered a disadvantage when compared with CHP.

Sugestão de um novo protocolo terapêutico em dente permanente traumatizado: relato de caso / Suggestion of a new therapeutic protocol in traumatized permanent tooth: case report

Introdução: o presente Caso Clínico se refere a dois dentes, de um único paciente, que foram, inicialmente, apenas imobilizados com uma contenção semirrígida por 15 dias e sem intervenção endodôntica. Objetivo: descrever o caso de dois dentes acometidos por luxação extrusiva e tratados por meio de uma pasta obturadora composta por hidróxido de cálcio, clorexidina gel a 2% e óxido de zinco. Métodos: após o acompanhamento de um mês, notou-se que os dentes não apresentavam vitalidade pulpar e que, radiograficamente, demonstravam sinais de reabsorção externa. Foi realizado o tratamento endodôntico e a utilização desse novo protocolo terapêutico de medicação intracanal, que pode ser concluído em uma única sessão, e com possibilidade de permanência por até quatro anos no conduto radicular. Resultados: no presente relato, a pasta obturadora permaneceu no canal radicular, sem necessidade de troca, por 24 meses, com regressão das lesões periapicais e paralisação das reabsorções inflamatórias. Conclusão: diante disso, pode-se concluir que essa pasta obturadora pode demonstrar sucesso e efetividade para o tratamento de dentes traumatizados com reabsorção radicular.

Intracanal dressing paste composed by calcium hydroxide, chlorhexidine and zinc oxide for the treatment of immature and mature traumatized teeth

AIM : To evaluate clinical and radiographic aspects before and after endodontic treatment with an intracanal dressing paste composed of calcium hydroxide, chlorhexidine and zinc oxide in traumatized teeth followed-up for 1 year. METHODS : Patients (n=105) treated at the Dental Trauma Service of Piracicaba School of Dentistry, Brazil were enrolled in the study. Two groups of teeth were formed: immature (G1) (n=28) and completely developed teeth (G2) (n=174). All teeth were endodontically treated and received an intracanal dressing with a paste composed by calcium hydroxide, 2% chlorhexidine gel and zinc oxide at a 2:1:2 rate. Clinical and radiographic aspects were evaluated initially, monthly and after 1-year. RESULTS : Most of the immature teeth suffered extrusive luxation (39.3%), whereas intrusive luxation (40.8%) was more common in completely developed teeth. There was a significant reduction in pain on percussion and mobility (p=0.0001) for immature teeth. Mature teeth showed reduction of spontaneous pain, fistula, mobility and pain on percussion (p<0.0001). Radiographic examination showed decrease in all evaluated parameters for both groups, in addition to stabilization of root resorption. CONCLUSIONS : This new intracanal dressing paste for traumatized teeth showed promising results in both immature and completely developed teeth, and may prevent post-traumatic complications.

Avaliação de dentes reimplantados submetidos a um novo protocolo terapêutico / Evaluation of reimplanted teeth submitted to a new therapeutic protocol

O objetivo do presente estudo foi avaliar clínica e radiograficamente a utilização da associação do hidróxido de cálcio, clorexidina gel 2% e óxido de zinco (2:1:2), como pasta obturadora, sem substituições periódicas, em dentes reimplantados. Foram examinados dentes unirradiculares de (n=18) de 18 pacientes, de ambos os gêneros, na faixa etária de 7 a 25 anos, atendidos no Serviço te de Traumatismos Dentários da Faculdade de Odontologia de Piracicaba FOP- Unicamp, Área de Endodontia. O período médio de permanência da pasta obturadora foi de 2 anos e foram observados sinais clínicos e radiográficos antes e após sua inserção nos canais radiculares. Os dados registrados foram: presença de dor espontânea, dor à percussão vertical e horizontal, dor à palpação, infraposição, presença da lâmina dura, reabsorções radiculares inflamatórias e por substituição, áreas de radioluscência periapical e a insolubilidade da pasta obturadora após período de até 4 anos, sem trocas periódicas. Verificou-se que houve uma diferença estatisticamente significante em relação à dor espontânea, à percussão e à palpação (teste Mcnemarj p<0,05). Os resultados mostraram, também, uma redução significante na radiolucência perirradicular e nas reabsorções inflamatórias (Teste Wilcoxonj p<0,05). Conclui-se que a pasta obturadora utilizada por períodos prolongados, sem substituições periódicas, sugere ser uma alternativa para o tratamento de dentes reimplantados.

The aim of this study was to evaluate clinically and radiographically the use of combination of calcium hydroxide, chlorhexidine gel 2% and zinc oxide (2:1 :2) as a root canal filling paste without periodic replacements in reimplanted teeth. We examined single-rooted teeth (n=18), non vital, from 18 patients aged 7 to 25 years, irrespective of gender, treated at the Dental Trauma Service of the Endodontics Area, of the Piracicaba Dental School, State University of Campinas. The average time of root canal filling permanence was 2 years and during this period, clinical signs and radiographic findings were observed before and after insertion into the root canais. The data recorded was: occurrence of spontaneous pain, pain on vertical and horizontal percussion pain on palpation, infraposition of replanted teeth, presence of lamina dura, inflammatory and/or replacement root resorption, areas of periapical radiolucency and solubility of the root canal filling paste after a period of up to 4 years, without periodic exchanges. After therapy it was found that there was a significant statistically correlation between the absence of spontaneous pain, and percussion and palpation sensitivity (McNemar Test, p <0.05). The results also showed a significant reduction in cases of periradicular radiolucency and inflammatory resorption (Wilcoxon Test, p <0.05). It suggests that the root canal filling paste, used for long periods of time, without periodic replacements, can be an alternative for treatment of reimplanted teeth.

Pulp revascularization after root canal decontamination with calcium hydroxide and 2% chlorhexidine gel.

INTRODUCTION: Pulp revascularization may be considered a promising alternative for necrotic immature teeth. Many studies have accomplished passive decontamination associated with an antibiotic paste. To date, there is no report evaluating calcium hydroxide associated with 2% chlorhexidine gel for revascularization therapy. The aim of this case report was to describe a new proposal for pulp revascularization with mechanical decontamination and intracanal medication composed of calcium hydroxide and 2% chlorhexidine gel. METHODS: The patient, a 9-year-old girl, suffered an intrusion associated with pulp exposure caused by an enamel-dentin fracture in her maxillary left central incisor. After diagnosis, treatment consisted of revascularization therapy with gentle manual instrumentation of the cervical and medium thirds of the root in addition to intracanal medication with calcium hydroxide and 2% chlorhexidine gel for 21 days. In the second session, a blood clot was stimulated up to the cervical third of the root canal. Mineral trioxide aggregate (MTA; Angelus, Londrina, Paraná, Brazil) was used for cervical sealing of the canal. Coronal sealing was performed with temporary filling material and composite resin. RESULTS: During the follow-up period, the root canal space showed a progressive decrease in width, mineralized tissue deposition on root canal walls, and apical closure. A cone-beam computed tomography scan taken at the 2-year follow-up confirmed these findings and did not show complete root canal calcification. CONCLUSIONS: This new proposal for revascularization therapy with 2% chlorhexidine gel may be used for the treatment of necrotic immature root canals.

Fratura radicular horizontal no terço médio: relato de caso / Horizontal root fracture in the middle third: Case report

Introdução: apesar do traumatismo dentário ser uma das principais causas de perda de dentes permanentes, fraturas radiculares são relativamente incomuns nessas situações. Objetivo: esse trabalho tem por objetivo relatar um caso clínico de fratura radicular horizontal decorrente de traumatismo dentário e discutir suas implicações clínicas. Métodos: a fratura radicular horizontal ocorreu no terço médio do incisivo central superior com afastamento dos fragmentos. O dente foi diagnosticado com necrose pulpar, sendo, então, realizado o tratamento endodôntico. Resultados: após dois anos de proservação, por meio de tomadas radiográficas e tomográficas, não foram constatadas complicações radiculares, ou sintomatologia dolorosa, demonstrando a importância de um diagnóstico correto, que resulte num bom prognóstico, preservando a estética e a integridade psicológica do paciente.

Apicificação sem trocas periódicas de medicação intracanal e com plug apical de MTA: caso de cinco anos de acompanhamento / Apexification without periodic changes of intracanal medicament and MTA apical plug: five years follow-up of a case

Objetivo: apresentar um caso clínico de apicificação de dentes traumatizados por meio de dois diferentes protocolos de tratamento. Métodos: paciente do sexo masculino, 11 anos de idade, compareceu ao Serviço de Trauma Dental da FOP-UNICAMP, tendo sofrido fratura de esmalte e dentina, e subluxação nos dentes 11 e 21 há três anos, após sofrer um acidente ciclístico. Radiograficamente, verificou-se que os dentes apresentavam rizogênese incompleta. Após o diagnóstico de necrose pulpar, o plano de tratamento consistiu na utilização de uma pasta que associa hidróxido de cálcio, clorexidina gel a 2% e óxido de zinco, sem trocas periódicas, no dente 11, e na confecção de um plug apical de MTA no dente 21. Resultados: após o período de acompanhamento de oito meses, o fechamento apical de ambos os dentes foi observado. Após cinco anos de acompanhamento clínico e radiográfico, verificou-se que os dentes não apresentavam sintomatologia e que as lesões periapicais foram reparadas. Conclusão: concluiu-se que os dois protocolos utilizados diminuem o número de sessões e podem fornecer sucesso clínico e conforto ao paciente

Clareamento dentário associado à aplicação de fosfopeptídio de caseína-fosfato de cãlcio amorfo (CPP-ACP): relato de caso / Association between dental bleaching and application of casein phosphopeptide - amorphous calcium phosphate (CPP-ACP): Clinical report

Com a valorização da Odontologia Estética, o clareamento dentário se tornou um procedimento de rotina na prática clínica. Atualmente, as variações da técnica são em relação à análise de cor (por escala visual ou espectrofotometria), às formas de aplicação (gel, líquido, pó/líquido, tiras clareadoras) e protocolos (externo ou interno), e a minimização dos seus efeitos colaterais,como a sensibilidade. Paciente de 23 anos, do sexo masculino,encontrava-se insatisfeito com a tonalidade amarelada de seus dentes, principalmente do incisivo inferior (41). Ao exame clínico, essa diferença de cor pôde ser constatada e, em exame radiográfico, pôde-se verificar alterações no espaço pericementário do elemento 41, decorrente de trauma ortodôntico. Instituiu-se o tratamento endodôntico desse dente, seguido de procedimentos clareadores externos nos demais dentes e procedimento clareador interno no elemento 41. Em seguida, foi preconizada a aplicação da pasta de caseína fosfato de cálcio amorfo, por meio de moldeiras individuais. A análise de cor foi realizada por meio da escala Vita® e do espectrofotômetro CM-700d previamente e após o clareamento, e após aplicação da pasta. A associação de técnicas clareadoras, como no presente caso, se mostrou efetiva para o restabelecimento estético do sorriso do paciente, dentro das suas expectativas.Com a valorização da Odontologia Estética, o clareamento dentário se tornou um procedimento de rotina na prática clínica. Atualmente, as variações da técnica são em relação à análise de cor (por escala visual ou espectrofotometria), às formas de aplicação (gel, líquido, pó/líquido, tiras clareadoras) e protocolos (externo ou interno), e a minimização dos seus efeitos colaterais, como a sensibilidade. Paciente de 23 anos, do sexo masculino, encontrava-se insatisfeito com a tonalidade amareladas, como no presente caso, se mostrou efetiva para o restabelecimento estético do sorriso do paciente, dentro das suas expectativas

With the appreciation of the esthetic treatment, the dental bleaching became a daily procedure in clinical practice. Currently, the technique variations are in relation to the color analysis (by visual shade or spectrophotometry),to the application forms (gel, liquid, liquid/powder) and protocols (vital or non-vital bleaching), and to minimizing their collateral effects, as the sensibility. A 23-years-old patient, male, presented himself unsatisfied with the color of his teeth, especially in the lower incisor (#41). On the clinical evaluation, this alteration could be perceived and, on the radiographic exam, alterations in the pericemental space could be observed, probably due to the orthodontic trauma. It was indicated the endodontic treatment to the element 41 and after vital bleaching and non-vital bleaching in this tooth. Then, the application of casein phosphopeptide-amorphous calcium phosphate was recommended by means of individual appliances. The color analysis was made by means of Vita® shade guide and of spectrophotometer CM-700d before and after bleaching, and after the use of the paste. The association of the bleaching techniques, as in this case, was effective in restoring patient's esthetic smile, according to his expectations.

Role of periodontics in the treatment to traumatized teeth: a 4-year retrospective evaluation

Treatment of dental trauma should be planned based on a multidisciplinary approach. It is knownthat the maintenance of oral health in these situations depends not only on the viability of dentaltissues, but also on the periodontal damage occurred and the emergency therapeutic proceduresperformed. Aim: The purpose of this epidemiological retrospective study was to assess theperiodontal involvement in traumatized teeth treated at the Piracicaba Dental School/,UNICAMPDental Trauma Attendance Service (DTAS), during a period of 4 years. Methods: Clinical chartsof patients (n=203) treated between 2006 and 2009 at DTAS were retrospectively analyzed.Results: A total of 295 traumatized teeth were assessed about history, type of dental trauma, andperiodontal tissue damage detected during clinical and radiographic examination. Moreover, thetreatment associated with periodontal damage resolution was also determined. Of the 295traumatized teeth, 184 had periodontal damage (62.3%) and from this total, crown-root fractureswith invasion of biological width were found in 42% of the cases, followed by bone injury (30%).Regarding the periodontal treatment performed, periodontal surgery to re-establish the biologicalwidth prevailed between procedures with 39% of the cases. Conclusions: It could be concludedthat Periodontics has an essential role in the multidisciplinary approach for the treatment of traumatizedpatients and that the conjunct work is important to re-establish the overall oral health.

Antibacterial photodynamic therapy for dental caries: evaluation of the photosensitizers used and light source properties.

Photodynamic therapy studies have shown promising results for inactivation of microorganisms related to dental caries. A large number of studies have used a variety of protocols, but few studies have analyzed photosensitizers and light source properties to obtain the best PDT dose response for dental caries. This study aims to discuss the photosensitizers and light source properties employed in PDT studies of dental caries. Three questions were formulated to discuss these aspects. The first involves the photosensitizer properties and their performance against Gram positive and Gram negative bacteria. The second discusses the use of light sources in accordance with the dye maximum absorbance to obtain optimal results. The third looks at the relevance of photosensitizer concentration, the possible formation of self-aggregates, and light source effectiveness. This review demonstrated that some groups of photosensitizers may be more effective against either Gram positive or negative bacteria, that the light source must be appropriate for dye maximum absorbance, and that some photosensitizers may have their absorbance modified with their concentration. For the best results of PDT against the main cariogenic bacteria (Streptococcus mutans), a variety of aspects should be taken into account, and among the analyzed photosensitizer, erythrosin seems to be the most appropriate since it acts against this Gram positive bacteria, has a hydrophilic tendency and even at low concentrations may have photodynamic effects. Considering erythrosin, the most appropriate light source should have a maximum emission intensity at a wavelength close to 530 nm, which may be achieved with low cost LEDs.