Iodoform Vs Calcium Hydroxide/Zinc Oxide based pastes: 12-month findings of a Randomized Controlled Trial.

This study evaluated clinical and radiographic twelve-month outcomes of root canal treatments (CT) with smear layer removal, performed in primary teeth, using two different root canal filling materials. Pulpectomy was performed on 27 primary teeth with necrosis or irreversible pulpitis, caused by dental caries or trauma, in 23 children (2-7 years old). A single trained operator performed the CT in a single visit in cases without periapical or interradicular radiolucency (PIR) or in multiple visits in cases with PIR. Participants were selected based on specific inclusion and exclusion criteria, and randomly allocated into two groups: Group 1 (G1) - iodoform paste (iodoform + camphorated parachlorophenol + ointment comprising prednisolone acetate 5.0 mg and rifamycin 1.5 mg); Group 2 (G2) - Calen®/ZO paste. Treated teeth were restored with composite resin immediately after the root canal filling. The outcomes were evaluated clinically and radiographically according to specific criteria. Two blinded and standardized evaluators assessed the radiographic outcomes. We used descriptive analyses due to the small sample size. CTs were performed due to caries lesions in 70.4% of the cases and due to trauma in 29.6%. Only one tooth of G1 was unsuccessful; hence, pulpectomy performance in both groups was not influenced by the filling material, nor by any other analyzed variable. The level of the root canal filling was better in the Calen®/ZO group. The clinical and radiographic twelve-month outcomes indicated successful treatment, independently of the root filling material used.

Iodoform Vs Calcium Hydroxide/Zinc Oxide based pastes: 12-month findings of a Randomized Controlled Trial

Abstract This study evaluated clinical and radiographic twelve-month outcomes of root canal treatments (CT) with smear layer removal, performed in primary teeth, using two different root canal filling materials. Pulpectomy was performed on 27 primary teeth with necrosis or irreversible pulpitis, caused by dental caries or trauma, in 23 children (2-7 years old). A single trained operator performed the CT in a single visit in cases without periapical or interradicular radiolucency (PIR) or in multiple visits in cases with PIR. Participants were selected based on specific inclusion and exclusion criteria, and randomly allocated into two groups: Group 1 (G1) - iodoform paste (iodoform + camphorated parachlorophenol + ointment comprising prednisolone acetate 5.0 mg and rifamycin 1.5 mg); Group 2 (G2) - Calen®/ZO paste. Treated teeth were restored with composite resin immediately after the root canal filling. The outcomes were evaluated clinically and radiographically according to specific criteria. Two blinded and standardized evaluators assessed the radiographic outcomes. We used descriptive analyses due to the small sample size. CTs were performed due to caries lesions in 70.4% of the cases and due to trauma in 29.6%. Only one tooth of G1 was unsuccessful; hence, pulpectomy performance in both groups was not influenced by the filling material, nor by any other analyzed variable. The level of the root canal filling was better in the Calen®/ZO group. The clinical and radiographic twelve-month outcomes indicated successful treatment, independently of the root filling material used.

Enfermedades pulpares y periapicales en pacientes sistémicamente comprometidos en el Centro de Salud de Uayma, Yucatán, México / Pulp and periapical diseases in systemically compromised patients: Health Center of Uayma, Yucatan, Mexico

Introducción: el diagnóstico preciso de las enfermedades pulpares y periapicales es una fase en que se evalúan los factores sistémicos y locales. La diabetes es un ejemplo de enfermedad sistémica crónica degenerativa. En México en el 2012, se reportaron 418 797 casos, así como otras enfermedades asociadas, como son la hipertensión arterial y la insuficiencia renal. Objetivo: determinar la frecuencia de enfermedades pulpares o periapicales en pacientes sistémicamente comprometidos que acudieron al Centro de Salud de Uayma, Yucatán, México durante el 2013. Métodos: estudio descriptivo observacional. El universo fue de 689 pacientes. El muestreo fue no probabilístico, por conveniencia de 100 pacientes de 18 y más años de edad que presentaron alguna enfermedad sistémica y enfermedad pulpar o periapical. Bajo un consentimiento informado y voluntario se realizó, previa evaluación médica por el galeno adjunto, una historia dental, evaluación de los signos y síntomas de dolor, pruebas pulpares (térmicas y eléctricas), palpación y percusión y abordaje diagnóstico con tinción/transiluminación, así como la toma, examinación e interpretación de las imágenes radiográficas periapicales para confirmar el diagnóstico de enfermedades periapicales. Para el procesamiento de los datos se empleó la estadística descriptiva. Resultados: el 67 por ciento presentó enfermedades pulpares o periapicales. Se analizaron 106 órganos dentales, 41,5 por ciento manifestaron enfermedades pulpares y 58,5 por ciento periapicales; entre estas la más prevalente fue el absceso dentoalveolar crónico con 45,2 por ciento. La enfermedad sistémica que prevaleció fue la diabetes mellitus con 38 por ciento, la cual se presentó acompañada con hipertensión en 17 por ciento y con epilepsia en el 1 por ciento. De estos pacientes con diabetes mellitus, la enfermedad más frecuente fue la periapical con 53,6 por ciento. Conclusiones: en el paciente sistémicamente comprometido existe una frecuencia alta de las enfermedades pulpares y periapicales. La presencia de estas manifestaciones puede ser consecuencia de una respuesta de la pulpa dental ante la ausencia de un tratamiento odontológico oportuno y de la condición sistémica del paciente(AU)

Introduction: accurate diagnosis of pulpal and periapical diseases is a phase in which systemic and local factors are evaluated. Diabetes is an example of chronic degenerative systemic disease. In 2012, there were 418 797 cases as well as other associated diseases, such as hypertension and renal failure in Mexico. Objective: to determine the frequency of pulpal and periapical diseases in systemically compromised patients who attended the Health Center Uayma, Yucatan, Mexico in 2013. Methods: observational and descriptive study was conducted. The universe of study was 689 patients. A non-probabilistic, convenience sampling of 100 patients aged 18 and older, which had some kind of systemic disease and also pulpal or periapical disease. With the voluntary informed consent and a prior medical evaluation by the attending physician, a dental history, the assessment of pain signs and symptoms of pain, pulp testing (thermal and electrical), palpation and percussion and diagnostic approach with staining/transillumination were made as well as radiographic periapical images were taken, analyzed and interpreted to confirm the diagnosis of periapical diseases. Summary statistics was used for data processing. Results: sixty-seven percent of patients had pulpal or periapical diseases. One hundred and six dental organs were analyzed, 41.5 percent showed pulpal diseases and 58.5 percent periapical diseases, being the chronic dentoalveolar abscess with 45.2 percent the predominant one. Prevailing systemic disease was diabetes mellitus with 38 percent of cases, accompanied with hypertension in 17 percent and epilepsy in 1 percent of patients. In the diabetic patients, the most common disease was the periapical one for 53.6 percent. Conclusions: the systemically compromised patient faces highly frequent pulpal and periapical diseases. They may result from the response of the dental pulp to the lack of timely odontologic treatment and the systemic condition of the patient(AU)

Avaliação da ocorrência de ramificações dos canais mandibulares em regiões afetadas ou não por inflamação por meio de tomografia computadorizada de feixe cônico / Mandibular canal branching and dental inflammation assessed through cone beam computed tomography

O canal mandibular precisa ser considerado em diversos procedimentos odontológicos, com vistas a evitar injúrias do nervo alveolar inferior. A ocorrência de variações anatômicas do canal mandibular aumenta o risco de lesões neurovasculares. Sensibilidade aumentada e falhas em procedimentos anestésicos em mandíbulas, especialmente em casos com inflamação, também podem estar relacionadas com alterações da inervação local. Este estudo visou avaliar a ocorrência de ramificações dos canais mandibulares em regiões afetadas por inflamação dentária, por meio de tomografia computadorizada de feixe cônico (TCFC), com o intuito de verificar se há algum relacionamento entre ramificações e inflamação. Uma base de dados de 2.484 TCFCs foi revisada para identificar ramificações dos canais mandibulares e inflamação dentária. A amostra final foi pareada para idade e gênero. As ramificações próximas aos dentes posteriores foram consideradas como variável dependente. A ocorrência e localização de inflamação dentária, assim como as medidas dos níveis de cinza nas mesmas regiões, foram consideradas como variáveis independentes. Os testes de Kolmogorov-Smirnov, Qui-quadrado, teste-T e análise por regressão logística foram aplicados para verificar o relacionamento estatístico dos dados (P<0,05). As lesões mais relacionadas às ramificações foram lesões endoperio e lesões apicais. Gênero (P=0,308) e idade (P=0,728) não mostraram associação com a ocorrência de ramificações dos canais mandibulares. A ocorrência de inflamação aumentou o risco para a ocorrência de ramificações dos canais mandibulares próximas aos dentes posteriores. (P<0,001; OR=11,640; IC-95%: 4.327-31.311). As lesões mais frequentemente associadas com as ramificações apresentaram origem endodôntica. Foi verificada associação entre as ramificações dos canais mandibulares e inflamação dentária na região dos dentes posteriores

The mandibular canal must be considered in several dental procedures in order to avoid injuries of the alveolar inferior nerve. The occurrence of anatomical variations of the mandibular canal increases the risk of neurovascular injuries. An increased sensitivity and failed anesthetic procedures in mandibles, especially in cases with inflammation, can be also related with alterations of the local innervation. This study aimed to assess the occurrence of mandibular canal branching (MCB) in alveolar ridges affected by dental inflammation by means of cone beam computed tomography (CBCT), in order to verify if there is some relationship between MCB and dental inflammation. A database of 2,484 CBCTs was reviewed for identifying mandibular canal branching (MCB) and dental inflammation in mandibular alveolar ridges. The final sample was matched by age and gender. MCB nearby the posterior teeth was considered as the dependent variable. Dental inflammation occurrence and location as well as measurements of gray levels at the same region were assessed as independent variables. The Kolmogorov-Smirnov, Chi-square, T-test and multiple logistic regression analysis were applied to verify the statistical relationship of the data (P<0.05). The most frequent inflammatory lesion was apical radiolucency with endodontic origin. The lesions mostly related to MCB were combined endodontic and periodontal lesions and apical lesions. Gender had no influence on mandibular canal branching (P=0.308), not did age (P=0.728). The occurrence of dental inflammation increased the risk for occurrence of the MCB nearby posterior teeth (P<0.001; OR=11.640; CI-95% 4.327-31.311). The gray levels had a minor role on the presence of MCB (P=0.002; OR=1.002; CI95% 1.002-1.003). The lesions most often associated with the branches had endodontic origin. An association between MCB situated around the posterior teeth and dental inflammation was found

Midbuccal canals of maxillary molars evaluated by cone-beam computed tomography: endodontic management of two cases.

Maxillary molars present variable root canal and root morphologies. This report describes the endodontic management of two cases of midbuccal canals found in maxillary molars. Midbuccal canals were present in a maxillary first molar with a single buccal root (Case 1), and in a maxillary second molar with three buccal roots (Case 2). An assessment of the internal configuration of these teeth was performed using cone-beam computed tomography (CBCT). Magnification with a dental operating microscope, surgical loupes, and the use of an endodontic explorer enabled the identification of the midbuccal canal orifices. The root canals in both cases were chemomechanically prepared and filled. Postobturation radiographic images revealed four (one midbuccal, two mesiobuccal and one palatal) and five (one midbuccal, two mesiobuccal, one distobuccal and one palatal) root canals, which were filled in Cases 1 and 2, respectively. Complex canal configurations of maxillary molars including the presence of midbuccal canals were presented. CBCT was a valuable tool in this diagnosis, as it provided a precise description of these unusual anatomical variations.

Microflora associated with primary endodontic infections: correlations among SEM evaluation, clinical features, and radiographic findings.

The aim of the present study was to characterize, by means of SEM, primary endodontic infections and to correlate with clinical and radiographic findings. Twelve (12) human extracted teeth (19 roots) presenting primary endodontic infection were examined. SEM qualitative observations of bacterial and defense cells, their features and distribution within the root canal lumen and root dentine were recorded for association with clinical and radiographic tabled data. Although a direct correlation between biofilm composition and clinical/radiographic findings was not established, structural organization and distribution of the biofilm, as well as the characteristics of host response, could be easily related to those features. Bacterial biofilm was predominant at the apical third. Symptomatic apical periodontitis was related to presence of bacterial biofilm all thirds. Defense cells could be seen in the apical third of some samples. These cells were present in all thirds in some of the cases with open cavities. The correlations performed in this study allowed a better understanding of the picture of primary endodontic infection, host response and relevant clinical features. The combined use of scanning electron microscopy with clinical and radiographic evaluation has the potential to overcome some limits of the current knowledge related to pulpal and periapical diseases, providing important insights for improving treatment strategies.