Dissimilar Sequelae Caused by Single Dental Trauma: A Case Report with Long-Term Follow-up.

Immediate care and accurate diagnosis are essential for treating dental trauma. This report presents a 7-year-old boy suffered a bicycle accident with direct trauma to the mouth and extrusive luxation of teeth #11 and #21. The emergency treatment was performed within the first hour. Clinical examinations showed that both teeth exhibited 3 mm extrusion from comparing their incisal edges to their neighboring teeth, had edematous gingiva, showed grade 3 mobility and were painful to percussion. Radiographic exams showed incomplete root formation, widened periodontal spaces along their entire lengths and absence of bone or root fractures. The treatment consisted of immediate repositioning and semi-rigid splinting. After 15 days, tooth #11 exhibited no clinical signor symptom and tooth #21 was diagnosed with pulp necrosis, with an acute dentoalveolar abscess and intraoral edema. Immediate endodontic treatment was initiated (intracanal dressing with calcium hydroxide paste). At 30 days, another pulp sensibility test was performed on tooth #11, which had a negative response. In the same visit, the intracanal dressing of tooth #21 was replaced. The Ca(OH)2 medication was replaced every 6 months until the formation of an apical barrier. The final dressing consisted of gutta-percha and Grossman's sealer and was placed two and a half years after the first dressing appointment. The extrusive luxation resulted in two different sequelae: complete root obliteration in tooth #11 and anomalous root development after the formation of an apical barrier in tooth #21. The patient received orthodontic treatment after 6 years from the initial treatment with no negative outcome. After 18 years follow-up, both teeth were stabilized with no symptom or sign. It's important to follow the evolution of every trauma case continuously because the sequelae can be unpredictable.

Effect of Different Root Canal Drying Protocols on the Bond Strength of Two Bioceramic Sealers.

OBJECTIVES: This study evaluated in vitro the effect of two different drying protocols on the dentin bond strength of two different bioceramic sealers (Sealer Plus BC [SP] and Bio C Sealer [BCS]). Bond strength and failure mode were evaluated according to the sealer, drying protocol, and root canal third. MATERIALS AND METHODS: Sixty extracted human mandibular single-rooted premolars were selected after anatomical standardization. The crowns were sectioned and root canals were prepared. Roots were randomly divided into four groups (n = 15 each). Each group was assigned a combination of one of the evaluated sealers (SP or BCS) and one of the drying protocols: canals dried with paper points (PP) or irrigation with saline followed by aspiration with silicon cannulas (IA). Obturations were performed using a single-cone technique. The teeth were temporized and stored for 7 days (100% humidity, 37°C). Roots were cut to obtain 2 mm thick discs for each third (coronal, middle, and apical). Push-out tests were performed on a universal testing machine, and the bond strength (MPa) of each specimen was calculated by dividing the load (N) by the interface area. Failure type was assessed under ×4 magnification. STATISTICAL ANALYSIS: Data were statistically analyzed with a significance set at 5%. An analysis of variance test followed by the Games-Howell post-hoc test was used to compare the mean values between the groups and the interaction of the variables. RESULTS: The predominant failure type was cohesive, followed by mixed failure and adhesive in all groups. The apical third presented the highest bond strength (p < 0.05) regardless of the group, followed by the middle and coronal thirds. Overall, the SP PP group had the highest mean bond strength (p < 0.01), but the SP sealer was negatively affected by the IA drying protocol in the coronal and middle thirds. The BCS presented similar results within the third stage, regardless of the drying protocol. CONCLUSIONS: Sealer Plus BC had a higher bond strength than Bio C Sealer, but it was negatively affected by the irrigation-aspiration protocol in the coronal and middle thirds. For the apical third, there was no difference between the groups; thus, a similar bond strength was observed regardless of the drying protocol or sealer.

Regenerative Endodontic Treatment of a Traumatized Immature Necrotic Permanent Incisor: A Case Report.

The current case report documents the clinical approach adopted for a traumatized immature necrotic permanent upper left central incisor after a bike accident. The treatment involved regenerative endodontic procedures (REPs) using "High Plasticity Mineral Trioxide Aggregate" (MTA Repair HP) as a cervical barrier over blood clot. The preservation included three years of follow-up appointments of clinical evaluations and periapical digital radiographs. Cone beam computer tomography (CBCT) was taken at six and thirty-six months for the evaluation of root development.

Percentage of Gutta-Percha-, Sealer-, and Void-Filled Areas in Oval-Shaped Root Canals Obturated with Different Filling Techniques: A Confocal Laser Scanning Microscopy Study.

OBJECTIVE: This study compared different obturation techniques, analyzing percentage of areas filled with gutta-percha, sealer, and voids (PGFA, PSFA, and PVFA, respectively) in oval-shaped root canals. MATERIALS AND METHODS: A total of 60 extracted human mandibular central incisors were decoronated, instrumented, and irrigated using the same protocol. After drying, the root canal was filled with AH Plus labeled with 0.1% rhodamine B dye using a Lentulo spiral. The filling procedure was performed by dividing the teeth into four groups according to the respective technique: G1, cold lateral condensation; G2, continuous wave of condensation; G3, modified cold lateral condensation using an F3 master cone; and G4, modified continuous wave of condensation using an ISO (International Organization for Standardization) sized 30 gutta-percha cone. Then, slices measuring 1.5 mm in thickness were obtained 3 and 6 mm from the apex and evaluated by confocal laser scanning microscopy to determine PGFA, PSFA, and PVFA. STATISTICAL ANALYSIS: The data were analyzed statistically with analysis of variance and Games-Howell's tests (p = 0.05). RESULTS: The groups showed no significant differences in the apical third (3 mm from the apex). In the middle third (6 mm from the apex), G3 and G1 showed higher PGFA and PVFA, respectively. G3 showed lower PSFA than G2 and G4. Both cold techniques (G1 and G3) promoted lower PSFA than both warm techniques (G2 and G4). CONCLUSIONS: Notwithstanding the limitations of this in vitro study, PGFA, PSFA, and PVFA ranged significantly only in the middle third, as observed by the different filling techniques. Higher PGFA and PVFA values were obtained for G3 and G1, respectively. Both cold techniques promoted lower PSFA than both warm techniques.

Microscopic evaluation of the dentinal walls of extracted human teeth following electrochemical dissolution of fragmented nickel-titanium instruments.

Electrochemical dissolution is a method in which fluoridated solution in direct contact with the fractured instrument receives an electrical current that speeds up fragment dissolution. The aim of this study was to assess the integrity of dentinal walls during the electrochemical dissolution of fractured rotary endodontic instruments in extracted human teeth. Forty-five human mandibular incisors subjected to the electrochemical dissolution process using fluoride solution with low NaCl concentration (LC group: NaF 12 g/L + NaCl 1 g/L, pH = 5.0), fluoride solution with saturating NaCl concentration (SC group: NaF 12 g/L + NaCl 180 g/L, pH = 5.0) and distilled water (control group) were evaluated. For each group, 15 incisors were submitted for the scanning electron microscopy (SEM) evaluation. The roots were sectioned longitudinally; each hemisection was analyzed (n = 30), and energy-dispersive spectroscopy (EDS) was performed. The amount of dentinal tubule openings was analyzed by SEM. Statistical analyses were performed. The test solutions did not alter the amount of dentinal tubule openings when compared with the control group. No Ni or Ti was impregnated into the dentinal tubules after electrochemical techniques. The dentinal structure remained unchanged following the electrochemical dissolution method.

Management of Dental Intrusion and Lateral Luxation: Case Report with 10 Years Follow-up.

This case report documents the clinical approach adopted for two maxillary incisors with intrusion and lateral luxation trauma. The proposed procedures involved reposition of both teeth, one of them with surgical extrusion and endodontic procedure for both, with 10 years of follow-up.

Fracture strength of teeth with access cavity preparation with operating microscope or on buccal surfaces / Resistência à fratura de dentes submetidos a cavidade de acesso endodôntico com microscópio operatório ou nas faces vestibulares

Objective: The present study assessed the fracture strength of teeth subjected to endodontic access cavity preparation on buccal surfaces, or with the aid of operating microscopy when compared to the conventional technique. Material and methods: Sixty mandibular incisors were split into four groups (n=15): conventional access cavity preparation (CCP); conservative (C); buccal surface (BS); and control. The canals were prepared and filled and the cavities were restored. A static compressive strength test was conducted until crown fracture. The force data were compiled and assessed statistically. Kolmogorov-Smirnov and ShapiroWilk tests were performed to assess normality, Levene's test to assess variance homogeneity, the one-way ANOVA to compare fracture strength in the assessed groups. Tukey's HSD test was used to determine whether the differences in the means were significant between the groups. Results: The experimental groups did not show any statistically significant differences in mean fracture strength (CCP = 585.65 N±107.64 N)(BS = 530.52 N±129.35 N) (C = 517.83 N±114.68 N). Conclusion: Therefore, the selection of surface or size of access cavity proposed did not influence the fracture strength of mandibular incisors when compared to conventional cavity preparation (AU)

Objetivo: O presente estudo avaliou a resistência à fratura compressiva de dentes submetidos as cavidades de acesso endodôntico nas faces vestibulares, ou com o auxílio de microscópio operatório quando comparados à técnica convencional. Material e métodos: Sessenta incisivos inferiores foram divididos em quarto grupos (n=15): cavidade de acesso convencional (CAC); conservadora (C); na face vestibular (FV); e controle. Os canais foram preparados e obturados, e as cavidades restauradas. O teste estático de resistência compressiva foi procedido até a fratura coronária. Os dados de força foram compilados e analisados estatisticamente. Os testes de KolmogorovSmirnov e Shapiro-Wilk foram realizados com o intuito de avaliar a normalidade. O teste de Levene para verificar a homogeneidade de variâncias. O teste de análise de variância a um critério (ANOVA) para comparar a resistência à fratura entre os grupos. O teste de Tukey HSD foi realizado para determinar se as diferenças entre as médias dos grupos apresentava significância. Resultados: Os grupos experimentais não apresentaram diferenças estatisticamente significantes com relação a média de resistência à fratura. (CAC = 585.65 N±107.64 N)(FV = 530.52 N±129.35 N) (C = 517.83 N±114.68 N). Conclusão: Portanto, a variação da face ou do tamanho da cavidade de acesso endodôntico não exerceram influência na resistência à fratura de incisivos inferiores quando comparados a tradicional cavidade de acesso endodôntico. (AU)

Management of Multiple Dental Trauma: Case Report with Eight-Year Follow-up.

This case report documents the clinical approach adopted for two maxillary incisors with intrusion and horizontal root fracture in the middle third after trauma. The proposed procedures involved maintaining pulp vitality and periodontal stability of the fractured teeth with 8 years of follow-up.

Maintenance of Pulp after Horizontal Root Fractures in Three Maxillary Incisors: A Thirteen-Year Evaluation.

This case report documents the clinical approach adopted for three upper incisors with horizontal root fracture in the middle or cervical third. The proposed procedures involved maintaining pulp vitality and periodontal stability of the fractured teeth with 13 years of follow-up.

Influência do comprimento das limas na qualidade do preparo do canal radicular / Influence of file length on the quality of root canal preparation

Introdução: diversos fatores relacionados às características dos instrumentos ­ como secção transversal, design da ponta e conicidade ­ podem intensificar a ação de ampliação das paredes do canal radicular. No entanto, não é claro se o comprimento das limas pode interferir na qualidade do preparo. Objetivo: o objetivo deste trabalho foi avaliar a influência do comprimento das limas na qualidade do preparo manual do canal radicular. Métodos: trinta canais simulados (IM do Brasil) foram divididos em dois grupos e preparados com limas FlexoFile de 21 mm e de 25 mm. A técnica coroa-ápice foi utilizada e o limite apical de alargamento foi de uma lima de diâmetro 35. Os canais radiculares simulados foram fotografados e radiografados antes e depois dos preparos, e as imagens foram analisadas utilizando-se o programa Image Tool 3.0. A distribuição do desgaste das paredes dos canais e o desvio apical foram analisados sobrepondo-se as imagens. Resultados: não foi observada diferença estatisticamente significativa entre os grupos, com relação à distribuição dos desgastes das paredes dos canais ou com relação ao desvio apical. Conclusão: o comprimento das limas não influenciou na centralização do preparo do canal radicular, nem no desvio apical de canais simulados.

Evaluation of cutting ability and plastic deformation of reciprocating files.

This in vitro study evaluated the cutting ability of reciprocating files and the deformations caused by their multiple use. Five Reciproc® R25 files were divided into five groups for 10 simulated root canal preparations each. The resin blocks were weighed and photographed (12.5X and 20X) before and after preparation. The canals were prepared according to the manufacturer's instructions. Enlargement of the root canals was evaluated by comparison of pre- and post-preparation images using a computer software. The preoperative and postoperative weight differences determined the cutting ability of repeatedly used instruments. The data were analyzed using Lilliefors and Friedman statistical tests. The cutting ability and enlargement of the canals gradually decreased after each use, with significant differences observed at the 8th and 9th repetitions, respectively. There was no evidence of file deformation. The cutting ability and enlargement of the simulated canals gradually decreased when a reciprocating file was used up to 10 times.

Evaluation of cutting ability and plastic deformation of reciprocating files

Abstract This in vitro study evaluated the cutting ability of reciprocating files and the deformations caused by their multiple use. Five Reciproc® R25 files were divided into five groups for 10 simulated root canal preparations each. The resin blocks were weighed and photographed (12.5X and 20X) before and after preparation. The canals were prepared according to the manufacturer’s instructions. Enlargement of the root canals was evaluated by comparison of pre- and post-preparation images using a computer software. The preoperative and postoperative weight differences determined the cutting ability of repeatedly used instruments. The data were analyzed using Lilliefors and Friedman statistical tests. The cutting ability and enlargement of the canals gradually decreased after each use, with significant differences observed at the 8th and 9th repetitions, respectively. There was no evidence of file deformation. The cutting ability and enlargement of the simulated canals gradually decreased when a reciprocating file was used up to 10 times.

Influence of calcium hydroxide dressing and two irrigants on the filling of artificial lateral canals.

CONTEXT: This study was carried out on the assumption that calcium hydroxide [Ca(OH) 2 ] dressing and irrigants may influence the obturation of lateral canals. AIMS: To evaluate the influence of 2.5% sodium hypochlorite (NaOCl), 2% chlorhexidine (CHX) gel and Ca(OH) 2 on the filling of artificial lateral canals. SETTINGS AND DESIGN: Ex vivo quantitative laboratory study. MATERIALS AND METHODS: Forty-two human mandibular premolars were selected. After cavity access, six lateral canals were performed, two in each root section, one mesial and one on the distal root surface. After preparation, the specimens were randomly divided into four groups: Group I: Under irrigation with 2% CHX and saline solution and with intracanal dressing Ca(OH) 2 paste; Group II: The same preparation as Group I, but without Ca(OH) 2 ; Group III: Under irrigation with 2.5% NaOCl without Ca(OH) 2 ; and Group IV: The same preparation as Group III, but with Ca(OH) 2 . Two teeth without intracanal dressing were used as negative controls. Lateral condensation technique was performed. Then, digital radiographic images were obtained. STATISTICAL ANALYSIS USED: Data were analyzed using SPSS 17.0, submitted to Kappa (reliability between examiners) and Kruskal-Wallis test. RESULTS: No statistical difference was registered between Groups II and III in all root sections (P > 0.05), but it was observed between Groups I and IV (P < 0.05), except on the apical section (P > 0.05). In all sections, the Group I filled more artificial lateral canals than in Group IV. CONCLUSIONS: The irrigants tested had no influence on the filling of artificial lateral canals. Nevertheless, intracanal dressing of Ca(OH) 2 influenced this filling.

A implementação do uso dos sistemas rotatórios em endodontia / The implementation of rotary systems in endodontics

A introdução da técnica de instrumentação rotatória com instrumentos de níquel-titânio (NiTi) diminuiu o número de erros operatórios e aumentou a qualidade dos tratamentos endodôntico. Contudo, poucos trabalhos, no Brasil e no mundo, mostram a difusão do uso de técnicas rotatórias entre os profissionais que realizam endodontia. O presente estudo tem como objetivo analisar o grau de implementação do preparo de canais radiculares com sistemas rotatórios de NiTi na endodontia no Brasil. Para a coleta de dados, foi desenvolvido um questionário on-line autoaplicável composto por 16 questões, enviado para 250 endereços eletrônicos. Das 108 respostas obtidas, os dados analisados nos permitiram observar que 71% eram especialistas em endodontia e 26% estavam cursando a pós-graduação; 88% utilizavam instrumentação mecanizada e, desses, 55% combinavam a rotação contínua com a alternada e, 41% faziam usoapenas da rotação contínua. O risco de fratura e custo operacionalforam os principais motivos abordados para a não implementação dos sistemas rotatórios de NiTi em endodontia.

The use of NiTi rotary instruments in Endodontics increased the quality of endodontic treatments and reduced the number of errors during root canal preparation. There are few papers in Brazil and around the world analyzing the diffusion of this new technology. The aim of this study involving Brazilian dentists was analyzed the accept of the new technologic in Endodontics. The increased purchasing of this new technology does not necessarily lead to correct use and incorporation into practice. A questionnaire survey comprising 16 questions was sent to 250 students and endodontics?s e-mails. The sampling frame was 108, comprising 71% specialists and 26% postgraduate students. Rotary instruments were used by 88%, 55% of them used rotary and alternatedrotation system and 41% only rotary instrumentation. Fracture and the high cost of the instruments were the main reasons for not using rotary NiTi in endodontics.

Regeneração endodôntica: existe um protocolo? / Endodontic regeneration: is there a protocol?

O tratamento de dentes com rizogênese incompleta e necrose pulpar representa grande desafio para a terapia endodôntica. O panorama atual recai no conceito de regeneração do tecido pulpar. A endodontia regenerativa propõe o controle da infecção do sistema de canais radiculares, com o mínimo de ação dos instrumentos, farta irrigação. Vários protocolos têm sido propostos com variáveis pequenas, sem um consenso entre os autores. O presente artigo descreve e discute os três principais protocolos e suas variáveis, especificando os pontos mais obscuros de uma terapia que é o mais excitante novo campo da Endodontia e cujos avanços proporcionarão benefícios inestimáveis para toda a população. Importa considerar que o sucesso da regeneração deve atender três principais objetivos: primeiro aeliminação dos sintomas e a evidenciação de reparo dos tecidos periapicais; segundo promover espessamento das paredes do canal e/ou a continuidade da formação radicular (desejável, mas não essencial) e terceiro, obter resposta positiva aos testes de vitalidade, que, se alcançado certamente indicará a presença de um tecido pulpar mais organizado.

Treatment of immature permanent teeth with pulpal necrosis presents a unique challenge to the endodontists. The current panorama lies in the concept of pulpal tissue regeneration. Endodontic regeneration is based on the control of endodontic infection with minimal instrumentation and plentiful irrigation of the root canal system. Different protocols have been suggested with very little differences. The aim of this article is to present the main three basic protocols and their variables, specifying the darkest points of a therapy that is the most exciting new of Endodontics and advances will provide invaluable benefits to the entire population. It considers that the success of regeneration must meet three main goals: primary: the elimination of the symptoms and the evidence of bony healing; secondary: increased root wall thickness and/or increased root length (desirable but perhaps not essential); tertiary: positive response to vitality testing (wich, if achieved, could indicate a more organized vital pulp tissue).

Atendimento endodôntico emergencial de paciente com diagnóstico inconclusivo para doença de von Willebrand / Emergency endodontic care of patient with inconclusive diagnosis of von Willebrand disease

Introdução: pacientes com distúrbios hemorrágicos precisam de cuidados especiais quando submetidos a procedimentos odontológicos. Objetivos: fornecer informações sobre como tratar um paciente com um diagnóstico provável da doença de von Willebrand e abscesso periapical agudo no dente 23. Métodos: paciente do sexo feminino, leucoderma, 35 anos de idade, se dirigiu ao Pronto Atendimento Odontológico da Faculdade de Odontologia da Universidade Federal do Paraná, apresentando cárie extensa abaixo do nível gengival, projetando-se para o palato, também com fratura da coroa, expondo o canal radicular ao meio bucal. A atenção estava focada em isolar o campo operatório, o que não poderia ser feito de forma convencional devido à extensão da cárie, à proliferação de tecido gengival e às condições sistêmicas do paciente. Conclusão: a estratégia utilizada nesse caso foi eficaz na gestão da coagulopatia e permitiu cuidados de emergência a serem realizados sem complicações.

Retratamento: protaper para retratamento X técnica híbrida manual / Retreatment: protaper x hibrid manual technique

O objetivo do presente estudo foi avaliar a capacidade de remoção do material obturador nos retratamentoscom o sistema Protaper Universal-Retratamento e com técnica híbrida manual auxiliada pelos instrumentosPré-Race. Foram selecionados vinte e quatro dentes humanos incisivos inferiores com comprimentos entre19 e 21mm os quais foram preparados e obturados, e armazenados em ambiente de umidade relativa de100% por 180 dias. Completado este período, os dentes foram radiografados individualmente no sentidomesio-distal e vestíbulo-lingual e divididos aleatoriamente em dois grupos. Os dentes do Grupo 1 foramdesobturados empregando-se os instrumentos Protaper Universal - Retratamento, D1, D2 e D3 seguindoseo preparo com instrumentos F1 e F2; no Grupo 2 os dentes foram desobturados empregando-se técnicahíbrida manual com auxilio dos instrumentos Pré-Race. Os dentes foram novamente radiografados em ambosos sentidos, as imagens digitalizadas e a medição linear das paredes foram realizados pelo softwareImage Tool 3.0. Os resultados mostraram diferenças estatisticamente significantes no remanescente quandoProtaper Universal - Retratamento foi empregado e com o uso de F1 e F2 em ambos os sentidos. A técnicahíbrida manual apresentou melhores resultados.

The aim of this study was to evaluate the ability of the Protaper Retreatment and a hybrid manualtechnique on removing the root canal filling during retreatment. Twenty-four human incisors teeth were selected,prepared and filled with gutta-percha and Endo Fill cement in a lateral condensation technique andstored for 180 days. The teeth were radiographed mesio-distally and bucco-lingually , and digitalized. Theteeth were divided into two groups. In Group 1 retreatment were performed with the Protaper Universal - RetreatmentD1, D2 and D3. An x-ray showed the remaining of endodontic filling material. A Protaper F1 andF2 were used to complete the removal. In group 2 hybrid manual techniques with Pré-Race instruments forthe radicular access were performed. Before and after retreatment the x-rays were digitalized and the linearrate determined with the Image Tool 3.0 software. The results showed statistically difference between theremaining filling material when Protaper Universal - Retreatment was employed and when Protaper F1 andF2 in both view. Hybrid manual technique showed the best results when compared with the use of PT-R F1and F2 but showed similar results when compared to Protaper Universal Retreatment.