Uso do sistema xp-endo para limpeza do sistema de canais radiculares em dente com reabsorção radicular interna e necrose pulpar: relato de caso / Use of XP-Endo system to clean the root canal system of a tooth with internal resorption and pulp necrosis: case report

Objetivo: este estudo reporta um caso clínico de reabsorção radicular interna em um dente com necrose pulpar que foi submetido ao tratamento endodôntico no qual, na fase de preparo químico-mecânico, foi utilizada uma técnica suplementar de irrigação com o instrumento XP-Endo Finisher. Métodos: após radiografia para diagnóstico e realização dos testes semiotécnicos, fez-se a instrumentação com sistema Protaper Universal, ativação da substância irrigadora utilizada (digluconato de clorexidina a 2%), com o sistema XP-Endo Finisher, remoção da smear layer, com EDTA a 17% ativada com o mesmo sistema, inserção de medicação intracanal Calen, com paramonoclorofenol, e selamento provisório da coroa dentária, com coltosol. Na segunda sessão, realizou-se a obturação utilizando a técnica de Schilder associada à técnica híbrida de Tagger. Conclusão: o sistema XP-Endo Finisher se mostrou eficaz como técnica suplementar de irrigação, capaz de favorecer a limpeza do sistema de canais radiculares (AU)..

Objective: This study presented a case of internal root resorption in a tooth with pulp necrosis that was submitted to endodontic treatment. In this treatment, an additional irrigation technique with a XP-Endo Finisher instrument was used during the chemical-mechanical preparation. Methods: After radiographic diagnostics and semi-technique tests, instrumentation was performed with Protaper universal system, activation of irrigation solutions, 2% chlorhexidine digluconate with the XP-Endo Finisher file, removal of the smear layer with EDTA 17% activated with the same system, intracanal medication Calen with paramonochlorophenol, temporary sealing of the tooth crown with Coltosol. In the second session, an obturation procedure was performed using the Schilder technique associated with the Tagger hybrid technique. Conclusions: The XP-Endo Finisher system was effective as supplementary irrigation technique and it facilitated the cleaning of the root canal system (AU).

Gustatory Stimulations and Their Capacity Influence Buffering of the Saliva

Objective: To evaluate the influence of gustatory stimuli on the buffering capacity of saliva. Material and Methods: The buccal ph of 18 male volunteers aged 18-35 years was measured after a mouthwash with 20 ml of water as a control, and in individual disposable cups they collected the saliva for two minutes. Then, each of chewed bubble gum with sugar for two minutes, discarding the gum and made new collection of saliva, for two minutes in other disposable cups individualized. After collection, each volunteer was again subject to regular brushing with toothpaste and waited another ten minutes. The same procedure was repeated with all other substances. Salivary buffer capacity was determined by Ericsson technique. Data were submitted to analysis of variance and the means were compared by the Scott-Knott grouping test and Mann-Whitney test at 5% probability. Estimates of Pearson correlations were calculated in order to determine possible associations between the variables. Results: It was not found statistically significant differences between the initial pH variation and after eating food (p>0.05), or between gustatory stimulation and variation of salivary buffer capacity (p>0.05). Conclusion: There is no influence of gustatory stimulus aroma and flavor on the variation of salivary buffer capacity.

Apical surgery as cystic lesion treatment for barodontalgia prevention: a case report / Cirugía apical como tratamiento de lesión quística para prevenir la barodontalgia: informe de caso

ABSTRACT Barodontalgia is not a pathology but a symptom of a subclinical oral problem that, although rare, may affect patients subjected to atmospheric pressure changes and have an influence on flights. This paper aims to discuss the clinical characteristics of pathologies related to the etiology of barodontalgia, as well as differential diagnoses, treatments, and prevention. This paper reports a case of a Brazilian air force officer who went to the Santos Dumont Air Force Dental Clinic reporting pain in the anterior maxillary during a flight. An endodontic treatment followed by periradicular surgery was performed, in order to quickly seal the bone lesion and to avoid new cases of barodontalgia. This work demonstrated a successful approach of a periradicular lesion solved by surgical treatment in order to avoid new cases of barodontalgia during flights. In addition, this paper highlights the importance of deepening knowledge on this event and the need for periodic oral and dental assessment, as well as conclusive treatment in aircrew members in order to prevent aircraft accidents.

ABSTRACT La barodontalgia no es una patología en sí misma, sino un síntoma de un problema oral subclínico que, si bien es poco frecuente, puede afectar a pacientes sometidos a cambios en la presión atmosférica y afectar la seguridad de los vuelos. Este artículo pretende analizar las características clínicas de las patologías relacionadas con la etiología de la barodontalgia, así como los diagnósticos diferenciales, los tratamientos y la prevención. Se presenta el caso de un agente de la fuerza aérea brasileña que acudió a la Clínica Dental de la Fuerza Aérea Santos-Dumont reportando dolor en el maxilar anterior durante un vuelo. Se realizó un tratamiento de endodoncia seguido de cirugía perirradicular, con el fin de sellar rápidamente la lesión del hueso y evitar nuevos casos de barodontalgia. Este trabajo describe un procedimiento acertado para una lesión perirradicular resuelta por tratamiento quirúrgico para evitar nuevos casos de barodontalgia durante los vuelos. Además, destaca la importancia de profundizar en el conocimiento sobre este evento y la necesidad de llevar a cabo no solo una evaluación bucodental periódica de los miembros de las tripulaciones, además de ofrecerles tratamientos definitivos, con el fin de prevenir los accidentes aéreos.

Transportation Assessment in Simulated Curved Canals after preparation with Twisted File Adaptive and BT-Race instruments.

BACKGROUND: This study compared the incidence of deviation along curved canals after preparation with two nickel-titanium (NiTi) rotary systems, Twisted File Adaptive and BT-RaCe. MATERIAL AND METHODS: Forty resin training blocks with curved canals were filled with ink and divided into two groups according to the instrumentation technique. Preinstrumentation images were acquired by using a stereomicroscope. The canals were up to an instrument #35/0.04. Postinstrumentation images were captured using the same conditions, and the images were superimposed. The amount of resin removed was measured at 8 different points, beginning at the apical terminus of the canal. Differences in the mesial and distal aspects were measured to evaluate the occurrence of deviation. The Student's-t test was used for comparison of the intragroup deviation. Intergroup analysis was performed by using one-way ANOVA for each level. For multiple comparisons, the Bonferroni test was used and a cutoff for significance was set at 5%. RESULTS: Intragroup analysis showed that both instrumentation techniques promoted some deviation at all levels. BT-RaCe showed significantly lower deviation at 0 and 4-mm levels than Group Twisted File Adaptive (p<0.05). On the other hand BT-RaCe showed worse performance at level 6. CONCLUSIONS: The results of this study demonstrated that none of the NiTi tested systems was able to instrument curved canals simulated in resin blocks without some deviation during the preparation. There is still need for improvement in the instruments manufacturing aiming the better performance of endodontic files in curved root canals. Key words:BT-RaCe, Curved root canals, Deviation, Twisted File Adaptive.

The Effect of Sodium Hypochlorite and Chlorhexidine as Irrigant Solutions for Root Canal Disinfection: A Systematic Review of Clinical Trials.

INTRODUCTION: This systematic review aimed to compare the effectiveness of sodium hypochlorite and chlorhexidine for root canal disinfection during root canal therapy. METHODS: A literature search for clinical trials was made on the PubMed (MEDLINE), Web of Knowledge, SCOPUS, and Science Direct databases and in the reference lists of the identified articles up to January 2015. Quality assessment of the selected studies was performed according to the Consolidated Standards of Reporting Trials statement. RESULTS: One clinical trial and 4 randomized clinical trials were selected from the 172 articles initially identified. There was heterogeneity in the laboratory methods used to assess the root canal disinfection as well as in the concentrations of the irrigants used. Therefore, meta-analysis was not performed. Two studies reported effective and similar reductions in bacterial levels for both irrigants. Sodium hypochlorite was more effective than chlorhexidine in reducing microorganisms in 1 study, and another reported opposite findings. Both root irrigants were ineffective in eliminating endotoxins from necrotic pulp root canals in 1 study. Trial design and information regarding randomization procedures were not clearly described in the clinical trials. No study compared laboratory results with clinical outcomes. CONCLUSIONS: The available evidence on this topic is scarce, and the findings of studies were not consistent. Additional randomized clinical trials using clinical outcomes to compare the use of sodium hypochlorite and chlorhexidine during root canal therapy are needed.

Efficacy of a new Activation Device in Irrigant Penetration Into Simulated Lateral Canals.

OBJECTIVE: The aim of the present study was to compare the effects of EasyClean (EC) on irrigant delivery into simulated lateral canals using an artificial closed canal system. Passive ultrasonic irrigation (PUI) was used as a reference technique for comparison. METHODS: Forty simulated curved root canals manufactured in transparent resin and with simulated lateral canals were instrumented with Reciproc R40 files and randomly assigned to four groups (n=10) according to the irrigant activation technique: PUI group, ECrec group (EC used in reciprocating motion), ECrot group (EC used in rotary motion), and control group (no activation performed). After activation, stereomicroscope images from each block were taken, and irrigant penetration into lateral canals was measured using Adobe Photoshop software. Data were analysed using ANOVA and Tukey's post hoc test (α=0.05). RESULTS: No penetration was observed in the control group. The ECrec group showed lower penetration than the other group (P<0.05). No differences were observed between the ECrot group and the PUI group (P>0.05). CONCLUSION: EC used in rotary motion was effective in increasing the penetration of the irrigating solution into simulated lateral canals.

Comparison of the effects of TripleGates and Gates-Glidden burs on cervical dentin thickness and root canal area by using cone beam computed tomography.

UNLABELLED: The search for new instruments to promote an appropriate cervical preparation has led to the development of new rotary instruments such as TripleGates. However, to the best of the authors' knowledge, there is no study evaluating TripleGates effect on the "risk zone" of mandibular molars. OBJECTIVES: The aim of this study was to evaluate the effects of a crown-down sequence of Gates-Glidden and TripleGates burs on the remaining cervical dentin thickness and the total amount of dentin removed from the root canals during the instrumentation by using cone beam computed tomography. The number of separated instruments was also evaluated. MATERIAL AND METHODS: Mesial roots of 40 mandibular first molars were divided into 2 equal groups: crown-down sequence of Gates-Glidden (#3, #2, #1) and TripleGates burs. Cervical dentin thickness and canal area were measured before and after instrumentation by using cone beam computed tomography and image analysis software. Student's t-test was used to determine significant differences at p < 0.05. RESULTS: No significant differences (p > 0.05) were observed between the instruments, regarding the root canal area and dentin wall thickness. CONCLUSION: Both tested instruments used for cervical preparation were safe to be used in the mesial root canal of mandibular molars.

Localização e tratamento do canal médio-mesial em raízes mesiais de molares inferiores û relato de dois casos / Location and treatment of middle-mesial canal in mesial roots of mandibular molars - two cases report

A morfologia da cavidade pulpar é complexa, e um exemplo dessa diversidade é um terceiro canal que pode ser localizado na raiz mesial dos molares inferiores, e que recebe o nome de canal médio-mesial. A taxa de ocorrência desse canal difere na literatura, mas essa é unânime em considerar que a ausência de seu manejo pode levar ao insucesso do tratamento. O objetivo do presente trabalho foi a realização de uma breve revisão de literatura e da apresentação de dois casos clínicos nos quais houve o tratamento do canal médio-mesial. Ao final, pode-se enfatizar a importância do conhecimento da anatomia, bem como da necessidade da correta inspeção do soalho da câmara pulpar para a localização e tratamento do canal médio-mesial, para assim, contribuir com o sucesso da terapêutica endodôntica...

The morphology of the pulp cavity is complex, and an example of this diversity is a third canal that can be located in the mesial root of mandibular molars, which is called the midmesial canal. The literature presents different data regarding the occurrence rate of this canal, but is unanimous that the absence of its management can lead to treatment failure. The objective of this study was to conduct a brief literature review and presentation of two cases of treatment of medium-mesial canal. At the end, one can emphasize the importance of knowledge of anatomy as well as the need for proper inspection of the floor of the pulp chamber to the location and treatment of middle-mesial canal, so as to contribute to the success of endodontic therapy...

Comparison of the effects of TripleGates and Gates-Glidden burs on cervical dentin thickness and root canal area by using cone beam computed tomography

The search for new instruments to promote an appropriate cervical preparation has led to the development of new rotary instruments such as TripleGates. However, to the best of the authors' knowledge, there is no study evaluating TripleGates effect on the “risk zone” of mandibular molars. Objectives : The aim of this study was to evaluate the effects of a crown-down sequence of Gates-Glidden and TripleGates burs on the remaining cervical dentin thickness and the total amount of dentin removed from the root canals during the instrumentation by using cone beam computed tomography. The number of separated instruments was also evaluated. Material and Methods : Mesial roots of 40 mandibular first molars were divided into 2 equal groups: crown-down sequence of Gates-Glidden (#3, #2, #1) and TripleGates burs. Cervical dentin thickness and canal area were measured before and after instrumentation by using cone beam computed tomography and image analysis software. Student’s t-test was used to determine significant differences at p<0.05. Results : No significant differences (p>0.05) were observed between the instruments, regarding the root canal area and dentin wall thickness. Conclusion : Both tested instruments used for cervical preparation were safe to be used in the mesial root canal of mandibular molars. .

Os cistos radiculares poem curar após tratamento endodôntico / Radicular cysts may heal after endodontic treatment

A etiologia das lesões perirradiculares e suas diferentes manifestações clínicas já estão bastante esclarecidas, porém o tratamento dos cistos radiculares ainda é um assunto controverso na Odontologia. O objetivo deste trabalho é realizar uma análise crítica, baseada na literatura, sobre o tratamento de cistos radiculares, buscando evidências que demonstrem que os cistos radiculares podem ser eliminados após tratamento endodôntico. Os cistos podem ser divididos em: cistos em bolsa e cistos verdadeiros, sendo que os cistos em bolsa respondem ao tratamento endodôntico, enquanto os cistos verdadeiros somente podem ser tratados através da cirurgia perirradicular. Pode-se concluir que sendo o agente microbiano o responsável pelas lesões perirradiculares, a maioria destas lesões, incluindo os cistos, regridem após a intervenção endodôntica não cirúrgica.

The etiology of apical periodontitis and its different clinical manifestations are already well versed, but the treatment of radicular cysts is still a controversial subject in Dentistry. The e aim of this study is to perform a critical analysis based on literature regarding treatment of radicular cysts, seeking evidence demonstrating that the radicular cysts can be eliminated after endodontic treatment. The cysts can be divided in: Apical Pocket Cysts and true cysts. Apical pocket cysts respond to endodontic treatment, while true cysts can only be treated by periradicular surgery. It can be concluded that since the microbial agent is responsible for the apical periodontitis, the majority of these lesions, including cysts regress after nonsurgical endodontic therapy.

Chlorhexidine gel associated with papain in pulp tissue dissolution.

OBJECTIVES: This study aimed to evaluate the capacity of 2% chlorhexidine gel associated with 8% papain gel in comparison with 5.25% sodium hypochlorite in bovine pulp tissue dissolution. MATERIALS AND METHODS: Ninety bovine pulps of standardized sizes were used and fragmented into 5-mm sizes. The fragments were removed from the root middle third region. They were divided into 6 experimental groups (n = 15), 1) 8% papain; 2) 2% chlorhexidine; 3) 2% chlorhexidine associated with 8% papain; 4) 0.9% saline solution; 5) 2.5% sodium hypochlorite; and 6) 5.25% sodium hypochlorite. The pulp fragments were weighed and put into immobile test tubes for dissolution for time intervals of 30, 60, 90, and 120 min. RESULTS: The 5.25% sodium hypochlorite had greater dissolution potential than the pure papain, and when associated with chlorhexidine, both promoted greater dissolution than did the saline solution and 2% chlorhexidine groups (p < 0.05). The 2.5% sodium hypochlorite promoted dissolution to a lesser extent than the groups with papain within a period of 30 min (p < 0.05), but, was comparable to the saline solution and chlorhexidine. After 120 min, the 2.5% and 5.25% sodium hypochlorite promoted dissolution of 100% of the pulp fragments, and papain, 61%, while chlorhexidine associated with papain and chlorhexidine alone dissolved only 55% and 3%, respectively. CONCLUSIONS: The 8% papain in gel, both alone and in association with chlorhexidine, was able to dissolve bovine pulp tissue, but to a lesser extent than did 5.25% sodium hypochlorite.

Fístula cutânea odontogênica: relato de caso / Odontogenic cutaneous sinus tract: Case report

Introdução: as fístulas odontogênicas são canais que se originam de um sítio de inflamação dentária e que drenam para as regiões orofacial e do pescoço. Uma das causas mais frequentes para a formação de fístulas odontogênicas é a presença de cáries ou de trauma dentário, com invasão bacteriana do tecido pulpar e posterior necrose pulpar. Objetivo: relatar a história clínica de uma paciente atendida na Faculdade de Odontologia da UESB, apresentando uma fístula cutânea odontogênica. Métodos: paciente de 47 anos de idade, apresentou-se ao serviço de endodontia da UESB queixando-se de uma fístula extrabucal, localizada na região esquerda da face. Depois de consultas a clínicos gerais, otorrinolaringologistas e oftalmologistas, a paciente procurou o atendimento odontológico. Ao exame radiográfico, constatou-se uma lesão cariosa no elemento 22, com presença de patologia periapical. O tratamento endodôntico foi proposto e realizado em única sessão. Resultados: três dias depois, a fístula já havia regredido, restando apenas um cicatriz no local por causa da retração tecidual para o fechamento do orifício de abertura da lesão. Dois meses depois, o exame radiográfico apontou uma formação óssea na região apical do elemento dentário. Conclusão: torna-se evidente a relevância do conhecimento dessa condição por cirurgiões-dentistas e médicos para a correta condução do diagnóstico e do tratamento da patologia

Sealing ability promoted by three different endodontic sealers.

INTRODUCTION: The aim of this study was to evaluate the apical and coronal seal of endodontic filling promoted by the combined use of Sealer 26/gutta-percha, Endofill/gutta-percha and Resilon/ Epiphany. MATERIALS AND METHODS: A total of 38 extracted human canine teeth were selected; 10 teeth for each test group and 4 for each control group. After conducting conventional endodontic treatment, the teeth were immersed in saline solution for thirty days, and subsequently sealed and stored in India ink for seven days. They were then cleaned and evaluated for infiltration by stereoscopic microscope. The data were statistically analyzed by ANOVA and Bonferroni tests. RESULTS: The results showed no significant differences between the three groups of filling materials used. CONCLUSION: Within the limitations of this in vitro study, no material showed superiority in their apical and coronal seal.

Avaliação em momentos diferentes do selamento apical de dois cimentos endodônticos: Endofill e Sealer 26 / Evaluation in two different times of apical seal of two endodontic sealers: Endofill and Sealer 26

O selamento apical proporcionado por dois cimentos endodônticos foi observado em momentos diferentes. Quarenta e quatro dentes unirradiculares humanos foram instrumentados e divididos em quatro grupos experimentais com dez dentes em cada um e dois controles com dois dentes. Os Grupos 1 e 3 foram obturados com Endofill e os grupos 2 e 4 com Sealer 26. Após a impermeabilização, os Grupos 1 e 2 foram imersos em azul de metileno a 2 por cento por sete dias. Os Grupos 3 e 4 foram imersos em recipientes contendo soro fisiológico por quinze dias. Após esse período, foram também impermeabilizados e colocados no corante por sete dias. Findo o prazo de permanência no corante, os dentes foram lavados, secos e seccionados longitudinalmente para exame por meio de uma lupa estereoscópica com aumento de vinte vezes. Os resultados mostram que entre os Grupos 1 e 2, não houve diferença. Já nos Grupos 3 e 4, houve infiltração apical significativamente maior, particularmente no Grupo 3, no qual se usou o Endofill. De acordo com os resultados deste trabalho, o cimento Sealer 26 apresenta um melhor selamento apical