Intra- and Interobserver Agreement during the Assessment of the Different Stages of Root Development Using 4 Radiographic Classifications.

INTRODUCTION: This study analyzed intra- and interobserver agreements during radiographic assessment of the different stages of root development using the dichotomous, Moorrees, Demirjian, and Cvek classifications, as well as the effect of the observer's level of experience on the result. METHODS: Two hundred eighty-five digital periapical radiographs were examined via visual inspection by 3 experienced and 3 nonexperienced observers (n = 6) under strict technological and viewing conditions. After observer calibration, determination of the presence or absence of an open apex and the assignment of a root development stage according to the different subdivisions of the 4 indexes were performed. This evaluation was carried out by each observer in duplicate in the first round (n = 8) and repeated in the second round (n = 8). The 16 examinations performed by each observer (N = 96) were analyzed to determine the percentage of concordance followed by intraobserver, interobserver, and global observer agreement using the kappa coefficient and a weighted kappa. Additionally, to determine the level of concordance between the visual determination of an open or closed apex and the apical foramen width measured in millimeters, a dichotomized kappa coefficient was applied. RESULTS: A good level of global observer agreement was found for the dichotomous, Demirjian, and Cvek classifications. However, a significantly low percentage of total concordance and global observer agreement (6.66% and 0.498, respectively) was obtained using the Moorrees classification, which was more pronounced among nonexperienced observers (0.247). Apical foramen width measurements indicated the presence of 143 roots with an open apex (50.2%) and 142 with a closed apex (49.8%), and the dichotomized kappa coefficient test revealed a good level of agreement during the visual determination of an open or closed apex (range, 0.611-0.636). CONCLUSIONS: The classifications of Cvek and Demirjian provided reliable results when determining the different stages of root development. In contrast, the Moorrees classification provided the lowest agreement values, with a significant negative effect among nonexperienced observers. Finally, the visual estimation of the presence (or absence) of an open apex provided a good level of concordance with the radiographic apical foramen width.

Autotransplantation, Surgical Repositioning of Retained Canine, and Apical Filling of Two Incisors with Root Resorption.

The purpose is to show the autotransplantation and surgical repositioning of a retained canine, and the apical filling of central and lateral resorbed incisors from a 12-year-old female patient, healthy and with clinical absence of left maxillary canine. Radiographically, the retained canine between the resorbed central and lateral incisors was observed. Root canal treatment of the canine was performed after 8 weeks; apical curettage and placement of bovine graft in inter-incisal zone was done after 4 months. During 6 months, orthodontic traction of the canine was carried out with no positive results, and 12 months after the autotransplantation, surgical repositioning was performed. Clinical-radiographic control at 30 days and 24 months showed absence of inflammation, restoration and integration of the tooth-supporting structures. Autotransplantation combined with surgical repositioning of the retained canine and the apical filling of two incisors achieved the harmonious, aesthetic, functional, dental and psychological preservation of the patient.

Modelo BRAN-RS para la enseñanza de la conductometría electrónica sin verificación radiográfica a alumnos de licenciatura: estudio piloto / BRAN-RS model for teaching electronic root canal lenght measurement without X-ray confirmation by undergraduate students: a pilot study

Propósito: demostrar la ejecución de la conductometría electrónica sin verificación radiográfica con el modelo BRAN-RS, por dos alumnas de licenciatura en odontología Material y métodos: Se emplearon dos molares naturales, de los cuales se utilizaron seis conductos permeables (cuatro mesiales y dos distales); el localizador de foramen apical Raypex 6, tipodonto de acrílico y alginato. Los dientes se incluyeron en el espacio de los molares, que se abocardó y rellenó con alginato. Se insertó el clip labial por debajo del tipodonto. Una cavidad de acceso fue realizada en cada molar, se determinó la entrada de los conductos y se amplió con fresa Gates-Glidden número 4. Con el dispositivo Raypex conectado, se introdujo gentilmente en cada conducto una lima tipo K número 15 o 20, cerrándose el circuito con el sujetador de limas. La posición de la lima en el foramen se observó en la pantalla, que se indica por medio de la barra y punto rojos. La lima fue reajustada en las dos primeras barras amarillas y se fi jó con resina fotopolimerizable. Los molares fueron retirados del alginato, se diafanizaron y evaluaron con microscopio clínico a 16X para confi rmar la longitud de trabajo. Resultados: La posición de la lima respecto al foramen apical en los seis conductos fue precisa al 100 por ciento. Conclusión: El modelo BRAN-RS es fácil de realizar, preciso, y puede utilizarse por alumnos de la licenciatura en la práctica preclínica de conductometría.

To demonstrate how two undergraduate students perform electronic root canal measurement without X-ray confi rmation using the BRAN-RS model. Material and methods: Six permeable root canals (4 mesial and 2 distal) from two natural molars; Raypex 6 electronic apex locator; acrylic typodont; and alginate. The teeth were inserted in the molar space, which had been widened and fi lled with alginate. The lip clip was placed below the typodont. An access cavity was made in each molar and the entrance to the root canal located and widened using a number 4 Gates-Glidden drill. Once the Raypex device was connected, a number 15 or 20 K-fi le was gently introduced into each canal and the measurement circuit closed using the fi le clip. The posi-tion of the fi le within the foramen was shown on the screen in the form of a red bar and a red dot. The fi le was readjusted within the fi rst two yellow bars and secured using a light-cured resin. The molars were removed from the alginate, then diaphonized and evaluated under a clinical microscope at 16X magnifi cation to confi rm the working length. Results: In the six root canals, the position of the fi le relative to the apical foramen was 100% accurate. Conclusion: The BRAN-RS model is accurate, easy to perform, and can be used by undergraduate students in the preclinical practice of root canal measurement.

Autotrasplante de tercer molar por un primer molar con periodontitis apical refractaria al tratamiento endodóntico / Autologous third molar to a first molar apical periodontitis refractory to endodontic treatment

Propósito: El presente caso describe el autotrasplante de tercer molar inferior en lugar de un primer molar inferior con diagnóstico de periodontitis apical persistente. Resumen: Paciente mujer de 20 años de edad que presenta un primer molar inferior en el que se había realizado tratamiento de conductos y que presentaba periodontitis apical persistente, se consideró inviable el retratamiento de conductos y se realizó el autotrasplante del tercer molar inferior derecho al espacio alveolar dejado por el primero. Se evaluó clínica y radiográficamente por 2 años, en donde se observó obliteración de la cavidad pulpar, anquilosis alveolodentaria, ausencia de reabsorción radicular, condiciones funcionales, integración de tejidos blandos y ausencia de enfermedad periodontal

Purpose: This case report describes the autologous mandibular third molar instead of a lower first molar diagnosed with persistent apical periodontitis. Summary: Female patient, 20 years of age having a first lower molar with persistent apical periodontitis refractory endodontic treatment. Retreatment was considered nonviable autologous conduit and right lower third molar alveolar space left by the first was made. We evaluated clinical and radiographically for 2 years, where obliteration of the pulp cavity, alveolar- dental ankylosis, no root resorption, functional conditions, soft tissue integration and no periodontal disease was observed. Conclusion: Autologous transplantation is a decibel option to replace teeth with persistent apical periodontitis in young patients

Blanqueamiento dental intrínseco utilizando técnica termo-catalítica: Presentación de un caso clínico / Intrinsic tooth whitening using thermo-catalytic technique: Clinical case report

Paciente femenino de 20 años de edad, quien acudió al Servicio de Odontología del Hospital Militar Regional de Guadalajara, Jalisco, por cambio de color en sus dientes. A la exploración, se observó discromía en el incisivo central superior derecho, las pruebas de sensibilidad negativas, radiográficamente ausencia de zona radio-lúcida, diagnosticándose necrosis pulpar, lo cual condujo al tratamiento de conductos en sesión única, para posteriormente realizar blanqueamiento intracoronario con técnica termocatalítica. Se llevó a cabo control clínico-radiográfico a uno, tres, seis y 12 meses, observándose en estos periodos, una adecuada evolución clínica, ausencia de sintomatología, zona radiolúcida y coloración adecuada de los tejidos dentales.

A 20 year old female patient attended the dental hospital of the Regional Military Hospital, Guadalajara, Jalisco. The patient's complaint was tooth discoloration. Exploration revealed dyschromia in the upper central right incisor. Sensitivity tests elicited negative results, radiographic examination revealed lack of radio-lucid areas. Emitted diagnosis was pulp necrosis. Root canal treatment was conducted in one single visit. Intra-coronary whitening with thermo-catalytic technique was achieved at a later date. Clinical and radiographic follow-up were conducted 3, 6 and 12 months after procedure. At these sessions the following traits were observed: suitable clinical evolution, absence of symptomatology, radio-lucid area and suitable coloring of dental tissues.

Reparación expectante de lesiones periapicales de origen endodóntico con cemento MTA-Fill-Apex en una sola cita / pectant repair of apical lesion of endodontic origin with MTA Fill-Apex in a single visit

Presentamos el caso de un paciente del sexo femenino de 26 años de edad, aparentemente, sana con diagnóstico de periodontitis apical crónica en incisivo central (4.1) y lateral inferior derecho (4.2). El tratamiento de conductos se realizó en sesión única y la obturación del sistema de conductos radiculares con técnica de obturación termomecánica y cemento sellador MTA Fill-Apex. La paciente refirió encontrarse asintomática a las 72 horas, posteriormente se realizó control clínico-radiográfico a los 4 meses, en el que se observó adecuada reparación del área periapical, así como ausencia de sintomatología. Se discute la influencia del cemento sellador MTA Fill-Apex utilizado, así como el tratamiento en sesión única en la reparación de lesiones periapicales de origen endodóntico (AU)

We report a case of a female of 26 years oldapparently healthy, diagnosed with chronic apical periodontitis in the lower central incisor (4.1) and lower right side (4.2). Root canal therapy was performed in single session and seal the root canal system obturation technique and sealer thermomechanical MTA Fill-Apex. The patient reported feeling no symptoms at 72 hours, then subjected to clinical and radiographic controls at 4 months, which showed adequate repair of periapical area and the absence of symptoms. We discuss both the influence of the use of the sealer MTA Fill Apex and the single-session treatment for the periapical lesions repair (AU)

Actividad antimicrobiana de la solución de nanopartícula de plata en cultivo de Enterococcus faecalis / Antimicrobial activity of silver nanoparticles solution on culture of Enterococcus faecalis

Objetivo. El objetivo del estudio fue evaluar la actividad antimicrobiana de la solución de nanopartículas de plata en cultivo de Enterococcus faecalis (ATCC 29212) comparándola con diversas soluciones de hipoclorito de sodio (NaOCl). Material y Métodos. Cinco placas de Petri en agar fueron inoculadas con E. faecalis y sobre cada una de ellas se colocó un disco de celulosa saturado de solución de nanopartículas de plata, así como en cada una de las soluciones de hipoclorito de sodio evaluadas (Viarzon, Cloralex, Clorox). El digluconato de clorhexidina al 2% y solución salina estéril fueron utilizados como control. Transcurridas 24 horas de incubación a 37°C, en condiciones de aerobiosis, las zonas de inhibición de crecimiento bacteriano fueron medidas y los resultados sometidos a la prueba “t” entre los grupos experimentales (= 5%). Resultados. El Cloralex presentó la mayor media de inhibición en comparación con las demás substancias (p < 0,05), excepto con digluconato de clorhexidina al 2% (p > 0,05). La solución de nanopartículas de plata proporcionó mayor zona de inhibición que Clorox y Viarzon (p <0,05). El Clorox y el Viarzon no proporcionaron zonas de inhibición y fueron semejantes entre sí (p > 0,05). Conclusiones. La solución de nanopartículas de plata presenta actividad antimicrobiana en cultivo de E. faecalis, incluso mayor que las formas comerciales de hipoclorito de sodio. Futuros estudios deben ser realizados para comprobar su viabilidad como solución de irrigación en endodoncia (AU)

Objective. The objective of this study was to evaluate the antimicrobial activity of the silver nanoparticles solution in enterococcus faecallis cultures (ATCC 29212), compared with various solutions of sodium hypoclorithe (NaOCl). Material and methods. Five Agar Petri plates were inoculated with E. faecallis and each of them was placed a cellulose dish embedded with silver nanoparticles solution, or a solution of sodium hypochlorite evaluated (Viarzon, Cloralex, Clorox). Chlorhexidine digluconate 2% was used as positive control and sterile saline solution was used as negative control. After 24 hours of incubation at 37ºc, under aerobic conditions, the zones of inhibition of bacterial growth were measured and the results subjected to the statistical t test among the experimental groups (= 5%). Results. The Cloralex showed to be the most effective reflected in the extent of inhibition in relation to other substances (p< 0.05), except that the chlorhexidine digluconate 2% (p> 0.05). The solution of silver nanoparticles provided a greater zone of inhibition than the sodium hypochlorite solution (Clorox) and Viarzon (p< 0.05). Clorox and Viarzon didn’t provide zones of inhibition and were similar to each other (p> 0.05). Conclusions. The solution of silver nanoparticles presents antimicrobial activity in cultured E. faecallis, even higher than other commercial forms of sodium hypochlorite. Further studies should be carried out to determine its viability as irrigating solution in endodontics (AU)

Deformación del área de corte de las limas endodónticas sometidas a diferentes métodos de precurvatura / No disponible

Objetivo: Evaluar las deformaciones ocasionadas en las artistas de corte en las limas tipo K (LK) # 25, sometidas a la precurvatura del tercio apical utilizando los métodos digital, pinza clínica y Flexobend a través de la microscopía electrónica de barrido (MEB). Material y métodos: Cuarenta y ocho LK #25 fueron divididas en cuatro grupos (n=12); G1, digital; G3, pinza clínica y G4, Flexobend. La curvatura fue estandarizada en el segmento apical de los instrumentos a 2 mm do D1 de las limas. Fue confeccionado un modelo de resina acrílica correspondiente a un conducto con 20º de curvatura. Las limas fueron examinadas en MEB (260x). Los datos fueron analizados mediante la prueba estadística de Fisher con un nivel de significancia del 5%. Resultados: Las imágenes del G1 no presentaron alteraciones en las Lk, similar al G3, sin diferencia estadística. Los G3 y G4 fueron diferentes estadísticamente a los demás grupos (p<0,05). Conclusiones: el método digital para curvado en el tercio apical de LK#25 no produjo alteraciones en las aristas de corte y los métodos que utilizan pinza clínica o Flexobend alteraron las aristas de corte de las limas (AU)

Objetive: Evaluate the deformations caused in the cutting edges in the K-file #25 (LK), subjected to pre-beinding of the apcial third using the following methods: finder-bending, cotton-pliers bendin and Flexobend, observed under scanning electron microscopy (SEM). Material and methods: Forty-eight LK#25 were divides into 4 groups (n=12); G1, control; G2, finger-bending; G3, cotton-plier bending, G4, Flexobend. The curvature was standardized in the apical segment of the file at 2 mm of D!. Was constructed a model of acrylic resin that correspond to a canal of 20º of curvature. The files were examined under SEM (260X). Data were analyzed using Fisher's statistical test with a significance level of 5%. Results: The images showed no alterations in the LK, similar to G3, with no statistical difference. G3 and G4 were statistically different form the other groups (p<0.05). Conclusions: the finger-bending method to curve apical third of LK #25 did not alter the cutting edges, the cotton-pliers bending and Flexobend did alter the cutting edges of the files (AU)

The use of a setting accelerator and its effect on pH and calcium ion release of mineral trioxide aggregate and white Portland cement.

The aim of this study was to evaluate the influence of adding 10% calcium chloride (CaCl2) indicated as setting accelerator on pH and release of calcium ions of commercially available materials: ProRoot MTA (tooth-colored formula), MTA Branco, and White Portland cement. The products were mixed for 30 seconds in previously established ratios. To estimate the values of pH and release of calcium ion, polyethylene tubes were filled with the materials and immersed in containers with 10 ml of deionized water. The analyses were performed baseline, 30 minutes, 60 minutes, and 24 hours after the mixing process. A pHmeter (MicroNal B 371, Sao Paulo, SP, Brazil) and an atomic absorption spectrophotometer (Model GBC 904; CG Corp, Melbourne, Australia) equipped with a hollow cathode lamp were used to determine the data. According to the Student's t-test, the comparison between the pure and the CaCl2-added products indicated that the presence of this substance increased immediately the pH, although the results were very similar when they were analyzed in the other intervals. In addition, products with CaCl2 released more calcium ions than pure materials in the 24-hour period (p<0.05). The results revealed that the addition of CaCl2 to MTA enhanced the physicochemical properties of this product. Thus, materials mixed with CaCl2 became easier to handle and needed lower amounts of water in the mixing process.

Healing of root perforations treated with Mineral Trioxide Aggregate (MTA) and Portland cement%Reparo de perfurações radiculares tratadas com Agregado Trióxido Mineral (MTA) e cimento Portland

Avaliou-se o reparo de perfurações em dentes de cães, tratadas com ProRoot MTA, MTA Angelus e cimento Portland branco. As perfurações foram feitas na região de furca de premolares, superiores e inferiores, com broca STP 58 sob refrigeração com soro fisiólogico. Os animais foram mortos após 90 dias e os dentes foram preparados para análise microscópica pela coloração da hematoxilina e eosina. Os três materiais propiciaram o selamento da perfuração com tecido mineralizado e o teste de Kruskal-Wallis demostrou não haver diferença estatística entre eles.

Healing of root perforations treated with Mineral Trioxide Aggregate (MTA) and Portland cement.

Fourteen root perforations were performed for microscopic evaluation of the repair of interradicular tissue in dogs' teeth. These perforations were accomplished at low-speed with a STP 58 bur at the cervical third of the mesial root toward the furcation under irrigation with saline solution, followed by immediate sealing with ProRoot MTA, MTA-Angelus and white Portland cement. The dogs were killed after 90 days, revealing good results. The Kruskal-Wallis test did not demonstrate any statistically significant difference. It was concluded that the three materials showed good sealing in mineralized tissue, with complete closure, and they were free of inflammation in most teeth.

Cambios histológicos en la pulpa dental, ocasionados por preparaciones protésicas empleando abrasivos de diamante vs carburo / Histological changes in dental pulp produced by dental preparation for prosthesis application, in comparison between reaming by diamond or carbide tips

Este estudio se realizó en 30 dientes, todos terceros molares superiores, los cuales se prepararon con el método para aplicación de prótesis, para investigar daño pulpar. La pulpa como es sabido es un órgano sensible a cualquier agente externo; el tallado dental puede en alguna forma lesionar estructuras dentales (dentina, pulpa). Se determinaron los cambios ocurridos en la pulpa dental provocados por un desgaste protésico. El grupo se subdividió en 3 de 10 cada uno; en el primero se hizo extracción sin desgaste, en el segundo desgaste con diamante y extracción. La preparación de los órganos dentarios fue con irrigación constante; al término de la misma, se colocó una prótesis provisional de acrílico con matriz de acetato al vacío y cementado con óxido de zinc y eugenol. Por medio del microscopio de luz a las 24 horas post-tallado se pusieron en evidencia cambios histológicos que consistieron en congestión vascular, incremento de fibroblastos, fibras colágenas y datos inflamatorios sólo en uno de los grupos investigados que fue el rimado con carburo