Conduta clínica frente à fratura de instrumentos endodônticos: relato de dois casos clínicos / Clinical management of endodontic instrument fracture: report of two clinical cases

Introdução: a fratura de um instrumento endodôntico constitui sério risco à continuidade do tratamento. A utilização abusiva e repetitiva dos instrumentos, a fadiga do metal, a falta de conhecimento das suas características físicas, o desrespeito à cinemática, a não observação de deformações, a pressão ou torção exagerada durante o preparo do canal radicular e a pouca habilidade do profissional contribuem para a fratura dos instrumentos endodônticos. Diante desse problema, as opções são a remoção dos instrumentos via canal, cirurgia periapical ou mantê-lo no interior dos canais. Objetivos: no presente trabalho, serão apresentados dois casos clínicos nos quais ocorreu o mesmo acidente: fratura de espiral Lentulo. Todavia, devido às particularidades de cada caso, optou-se por condutas clínicas diferentes. Relato de caso: no primeiro caso, em função da dificuldade de remoção e particularidades anatômicas, optou-se pela obturação com o fragmento no canal; no segundo caso, realizou-se a remoção do instrumento que obstruía o forame apical, empregando uma técnica simples e acessível, utilizando uma agulha hipodérmica associada a um instrumento manual. Conclusão: em função do exposto, é imperativo que o profissional, além de deter habilidade e experiência para conduzir os casos, tenha conhecimento sobre as características dos instrumentos por ele empregados, pois a cuidadosa aplicação dos princípios de uso irá minimizar a ocorrência de acidentes e complicações.

Persistent extra-radicular bacterial biofilm in endodontically treated human teeth: scanning electron microscopy analysis after apical surgery.

Biofilms are the main cause of endodontic failures. Even the best executed endodontic treatment can fail, when the infection is resistant to treatment or when it is located in inaccessible areas, such as the external surface of the root apex. The purpose of this study was to evaluate, by scanning electron microscopy, the presence of bacterial biofilm on endodontically treated teeth considered clinical failures and suitable for apical surgery. Root apices were collected from 20 teeth undergoing apical surgery and one negative control and analyzed under SEM. Digital photomicrographs of the root apices of 21 specimens at different magnifications were taken. Data were analyzed using descriptive statistics. Apical biofilms were observed in 100% of root canal treatments considered endodontic failure. Topographical analysis of the root apices revealed areas of resorption, microcracks, and apical foramina in 90%, 80%, and 50% of cases, respectively. Within the limits of this study, it can be concluded that endodontic failures present bacterial biofilm in areas inaccessible to conventional endodontic treatment, such as the external surfaces of the root apex.

Uso dos sistemas reciprocantes Reciproc® e Wave One® em Endodontia: revisão de literatura / Use of Reciproc® and Wave One® reciprocating systems in endodontics: literature review

Introdução: o preparo e a limpeza dos canais radiculares podem ter sua eficácia comprometida por fatores como a anatomia do sistema de canais radiculares e infecções intrarradiculares. A modelagem dos canais radiculares é uma etapa complexa do tratamento, pois requer prudência e cautela em sua execução. Mais recentemente, sistemas reciprocantes com uso de lima única têm sido empregados em Endodontia no preparo dos canais radiculares. Sua utilização deve ser pautada com base em seu desempenho em relação a variáveis como: menor extrusão de detritos, melhor resistência à fratura, melhor padrão de limpeza, menor desvio de canal radicular e menor tempo de execução. Objetivo: o presente trabalho visou comparar os sistemas reciprocantes Reciproc® e Wave One®, por meio de uma revisão de literatura, em relação às variáveis mencionadas. Métodos: realizou-se uma pesquisa bibliográfica, nas bases de dados PubMed, Medline, Lilacs e Scopus, nos últimos cinco anos, em que 660 artigos foram encontrados e 25 foram selecionados, pois cumpriam os critérios preestabelecidos. Resultados: com relação à extrusão de detritos via forame apical, não se observou diferenças entre os sistemas avaliados nos estudos. Com relação à resistência à fadiga cíclica e ao tempo de preparo, o sistema Reciproc® se destaca. Já o sistema Wave One® tem maior resistência à fratura torsional. Com relação ao desvio da trajetória do canal e padrão de limpeza, os sistemas não apresentaram diferenças significativas. Conclusão: os sistemas reciprocantes, segundo as variáveis avaliadas no presente trabalho, se apresentaram favoráveis ao uso em Endodontia em tratamentos e retratamentos endodônticos.

Hypochlorite-induced severe cellulitis during endodontic treatment: case report

Introduction: Sodium hypochlorite is a solution used in endodontic treatment, and if an accidental apical extrusion occurs, serious complications may affect soft tissue. Objective: The aim of this article is to present a case of apical extrusion of sodium hypochlorite (NaOCl) during root canal system instrumentation. Case report: A 28-year-old woman sought a local dental service for root canal treatment of tooth #24. Conventional endodontic treatment was adopted, which consisted of the use of 2.5% NaOCl solution as irrigation solution applied with a 10-ml syringe and 22G hypodermic needle. At that time, the patient reported extreme pain and a burning sensation in the left maxillary region, followed by the formation of intense edema. A clinical diagnosis of hypochlorite-induced cellulitis was made. The patient was treated immediately with amoxicillin (500 mg, orally) at intervals of 8 h for 7 days and dexamethasone (4 mg, intramuscularly) at intervals of 24 h for 3 days. In the subsequent endodontic treatment, 2% chlorhexidine gel applied with a 5-ml syringe and 24G needle was used as irrigation for a better control of treatment and to prevent new accidents. The root canals were instrumented using adequate crown-down technique, which provides a conical shape, and filled by lateral condensation technique. The patient was symptom free at the 8-month clinical follow-up. Conclusion: Dentists should always carefully follow all stages of dental treatment planning without neglecting any of them, paying attention to the solutions used and their storage as well as performing a specific technique with maximum accuracy. If an accident occurs, the appropriate handling of the situation will enable the satisfactory completion of treatment.

Endodontic treatment for necrotic immature permanent teeth using MTA and calcium hydroxide: A retrospective study

Introduction: Endodontic treatment of young permanent teeth with incomplete root formation and necrotic pulp has been a challenge for the dentist. It is necessary to induce the formation of apical barrier (apical plug), enabling the complete root canal filling. Objective: This retrospective clinical study compared the protocols for treatment of teeth with incomplete root formation, using calcium hydroxide (CH) or mineral trioxide aggregate (MTA). Material and methods: 28 patients with incomplete root formation have undergone root canal treatments in the period from 2000 to 2009 were selected. The procedures for cleaning, shaping and intracanal medication (CH paste) were performed in a standardized manner. In 13 patients, after using the CH paste (14 days), apical plugs with MTA were made. In the remaining 15 teeth monthly exchanges with CH paste were executed until it was observed radiographically the formation of the apical barrier. In all cases the canals were filled conventionally with gutta-percha and sealer. Initially, follow-ups were made on a quarterly and semiannually at the end of first year. Results: All apical lesions showed apical healing between 4 and 13 months after starting treatment. There was not noted the continuing process of root formation. Conclusion: It was concluded that the treatment of teeth with incomplete root formation and necrotic pulp with the use of MTA as apical plug has the same clinical results compared with the use of CH, with the advantage of less clinical time.

Two root canals in maxillary central incisor

Introduction and objective: The success of endodontic treatment requires the knowledge of tooth morphology and its variations. Case report: This clinical article reports an unusual root canal configuration that was detected in a maxillary central incisor with two root canals, demonstrated by radiographic and computerized tomography exams. Conclusion: Knowledge of endodontic anatomy as well as the obtainment of both preoperative radiographs and tomography is important to detect abnormal tooth morphology.

Avaliação da presença de biofilme apical em insucessos endodônticos / Presence of biofilm apical endodontic failures

Esta pesquisa teve como objetivo avaliar a presença de biofilme apical em dentes considerados insucessos no retratamento endodôntico e indicados para resolução cirúrgica...

The purpose of this study was to evaluate the presence of apical biofilm on teeth considered clinical failures and suitable for apical surgery...