Comparative Study of the SEM Evaluation, EDX Assessment, Morphometric Analysis, and Cyclic Fatigue Resistance of Three Novel Brands of NiTi Alloy Endodontic Files.

In this study, we compare and analyze the scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDX), morphometry and cyclic fatigue resistance of Endogal, PathMax, and Smarttrack novel brands of nickel−titanium (NiTi) alloy endodontic files. Material and Methods: Thirty sterile NiTi endodontic rotary files were randomly selected and assigned to one of the following study groups: A: 25.08 F2 Endogal (EDG) (n = 10); B: 25.08 F2 Path Max Pro (PMP) (n = 10); and C: 25.06 Smarttrack (ST) (n = 10). Dynamic cyclic fatigue tests were conducted using a cyclic fatigue device in stainless steel artificial root canal systems with an apical diameter of 250 µm, curvature angle of 60°, radius of curvature of 3 mm, and taper of 6%. Additionally, we analyzed the NiTi endodontic rotary files using EDX, SEM, and morphometry after micro-CT scanning. The results were analyzed using Weibull statistical analysis and ANOVA testing. Results: SEM, EDX, and morphometric analyses showed differences between the three novel brands of NiTi endodontic rotary files. Moreover, statistically significant differences were observed between the number of cycles to failure and time to failure of the three novel brands of NiTi endodontic rotary files (p < 0.001). Conclusions: Smarttrack NiTi alloy endodontic reciprocating files display greater resistance to cyclic fatigue than Endogal and Path Max Pro NiTi alloy endodontic rotary files, due to the reciprocating movement and metallurgical composition.

Autotrasplante de un 3.8 incluido, en el lecho de un 3.7 con reabsorción radicular: a propósito de un caso / Autotransplantation of a 3.8, instead of a 3.7 with root resorption: a case report

INTRODUCCIÓN: El autotrasplante es una opción predecible para sustituir dientes no restaurables. El presente caso clínico describe el autotrasplante de un tercer molar inferior (3.8) en lugar de un segundo molar inferior (3.7).Caso clínico: Paciente varón de 22 años de edad que acude a una revisión general. A la exploración radiográfica, se observa reabsorción radicular del 3.7, producida por el 3.8 incluido. Se valoró el caso mediante un CBCT confirmando la inviabilidad del 3.7 y una correcta anatomía para la sustitución del 3.8. Después de valorar junto al paciente, las diferentes opciones de tratamiento posibles, se decide realizar el autotrasplante del diente 3.8, en el lugar del 3.7. Se realizó la exodoncia de ambos dientes, realizando el tratamiento de conductos extraoralmente del diente donante, bajo magnificación, y en un tiempo inferior a 20 minutos. Posteriormente se coloca una ferulización semirrígida a los dientes ad-yacentes durante 2 meses. Después del tratamiento quirúrgico/endodóntico, en el control a los 6 meses debido a la buena evo-lución clínica y la ausencia de sintomatología se realiza el trata-miento rehabilitador del diente autotrasplantado. CONCLUSIÓN: Las ventajas del autotrasplante quedan demostradas con los altos porcentajes de éxito que se obtienen al elegir esta opción de tratamiento. Es fundamental el uso del CBCT, tanto para la planificación, como para los posteriores controles radiográficos

INTRODUCTION: Autotransplantation is a predictable option to replace non restaurable teeth. This clinical case describes the autotransplantation of a lower third molar instead of a lower second molar. Clinical case: A 22 years-old male patient came to the clinic. On radiographic examination, it was observed root resorption of the lower second molar (3.7), produced by an included lower third molar (3.8). After checking with the patient all possible treatments, we decided to perform an autotransplant of tooth 3.8, instead of 3.7. Extraction of both teeth was necessary, performing the extraoral root canal treatment of the donor tooth, under magnification, and in less than 20 minutes. After that, a semi-rigid splint was placed to the adjacent teeth for 2 months. After the surgical / endodontic treatment, in the 6-month follow-up due to the good clinical evolution and the absence of symptoms, autotransplanted molar prosthetic rehabilitation treatment takes place. CONCLUSION: The advantages of autotransplantation are demonstrated by the high success rates that we obtain when choosing this treatment option. The use of CBCT is essential both for planning and for subsequent radiographic controls

Manejo terapéutico de un diente anterior calcificado, y el abordaje de múltiples perforaciones realizadas durante su tratamiento de conductos / Therapeutic management of a calcified anterior teeth, and the approach of multiple perforations performed during root canal treatment

Se trata de un retratamiento de conductos en el diente 1.1. El diente presenta percusión y palpación positiva y movilidad grado II. Ante la falta de información en la radiografía convencional se realiza una TCHC donde se observa tres perforaciones y perdida de la cortical vestibular y apical en el diente 1.1. Se llevó a cabo un tratamiento combinado, primero se realizó el retratamiento ortógrado del conducto con gutapercha termoplástica, segundo una apicectomía y sellado de las perforaciones con MTA de manera quirúrgica. A los 12 meses se comprueba mediante TCHC que se ha producido curación ósea y el diente esta asintomático, pero observamos una discoloracion a nivel de la perforación coronal. A los 5 años esta zona presenta una cavitación y se decide realizar un sellado de la perforación con resina compuesta debido a su localización supracrestal. Un año después la paciente no presenta signos clínicos ni radiológicos de patología

This is a root canals retreatment in tooth 1.1. The tooth presents positive percussion and palpation and grade II mobility. Due to the lack of information from the conventional radiography, we performed a CBCT, three root perforations and loss of the vestibular cortical bone and apical bone were observed in tooth 1.1. A combined treatment was carried out, first the orthograde retreatment of the root canal with thermoplastic obturation technique, second and apicoectomy and sealing of the perforations with MTA by surgery. At 12 months, it is observed in a new TCHC that bone healing has occurred and the tooth is asymptomatic, but we observed a discoloration at the level of the coronal perforation. At 5 years this area presents cavitation and it was decided to seal the perforation with composite resin due to its supracrestal location. A year later, the patient had no clinical or radiological signs of pathology

Influence of the Pecking Motion Frequency on the Cyclic Fatigue Resistance of Endodontic Rotary Files.

PURPOSE: To analyze the influence of the pecking motion frequency on the cyclic fatigue resistance of endodontic rotary files. MATERIAL AND METHODS: Sixty PlexV 25.06 endodontic rotary files were selected and distributed into three groups: 30 movements/min (n = 20), 60 movements/min (n = 20), and 120 movements/min (n = 20). A dynamic cyclic fatigue device was designed using Computer Aided Design/ Computer Aided Engineering (CAD/CAE) technology and manufactured by 3D impressions to simulate the pecking motion performed by an operator. Failures of the endodontic rotary files were detected by a Light-Emitting Diode (LED)/Light-Dependent Resistor (LDR) system controlled by an Arduino-Driver complex and management software. Endodontic rotary files were tested on an artificial root canal manufactured by wire electrical discharge machining (EDM), with similar dimensions to those of the instrument under examination. Endodontic rotary files were used following the manufacturer's recommendations. The results were analyzed by ANOVA and Weibull statistics. RESULTS: All pairwise comparisons revealed statistically significant differences in all three variables, except for the difference in the number of cycles between the groups with 60 and 120 movements/min (p = 0.298). The scale distribution parameter of Weibull statistics showed statistically significant differences in all three variables, except for the differences in the number of cycles between groups with 30 and 60 movements/min (p = 0.0722). No statistically significant differences in the three variables were observed for the shape distribution parameter. CONCLUSION: A low frequency of pecking motion is recommended to reduce the risk of failure of endodontic rotary files associated with cyclic fatigue.

Use of antibiotics by spanish dentists receiving postgraduate training in endodontics.

BACKGROUND: The incidence of endodontic infections is high. The contribution of Endodontics to the global problem of antibiotic resistance could be significant. The ESE, together with the World Health Organization, are promoting the World Antibiotic Awareness Week (13-19 November 2017) to promote the appropriate use of systemic antibiotics in Endodontics. The objective of this study was to determine the prescription pattern of antibiotics in the treatment of endodontic infections of Spanish dentists attending specialization programs in Endodontics. MATERIAL AND METHODS: Dentists from five Spanish endodontic postgraduate programs were requested to answer a one-page questionnaire surveying about antibiotics indications. Seventy-three dentists were required to participate in this investigation, and 67 (91.2%) fulfilled satisfactorily the survey and were included in the study. Data were analyzed using descriptive statistics and chi square test. RESULTS: The average duration of antibiotic therapy was 6.8±1.2 days. All respondents chose amoxicillin as first choice antibiotic in patients with no medical allergies, alone (40%) or associated to clavulanic acid (60%). The first drug of choice for penicillin allergic patients was clindamycin (72%). For cases of irreversible pulpitis, 22% of respondents prescribed antibiotics. For the scenario of a necrotic pulp, symptomatic apical periodontitis and no swelling, 37% prescribed antibiotics. A quarter of dentists prescribed antibiotics for necrotic pulps with asymptomatic apical periodontitis and a sinus tract. CONCLUSIONS: The results of this study show that postgraduate training in Endodontics provides greater awareness of the correct indications of antibiotics. Dentists who have received specialized training in Endodontics have a prescription pattern of antibiotics more adjusted to the guidelines recommended by international organizations and by scientific societies. Key words:Antibiotics, apical periodontitis, dental curriculum, endodontic infections, postgraduate endodontic training.

Concrescencia clínica pero no histológica: presentación de un caso clínico / Fused roots does not imply concrescence: a case report with histological analysis

La concrescencia es una anomalía dentaria poco frecuente que se define como la unión de las raíces de dos dientes adyacentes a través del cemento. Aunque en la práctica clínica el término "concrescencia" es utilizado para referirse a todos los casos de unión entre las raíces de dos dientes adyacentes, para confirmar el diagnóstico de concrescencia es necesario un estudio histológico que demuestre la unión a nivel del cemento. Esta anomalía se ha identificado en el 0,8% de los casos de exodoncia de dientes permanentes, siendo su incidencia mayor en la región posterior del maxilar superior. La detección previa de la concrescencia mediante la exploración clínica y radiográfica es, la mayoría de las ocasiones, casi imposible, por lo que el diagnostico suele hacerse después de la extracción. No obstante, es conveniente que el clínico evalúe cada paciente y cada diente de forma exhaustiva para poder planificar, caso de que exista concrescencia, la técnica quirúrgica adecuada para la extracción. Por lo tanto, deben conocerse la incidencia e implicaciones de esta anomalía para llevar a cabo un diagnóstico y plan de tratamiento correcto. En este artículo se presenta un caso clínico de aparente concrescencia diagnosticado post-extracción y cuyo estudio histológico no mostró unión de cemento entre ambas raíces. Por lo tanto, en la práctica clínica es más conveniente utilizar el término "raíces fusionadas" que "concrescencia", el cual sólo debería ser utilizado después del examen histológico de la pieza extraída

Concrescence is a rare dental anomaly defined as the cemental union of two adjacent teeth. Concrescence diagnosis requires histological confirmation, but in the clinical practice the term "concrescence" is used to refer to all the cases of union of the roots of two adjacent teeth. The anomaly has been reported in extraction cases with an incidence of 0.8% in the permanent dentition. Also has been reported a higher incidence of concrescence in the posterior maxilla. It is prudent for the clinician to evaluate carefully each patient and each tooth to be removed for the possibility and desirability of a surgical extraction technique. Therefore, consideration should be given to the possible occurrence, recognition, and implications of this anomaly in diagnosis and treatment planning. Clinically and radiographically is nearly impossible to detect concrescent teeth, and most of these cases are diagnosed post extraction. The purpose of this article is to report a case of clinical concrescence between a retained third molar and an erupted second molar identified during the extraction, which histological study did not show cementum union between both roots. Thus, in the clinical practice is better to use the term "fused roots" than "concrescence", which would be used only after the histological examination of the specimen

Presencia de biofilm en la superficie radicular externa asociado a periodontitis apical persistente: a propósito de dos casos / Biofilm on external root surfaces associated with persistent apical periodontitis: report of two cases

Se presentan dos casos en los cuales fue identificado biofilm en la superficie radicular externa de los dientes con periodontitis apical persistente (PAP). En el primer caso presentado, dos incisivos centrales superiores derechos con tratamientos de conductos realizados previamente y con PAP, fueron retratados y después realizada una cirugía periapical. Los ápices radiculares resecados fueron examinados y se observaron sus superficies cubiertas con un material duro similar al cálculo. El análisis histológico del tejido blando apical indicó tejido de granulación y abundantes elementos granulomatosos. Examinados ambos ápices con microscopía electrónica de barrido (MEB), se pudieron observar gruesas capas de biofilm bacteriano, en su mayoría formado por cocos, sobre el material duro que se asemeja al cálculo. En el segundo caso presentado, un primer molar superior derecho con PAP, con un tratamiento incorrecto de conductos realizado anteriormente, fue retratado y posteriormente realizada una cirugía apical. Examinada la raíz palatina mediante MEB, se identificaron gruesas capas de biofilm bacteriano, compuestas por células del tipo actinomices con forma de bastoncillos irregulares, adheridos a la superficie del material duro que se asemeja al cálculo. Los casos que se exponen a continuación, apoyan el concepto de que las infecciones persistentes periapicales de origen pulpar, en especial los casos sintomáticos, pueden estar asociadas a la presencia de biofilms adheridos a la superficie externa de la raíz, interfiriendo con la reparación apical

Two cases in which biofim was identified on the external root surface of root-filled teeth with persistent apical periodontitis (PAP) are reported. In the first case, the root canals of two maxillary right incisors with PAP were retreated and the apices were surgically resected. The resected root ends were examined and the surfaces covered with a hard calculus-like material. Histological analysis of the apical soft tissue indicated both granulation and granulomatosus elements. Scanning electron microscopy (SEM) examination showed thick layers of bacterial biofilm, mostly cocciform bacteria, on the calculus-like material. In the second case, the root canals of a maxillary left first molar with PAP, were treated and the root end of the palatal root was resected. SEM examination of the palatal root tip indentified thick layers of bacterial biofilm composed of actinomyces-like cells and irregular rod-shaped bacteria attached to the surface of a calculus-like material. The cases reported here support the concept that persistent periapical infections of pulpal origin may be associated with the presence of biofilms on the external root surface infections, causing impaired healing of the, may be associated to bacterial biofilms on external root Surface

Pregabalin in the treatment of inferior alveolar nerve paraesthesia following overfilling of endodontic sealer.

A case of orofacial pain and inferior alveolar nerve (IAN) paraesthesia after extrusion of endodontic sealer within the mandibular canal treated with prednisone and pregabalin is described. A 36-year-old woman underwent root canal treatment of the mandibular second right premolar tooth. Post-operative panoramic radiograph revealed the presence of radiopaque canal sealer in the mandibular canal. Damage to IAN consecutive to extrusion of endodontic sealer was diagnosed. Non-surgical management was decided, including: 1 mg/kg/day prednisone 2 times/day, once-daily regimen, and 150 mg/day pregabalin, two doses per day, monitoring the progress with periodic follow-up visits. Six weeks after the incident the signs and symptoms were gone. The complete resolution of paraesthesia and the control of pain achieved suggest that a non-surgical approach, combining prednisone and the GABA analogue pregabalin, is a good option in the management of the IAN damage subsequent to endodontic sealer extrusion. Key words:Endodontics, inferior alveolar nerve, neuropathic pain, orofacial pain, paraesthesia, pregabalin.

Endodontic treatment failure consecutive to unsystematic radiographic examination.

This case report describes the endodontic therapy on a three-rooted mandibular first molar. The initial endodontic treatment was carried out after misreading preoperative periapical radiograph. Moreover, the working length was determined only with the apex locator. So, the additional disto-lingual root left unidentified and remained untreated, failing the treatment. A thorough radiographic examination in the initial therapy would have allowed the identification of the supernumerary root and its canal. Although the apex locators determine accurately the working length, it does not inform about the root canal morphology. It can be concluded and remarked that a systematic radiographic examination, including preoperative radiographs, is essential for success in endodontic therapy.