Assessment of Dentinal Tubules Penetration by Hyben X Delivered into the Root Canal System as an Irrigant; An in Vitro Study.

Introduction: Disinfection of the root canal system is crucial for a successful endodontic treatment. Several factors influence the performance of effective irrigation. Diverse irrigating substances have been used but none has proved to completely penetrate the root canal system. HybenX dries biofilm due to its hygroscopic properties; therefore, it is effective in the treatment of biofilm-related diseases. This investigation aimed to estimate HybenX's degree of penetration into the dentinal tubules of upper first premolars. Materials and Methods: Experimental in vitro intervention where 30 extracted maxillary premolars were evaluated to determine HybenX's degree of penetration and 5% sodium hypochlorite in the dentinal tubules using three different irrigation techniques (passive ultrasonic irrigation, dynamic manual irrigation and conventional single jet irrigation technique). After preparation, the root canals were irrigated with fluorescent rhodamine 6G; then 500-micrometer sections were made to be analyzed under a fluorescence microscope. Measurements were made in micrometer in ZEN software to determine the penetration degree of each substance in the different root thirds. Results: In the apical third, significant differences between the 3 irrigation techniques were found (P<0.05), similarly, for the middle and cervical thirds. Significant statistical differences between the HybenX and sodium hypochlorite were found at the cervical and middle levels when using the conventional Monoject irrigation and passive ultrasonic irrigation techniques. As for the apical level, differences were found between the passive ultrasonic irrigation techniques and the dynamic manual irrigation technique. Conclusions: Based on this in vitro study, HybenX proved to highly penetrate into the dentinal tubules, especially when using the passive ultrasonic irrigation technique. HybenX may be a useful option for root canal irrigation in endodontics.

Uso del laser de baja potencia como coadyuvante en el tratamiento de lesiones periapicales. Revisión sistemática / Use of low power laser as an adjuvant in the treatment of periapical lesions. Systematic review

Resumen Las lesiones periapicales son el resultado de la exposición crónica de la pulpa dental a los microorganismos del medio oral, y afectan progresivamente la región periapical del diente afectado. En la actualidad, el láser de baja potencia (LBP) se emplea como coadyuvante en el tratamiento de este tipo de lesiones, al cual se le atribuyen propiedades analgésicas, antiinflamatorias, bio-estimulantes y promotoras de la respuesta tisular. Este trabajo consistió en revisar sistemáticamente la literatura que evidenciara el uso y la efectividad terapéutica del LBP como coadyuvante en el tratamiento de lesiones periapicales. Para esto se realizó una búsqueda en la base de datos PubMed empleando los termino MeSH [low-level light therapy], [periapical diseases], [endodontics] y [laser therapy]. Tras realizar la búsqueda no se encontró literatura relacionada que demostrara la efectividad del LBP. Sin embargo, cuatro documentos reportaron la utilidad del láser de alta potencia como alterativa terapéutica de primera elección o como coadyuvante de terapéuticas actuales. No se encontró evidencia que sustente el uso del LBP en el tratamiento de lesiones periapicales.

Abstract Periapical lesions result in the chronic exposure of the dental pulp to oral microorganisms that progressively affect the periapical region of the involved tooth. Today, low power laser (LPL) is used as an adjuvant in the treatment of these types of lesions, as it promotes tissue response and because of its analgesic, anti-inflammatory and bio-stimulant properties. The present article consists of a systematic review of the literature that will evidence the effectiveness of low power laser therapy as an adjuvant in the treatment of periapical lesions. A search in the Pubmed database was performed using the MeSH terms [low-level light therapy], [periapical diseases], [endodontics] and [laser therapy]. After the search was performed, no related literature demonstrated the effectiveness of low power laser therapy. However, 4 documents reported the usefulness of high power laser therapy as a first choice alternate therapy or as an adjuvant of actual protocols. No evidence was found that supported the use of low power laser therapy in the treatment of periapical lesions.

Accidente con hipoclorito de sodio durante la terapia endodóntica / Accident with sodium hypochlorite during endodontic therapy

Introducción: el accidente con hipoclorito de sodio es una de las complicaciones que pueden presentarse durante la terapia endodóntica convencional. Constituye el sobrepaso del irrigante a los tejidos periapicales ya sea durante la irrigación de los conductos radiculares o por medio de la inyección accidental en los tejidos blandos. Produce al paciente una sintomatología dolorosa inmediata, con una respuesta inmunológica exacerbada y necrosis hística. Objetivo: determinar las posibles causas del accidente con hipoclorito de sodio y exponer el protocolo de manejo clínico y farmacológico establecido para esta eventualidad. Caso clínico: se informa el caso de un sobrepaso accidental de hipoclorito de sodio hacia el periápice en la raíz distovestibular del diente 17 en un paciente de 67 años de edad, con hipertensión arterial controlada, diagnóstico de pulpa sana y requerimiento de realización de endodoncia preprotésica. Se exponen la toma de medidas clínicas y farmacológicas posterior al accidente con hipoclorito de sodio, así como el suministro de corticoterapia inmediata, analgesia, manejo del dolor por bloqueo anestésico del área comprometida y para disolución del hipoclorito de sodio, para completar el esquema de manejo medicación antibiótica profiláctica. Conclusiones: los factores predisponentes para la generación de un accidente con hipoclorito son: enfermedades que causen resorción periapical, selección inadecuada del tipo de jeringa y aguja con la que se realiza la irrigación y la no determinación adecuada de la longitud radicular. El manejo de estos accidentes con corticoides y analgesia reduce la agresividad de la sintomatología presentada por el paciente, así como la profilaxis antibiótica, disminuye el riesgo de daño hístico(AU)

Introduction: sodium hypochlorite accidents are one of the complications that may arise during conventional endodontic therapy. In hypochlorite accidents, the irrigant flows into the periapical tissue either during irrigation of root canals or by accidental injection into soft tissue. This situation causes immediate pain symptoms in the patient, with an exacerbated immune response and tissue necrosis. Objective: determine the possible causes of sodium hypochlorite accidents and present the clinical and pharmacological management protocol established for these events. Clinical case: a case is reported of accidental flowing of sodium hypochlorite to the apex of the distovestibular root of tooth 17 in a 67-year-old male patient with controlled hypertension and a diagnosis of healthy pulp requiring preprosthetic endodontic therapy. A description is provided of the clinical and pharmacological actions taken after the sodium hypochlorite accident, as well as the immediate application of corticotherapy, analgesia, pain management by anesthetic block of the compromised area and for dissolution of the sodium hypochlorite, to complete the management scheme with prophylactic antibiotic medication. Conclusions: the following are predisposing factors for the occurrence of a hypochlorite accident: conditions that cause periapical resorption, inadequate choice of the type of syringe and needle to perform the irrigation, and incorrect determination of the root length. Management of these accidents with corticosteroids and analgesia reduces the aggressiveness of symptoms, whereas antibiotic prophylaxis lessens the risk of tissue damage(AU)

Accidente con hipoclorito de sodio durante la terapia endodóntica / Accident with sodium hypochlorite during endodontic therapy

Introducción: el accidente con hipoclorito de sodio es una de las complicaciones que pueden presentarse durante la terapia endodóntica convencional. Constituye el sobrepaso del irrigante a los tejidos periapicales ya sea durante la irrigación de los conductos radiculares o por medio de la inyección accidental en los tejidos blandos. Produce al paciente una sintomatología dolorosa inmediata, con una respuesta inmunológica exacerbada y necrosis hística. Objetivo: determinar las posibles causas del accidente con hipoclorito de sodio y exponer el protocolo de manejo clínico y farmacológico establecido para esta eventualidad. Caso clínico: se informa el caso de un sobrepaso accidental de hipoclorito de sodio hacia el periápice en la raíz distovestibular del diente 17 en un paciente de 67 años de edad, con hipertensión arterial controlada, diagnóstico de pulpa sana y requerimiento de realización de endodoncia preprotésica. Se exponen la toma de medidas clínicas y farmacológicas posterior al accidente con hipoclorito de sodio, así como el suministro de corticoterapia inmediata, analgesia, manejo del dolor por bloqueo anestésico del área comprometida y para disolución del hipoclorito de sodio, para completar el esquema de manejo medicación antibiótica profiláctica. Conclusiones: los factores predisponentes para la generación de un accidente con hipoclorito son: enfermedades que causen resorción periapical, selección inadecuada del tipo de jeringa y aguja con la que se realiza la irrigación y la no determinación adecuada de la longitud radicular. El manejo de estos accidentes con corticoides y analgesia reduce la agresividad de la sintomatología presentada por el paciente, así como la profilaxis antibiótica, disminuye el riesgo de daño hístico(AU)

Introduction: sodium hypochlorite accidents are one of the complications that may arise during conventional endodontic therapy. In hypochlorite accidents, the irrigant flows into the periapical tissue either during irrigation of root canals or by accidental injection into soft tissue. This situation causes immediate pain symptoms in the patient, with an exacerbated immune response and tissue necrosis. Objective: determine the possible causes of sodium hypochlorite accidents and present the clinical and pharmacological management protocol established for these events. Clinical case: a case is reported of accidental flowing of sodium hypochlorite to the apex of the distovestibular root of tooth 17 in a 67-year-old male patient with controlled hypertension and a diagnosis of healthy pulp requiring preprosthetic endodontic therapy. A description is provided of the clinical and pharmacological actions taken after the sodium hypochlorite accident, as well as the immediate application of corticotherapy, analgesia, pain management by anesthetic block of the compromised area and for dissolution of the sodium hypochlorite, to complete the management scheme with prophylactic antibiotic medication. Conclusions: the following are predisposing factors for the occurrence of a hypochlorite accident: conditions that cause periapical resorption, inadequate choice of the type of syringe and needle to perform the irrigation, and incorrect determination of the root length. Management of these accidents with corticosteroids and analgesia reduces the aggressiveness of symptoms, whereas antibiotic prophylaxis lessens the risk of tissue damage(AU)

Knowledge about emergency dental trauma management among school teachers in Colombia: A baseline study to develop an education strategy.

BACKGROUND/AIM: Dental trauma in school populations has a high frequency and school teachers are often close to the place where such injuries occur. However, many studies have confirmed the lack of knowledge as to how to act in these cases. The aim of this study was to determine the knowledge in regard to dental trauma of school teachers in Colombia. MATERIALS AND METHODS: A multicentre, descriptive cross-sectional study was performed in 251 schools using a stratified randomized sampling. A structured hard copy survey was personally delivered to 2390 school teachers in the selected schools. The survey contained questions related to work experience, teaching level and demographic data, as well as questions related to their knowledge of and attitude towards emergency dental trauma management. RESULTS: The response rate was 96%. Most of the school teachers (95%) had never received training related to dental trauma, although 35% had witnessed at least 1 case. Of 2296 school teachers surveyed, only 5.8% would have replanted an avulsed tooth. An association was found between work experience and appropriate management of an avulsed tooth. No significant differences were found in regard to school location (city), school type (private/public), gender and school teachers' education level. CONCLUSIONS: The knowledge of school teachers in Colombia about emergency dental trauma management is inadequate. The findings strongly suggest a need for an education strategy with the involvement of the government, dentistry schools and private organizations.

Cambios histomorfométricos en dentina al utilizar biomodificadores radiculares. Revisión sistemática / Histomorphometric changes in root dentine after using biomodifiers. A systematic review

Antecedentes: El éxito del tratamiento endodóntico depende de una óptima preparación biomecánica, la cual incluye la remoción del barro dentinario que se forma durante la instrumentación del conducto. Esta capa se adhiere a la superficie de la dentina, ocluye los túbulos dentinarios e impide la adhesión del material obturador. Debe ser removido por soluciones irrigadoras que causan cambios en la superficie dentinaria. Se han utilizado ácido etilendiaminotetracético (EDTA), ácido cítrico y tetraciclina como irrigantes. Objetivo: Identificar los cambios producidos en la dentina al aplicar EDTA, ácido cítrico y tetraciclina como agentes irrigadores, descritos en la literatura disponible. Métodos: En esta revisión sistemática se estudiaron los diferentes cambios histomorfométricos encontrados al utilizar biomodificadores radiculares sobre la estructura dentinaria, teniendo en cuenta el tiempo de aplicación y la concentración de las soluciones. La muestra consistió en 20 artículos seleccionados de 889 revisados, publicados entre 2009 y 2016. La medida global del resultado fue la diferencia estándar de la profundidad de desmineralización dentinaria, obtenida por los acondicionadores empleados. Resultados: De acuerdo con la literatura, la profundidad de desmineralización es directamente proporcional al tiempo de exposición y concentración de la solución después de su aplicación. Para otras variables, como el pH, no se contó con evidencia suficiente para hacer inferencias. Así, se sugiere que no existen las pruebas científicas suficientes para respaldar este tipo de estudio. Conclusiones: Los cambios que se presentan en la dentina al utilizar biomodificadores radiculares dependen del tiempo de aplicación y de su concentración.

Background: The success of endodontic therapy depends on an optimal biomechanical preparation, which includes removal of smear layer formed during root canal preparation. Smear layer adheres to the dentin surface and occludes the tubules, preventing the adhesion of the sealant material. It must be removed through irrigants that cause changes on the dentinal surface. Ethylenediaminetetraacetic acid (EDTA), citric acid, and tetracycline have been used as irrigants. Purpose: To identify changes in dentine after applying EDTA, citric acid, and tetracycline as irrigants, as described in available literature. Methods: In this systematic review, histomorphometric changes in dentin surface observed after using root biomodifiers, regarding application time and concentration of solution. The sample consisted of 20 articles selected from a population of 889 articles found and published between 2009 and 2016. The overall measure of results was the standard difference of dentinal demineralization depth, obtained for each solution. Results: According to the literature, the depth of demineralization is directly proportional to exposition time and concentration after application of the irrigant. Regarding other variables, such as pH, evidence was limited to draw conclusions. Thus, it is suggested there is not enough scientific evidence to support this type of study. Conclusions: Dentinal changes that occur after using root biomodifiers depend on the length of the application time and its concentration.

Validez y Confiabilidad de dos técnicas radiográficas para la identificación de conductos radiculares / Validity and reliability of two radiographic techniques to identify radiculars canals in endodontics

Introducción y objetivo: La radiografía es el principal medio usado por el endodoncista para verificar las características del sistema de conductos, el problema es su carácter bidimensional, que puede esconder información importante para garantizar el éxito del tratamiento, lo que hace necesario evaluar medios de contraste coadyuvantes que aumenten la sensibilidad del instrumento. Determinar validez y confiabilidad de dos técnicas de identificación de conductos laterales. Materiales y métodos: Estudio de prueba diagnóstica en 82 premolares inferiores de humanos recién extraídos, con formación radicular completa. Las mediciones se realizaron en radiografías periapicales de dientes con y sin medio de contraste, usando tres dimensiones (orto-mesio y disto-radial). Para el análisis se utilizaron pruebas de sensibilidad y especificidad con un nivel de significancia del 5%. La confiabilidad de la prueba para el tipo de conducto se evaluó con el Kappa Cohen. Resultados: La técnica radiográfica con medio de contraste con orientación distal fue la más sensible (p=0,000). Mientras que la técnica radiográfica sin medio de contraste con orientación mesial fue la más específica (p=0,000). No se encontró concordancia entre las dos técnicas para la identificación de conductos. Conclusión: La técnica radiográfica con medio de contraste presentó baja sensibilidad para identificar las variantes anatómicas en el conducto radicular, excepto en los conductos tipo delta, donde los resultados se sobreestimaron. No hubo concordancia entre las dos técnicas para identificar el tipo de conducto, lo que sugiere no ser confiable al momento de utilizarla para tratamientos de conductos.

Introduction and objective: Radiograph is the head tool used for the endodontist to verify the characteristics of the root canal system; the problem is its two-dimensional character that could hide important information to ensure the success of the treatment, for that reason, it is necessary to evaluate the coadjutant contrast methods that increase the sensitivity of the instrument. To determine validity and reliability of two identifying techniques of radicular lateral ducts. Materials and methods: A diagnostic study was carried out in 82 recently extracted human lower premolars, with complete radicular formation. The measures were carried out by means of periapical radiographs with and without contrast media, using three dimensions (ortho-radial, medialradial and distoradial). For the analysis, tests of sensitivity and specificity were used with a level of significance of 5%. Reliability of the test for the type of radicular duct was evaluated by means of Kappa Cohen. Results: Radiographic technique with the contrast media and with distal orientation was the most sensitive (p=0.000). While the radiographic technique without contrast media and with mesial orientation was the most specific (p=0.000). No concordance was found between both techniques for the identification of radicular ducts. Conclusions: Radiographic technique with contrast media showed a low sensitivity to identify anatomic variants in the radicular duct, except in delta type ducts, where the results were overestimated. There was no concordance between both techniques to identify the type of duct what suggests not to be reliable at the moment of being used to endodontic treatment.