Frequency and Risk Factors of Maxillary Sinusitis of Endodontic Origin Evaluated by a Dynamic Navigation and a New Filter of Cone-Beam Computed Tomography.

INTRODUCTION: The aim of this study was to determine the frequency and risk factors of maxillary sinusitis of endodontic origin (MSEO) on posterior maxillary teeth evaluated using dynamic navigation and a novel filter of cone-beam computed tomographic (CBCT) imaging. METHODS: CBCT scans of 453 patients (814 teeth) were selected. Data were divided into 4 groups: (1) root canal treatment (RCT), (2) relation of the root apex to the maxillary sinus, (3) apical periodontitis (AP), and (4) maxillary sinus inflammation (no inflammation, periapical osteoperiostitis, periapical mucositis, partial obstruction, or total obstruction). Frequency distribution and cross-tabulation were used for data analysis. The association of maxillary sinus abnormalities with other variables was analyzed using the chi-square test. The significance level was set at 5%, and the association between dependent and independent variables was analyzed using robust Poisson regression models. RESULTS: MSEO was found in 65.6% of the cases, and the highest frequency rates were in the periapical mucositis (44%) and partial obstruction (15.8%) groups. The rates of risk factors were highest in the cases of RCT (54.9%), AP (34.3%), and the root apex in contact with the maxillary sinus (53.8%). The most frequent sex and age group were female (55.8%) and 41-50 years (30.5%). CONCLUSIONS: The frequency of MSEO was high and positively associated with RCT, AP, and the root apex's position in contact with the floor of the maxillary sinus. The maxillary sinus filter of the CBCT software provides a clear image of maxillary sinus abnormalities.

A Conservative Approach to Surgical Management of Root Canal Perforation.

This study describes a conservative approach to surgical management of root canal perforation in maxillary lateral incisors. A patient was referred for retreatment of a maxillary lateral incisor. Her chief complaint was discomfort in the buccal mucosa. Periapical radiography showed radiopaque material consistent with sealing material inside the root canal. A CBCT scan was acquired and revealed a gutta-percha cone outside the root canal, from the middle third to beyond the root apex. The imaging examination showed that the pulp cavity had not been affected. Thus, we took the clinical alternative of surgically managing the perforation by sealing with MTA, thereby avoiding endodontic treatment, and followed up with only clinical and radiographic control. At the two-year follow-up, after the surgical procedure to remove the extruded filling material, we observed bone tissue formation and positive response to pulp tests, without any clinical signs or symptoms. Root perforation is considered an unpleasant error in an operative procedure. Once a perforation is properly diagnosed, located, and sealed with biomaterial, a favorable prognosis is often achieved. MTA offered good sealing of the perforation, with promising results. Decision-making using the CBCT scan enabled us to adopt a conservative approach and favored more reliable treatment predictability.

Potential of a New Cone-Beam CT Software for Blooming Artifact Reduction.

This study evaluated the dimensions of intraradicular posts using a new cone beam CT (CBCT) software, and verified the potential of blooming artifact reduction. Sixty-three single-rooted human teeth were shaped, obturated, prepared for intracanal post placement and distributed into three groups: G1: anatomically customized prefabricated glass fiber posts; G2: low-fusion alloy posts; G3: gold alloy posts. After post fabrication and luting with RelyX U200®, specimens were sectioned axially at 9 mm from the root apex, and markings were made on the root surfaces (X-, Y- and Z-axes). The dimensions of the original posts (control group) were measured using a digital micrometer. CBCT scans of the teeth were obtained using a PreXion 3D Elite® scanner. Posts were measured on CBCT scans using DICOM files and the e-Vol DX software. A specific filter, Blooming Artefact Reduction (BAR), was developed to analyze intracanal posts. Statistical data were evaluated using the Van de Waerden nonparametric analysis of variance and, after that, normalized data were analyzed using the Tukey test. The level of significance was set at α = 5%. The measures of the anatomical prefabricated, low-fusion alloy and gold alloy intracanal posts obtained using the e-Vol DX CBCT software and a micrometer were not significantly different (p>0.05). The use of the BAR filter of the e-Vol DX software application did not induce any dimensional differences on CBCT scans of intracanal posts when compared with measurements made with a micrometer on original posts. The use of the BAR filter eliminated blooming artifacts.

Ortodontia interceptativa no tratamento de mordida cruzada posterior bilateral e mordida aberta anterior: relato de caso / Interceptive orthodontics in the treatment of bilateral posterior crossbite and anterior open bite: case report

O diagnóstico e a intervenção precoce da má oclusão, possibilitam um crescimento adequado do complexo maxilo mandibular. O objetivo deste trabalho é apresentar um relato de caso clínico de um paciente em fase de dentadura mista que apresentava mordida aberta anterior e mordida cruzada posterior bilateral. Foi proposto a instalação de um disjuntor maxilar tipo Haas. Considerações finais: Após a instalação do aparelho o paciente interrompeu o hábito de sucção digital que possuía. A expansão maxilar promovida pelo expansor Haas associada à interrupção do hábito, resultaram na correção da mordida aberta e mordida cruzada posterior bilateral. Paciente faz uso de placa de Hawley para contenção há 9 meses.

Diagnosis and early intervention of malocclusion enable adequate growth of the mandibular maxillary complex. The aim of this paper is to report a case of a patient with mixed dentition who presented anterior open bite and bilateral posterior crossbite. It has been proposed to install a Haas type jaw breaker. Final considerations: After the device was installed, the patient discontinued his digital sucking habit. The maxillary expansion promoted by Haas expander associated with the interruption of the habit resulted in the correction of the open bite and bilateral posterior crossbite. Patient has been using Hawley plaque for retention for 9 months.

Method to Determine the Root Canal Anatomic Dimension by using a New Cone-Beam Computed Tomography Software.

This study discusses a method to determine the root canal anatomic dimension by using e-Vol DX software. The methodology consists in initially establishes the correct positions which will be measured, define the point on the edge of the anatomical structure, and next adjust the intermediate position in the grayscale of CBCT image. Afterward, thin sections (0.10 mm) are obtained from 3D reconstructed slices in the filter for the measurements, in order to determine the edge of the anatomical surface in the axial plane. A replication of positions in 3D mode is done in multiplanar reconstruction (MPR) of CBCT images, where the correct position is established with the aid of a positioning guide. The 3D density is adjusted so that it is in the same dimension as the 2D image, and a dimension calibration occurs to the point where there is a coincidence between 3D and 2D. This calibration is done only at the beginning of the measurement. Next, the intermediate position of the division between the grayscale is verified in the CBCT scan. Once one side has been completed, it is moved to the other side and follows the same guidelines described above. When setting the position of the courses in the other margin, being that 2D mode is used as reference. Thus, one obtains the required measure, being checked in the two points. The creation of this filter in the e-Vol DX software for measurement, and its appropriate management, allows more effective applications when it is desired to obtain diameters of anatomical structures.

Method to determine the root canal anatomic dimension by using a new cone-beam computed tomography software

Abstract This study discusses a method to determine the root canal anatomic dimension by using e-Vol DX software. The methodology consists in initially establishes the correct positions which will be measured, define the point on the edge of the anatomical structure, and next adjust the intermediate position in the grayscale of CBCT image. Afterward, thin sections (0.10 mm) are obtained from 3D reconstructed slices in the filter for the measurements, in order to determine the edge of the anatomical surface in the axial plane. A replication of positions in 3D mode is done in multiplanar reconstruction (MPR) of CBCT images, where the correct position is established with the aid of a positioning guide. The 3D density is adjusted so that it is in the same dimension as the 2D image, and a dimension calibration occurs to the point where there is a coincidence between 3D and 2D. This calibration is done only at the beginning of the measurement. Next, the intermediate position of the division between the grayscale is verified in the CBCT scan. Once one side has been completed, it is moved to the other side and follows the same guidelines described above. When setting the position of the courses in the other margin, being that 2D mode is used as reference. Thus, one obtains the required measure, being checked in the two points. The creation of this filter in the e-Vol DX software for measurement, and its appropriate management, allows more effective applications when it is desired to obtain diameters of anatomical structures.

Resumo Este estudo discute um método para determinar a dimensão anatômica do canal radicular usando o software e-Vol DX. A metodologia consiste em inicialmente estabelecer as posições corretas que serão medidas, definir o ponto na borda da estrutura anatômica e ajustar a posição intermediária na escala de cinza na imagem em tomografia computadorizada de feixe cônico (TCFC). A seguir, slices finos (0,10mm) são obtidos a partir de cortes 3D reconstruídos no filtro para as medidas, a fim de determinar a borda da superfície anatômica no plano axial. Uma replicação de posições no modo 3D é feita em reconstrução multiplanar (MPR) em imagens de TCFC, onde a posição correta é estabelecida com o auxílio de um guia de posicionamento. A densidade 3D é ajustada de modo a ficar na mesma dimensão da imagem 2D, e então realiza-se uma calibração de dimensão até o ponto em que há uma coincidência entre o modo 3D e 2D. Essa calibração é feita apenas no início da medição. Posteriormente, a posição intermediária da divisão entre a escala de cinza é verificada na TCFC. Uma vez que um lado tenha sido concluído, o guia é movido para o outro lado, e segue-se as mesmas diretrizes descritas. Define-se a posição do marcador na outra margem, sendo que o modo 2D usado como referência. Assim, obtém-se a medida necessária, sendo verificado nas duas margens do canal radicular. A criação deste filtro no software e-Vol DX para medição e seu uso apropriado permite aplicações eficazes quando se deseja obter diâmetros de estruturas anatômicas.

Demetallization of Enterococcus faecalis biofilm: a preliminary study.

Objectives To determine the concentration of calcium, iron, manganese and zinc ions after the application of chelator to Enterococcus faecalis biofilms. Material and Methods Fifty bovine maxillary central incisors were prepared and inoculated with E. faecalis for 60 days. The following were used as irrigation solutions: 17% EDTA (pH 3, 7 and 10), 2.5% sodium hypochlorite (NaOCl) combined with 17% EDTA (pH 3, 7 and 10), distilled water (pH 3, 7 and 10), and 2.5% NaOCl. Each solution was kept in the root canal for five minutes. Fifteen uncontaminated root canals were irrigated with 17% EDTA (pH 3, 7 and 10). Six teeth were used as bacterial control. The number of calcium, iron, manganese and zinc ions was determined using flame atomic absorption spectrometry. Mean ± standard deviation (SD) values were used for descriptive statistics. Results Calcium chelation using 17% EDTA at pH 7 was higher than at pH 3 and 10, regardless of whether bacterial biofilm was present. The highest concentration of iron occurred at pH 3 in the presence of bacterial biofilm. The highest concentration of manganese found was 2.5% NaOCl and 17% EDTA at pH 7 in the presence of bacterial biofilm. Zinc levels were not detectable. Conclusions The pH of chelating agents affected the removal of calcium, iron, and manganese ions. The concentration of iron ions in root canals with bacterial biofilm was higher after the use of 17% EDTA at pH 3 than after the use of the other solutions at all pH levels.

Demetallization of Enterococcus faecalis biofilm: a preliminary study

Abstract Objectives To determine the concentration of calcium, iron, manganese and zinc ions after the application of chelator to Enterococcus faecalis biofilms. Material and Methods Fifty bovine maxillary central incisors were prepared and inoculated with E. faecalis for 60 days. The following were used as irrigation solutions: 17% EDTA (pH 3, 7 and 10), 2.5% sodium hypochlorite (NaOCl) combined with 17% EDTA (pH 3, 7 and 10), distilled water (pH 3, 7 and 10), and 2.5% NaOCl. Each solution was kept in the root canal for five minutes. Fifteen uncontaminated root canals were irrigated with 17% EDTA (pH 3, 7 and 10). Six teeth were used as bacterial control. The number of calcium, iron, manganese and zinc ions was determined using flame atomic absorption spectrometry. Mean ± standard deviation (SD) values were used for descriptive statistics. Results Calcium chelation using 17% EDTA at pH 7 was higher than at pH 3 and 10, regardless of whether bacterial biofilm was present. The highest concentration of iron occurred at pH 3 in the presence of bacterial biofilm. The highest concentration of manganese found was 2.5% NaOCl and 17% EDTA at pH 7 in the presence of bacterial biofilm. Zinc levels were not detectable. Conclusions The pH of chelating agents affected the removal of calcium, iron, and manganese ions. The concentration of iron ions in root canals with bacterial biofilm was higher after the use of 17% EDTA at pH 3 than after the use of the other solutions at all pH levels.

Oxygen Saturation in the Dental Pulp of Maxillary Premolars in Different Age Groups - Part 1.

The aim of this study was to determine oxygen saturation levels in the dental pulp of maxillary premolars in different age groups. A total of 120 human maxillary premolars with normal dental pulps were selected covering the following age groups: 20-24, 25-29, 30-34, 35-39 and 40-44 years (n=24 each group). Oxygen saturation was assessed using pulse oximetry. Analysis of variance was used to assess differences in oxygen saturation levels and Tukey's test was used to identify the age groups that differed from each other. Significance was set at 0.05. Mean oxygen saturation of 120 premolars was 86.20% considering all age groups. Significantly reduced levels were found in the oldest group compared to the other groups: 40 to 44 years - 80.00% vs. 89.71, 87.67, 88.71, and 84.80% for age groups 20-24, 25-29, 30-34, 35-39 years, respectively. The mean oxygen saturation levels were similar between 20 and 39 years of age (86.20%) in the whole sample, but reduced significantly in the 40-44-year age group, suggesting that older patients present lower oxygen saturation results even in the absence of pulp tissue injury.

Common Operative Procedural Errors and Clinical Factors Associated with Root Canal Treatment.

Operative procedural errors must be well analyzed in order to avoid influence negatively the root canal treatment (RCT) prognosis. The successful RCT prevents tooth loss and avoids pain and apical periodontitis. This review aimed to categorize common operative procedure errors and clinical factors associated with RCT. Based on this, will be approached common errors of procedures within the clinical operative sequence: endodontic treatment planning, pulp and periapical disease diagnosis, anaesthesia, access cavity preparation, isolation with rubber dam, root canal preparation, root canal filling and retreatment, restoration of endodontically treated teeth, postoperative pain, follow up of endodontically treated teeth. The professional must remind that in each phase of RCT an operative error may have adverse implication on prognosis, and these errors characterize risk factors to failure. The knowledge of probable operative procedural errors and its consequences are essentials to avoid future problems to the tooth health.

Evaluation of Periapical Lesions and Their Association with Maxillary Sinus Abnormalities on Cone-beam Computed Tomographic Images.

INTRODUCTION: Periapical inflammation is often responsible for distinct maxillary sinus (MS) changes. This retrospective, cross-sectional study evaluated the association between the clinical characteristics of periapical lesions (presence, size, and distance) in maxillary posterior teeth and the presence of sinus abnormalities by evaluating cone-beam computed tomographic (CBCT) images obtained from an archived collection. Apart from sex, no other patient information was available. METHODS: The study sample was composed of CBCT images of 143 MSs of patients with at least 1 maxillary posterior tooth with a periapical lesion and 178 MSs of patients without periapical radiolucent lesions. Sinus abnormalities were classified as mucosal thickening, sinus polyp, antral pseudocyst, nonspecific opacification, periostitis, and antral calcification; periapical radiolucent areas were classified using the CBCT periapical index, and the distance between the periapical lesion edge and the MS floor was measured. Data were analyzed using chi-square tests at a level of significance set at α = 0.05. RESULTS: Most sinus abnormalities were associated with at least 1 maxillary posterior tooth with a periapical lesion (P > .05). The most frequent sinus abnormality in the presence of a periapical lesion was mucosal thickening. All teeth with a CBCT periapical index score of 5 were associated with sinus abnormalities. The highest frequency of abnormalities was found when the radiolucent area was subjacent to the sinus floor. CONCLUSIONS: Maxillary posterior teeth with periapical radiolucent lesions had the highest frequency of sinus abnormalities. The size of a periapical lesion was not associated with the frequency of sinus abnormalities. A close spatial relationship between periapical lesions and sinuses resulted most frequently in sinus abnormalities.

Identification of Apical and Cervical Curvature Radius of Human Molars.

To determine the frequency of apical and cervical curvatures in human molars using the radius method and cone-beam computed tomography (CBCT) images. Four hundred images of mandibular and maxillary first and second molars were selected from a database of CBCT exams. The radius of curvature of curved root canals was measured using a circumcenter based on three mathematical points. Radii were classified according to the following scores: 0 - straight line; 1 - large radius (r > 8 mm, mild curvature); 2 - intermediate radius (r > 4 and r < 8 mm, moderate curvature); and 3 - small radius (r ≤ 4 mm, severe curvature). The frequency of curved root canals was analyzed according to root canal, root thirds, and coronal and sagittal planes, and assessed using the chi-square test (significance at α = 0.05). Of the 1,200 evaluated root canals, 92.75% presented curved root canals in the apical third and 73.25% in the cervical third on coronal plane images; sagittal plane analysis yielded 89.75% of curved canals in the apical third and 77% in the cervical third. Root canals with a large radius were significantly more frequent when compared with the other categories, regardless of root third or plane. Most root canals of maxillary and mandibular first and second molars showed some degree of curvature in the apical and cervical thirds, regardless of the analyzed plane (coronal or sagittal).

Identification of Apical and Cervical Curvature Radius of Human Molars

To determine the frequency of apical and cervical curvatures in human molars using the radius method and cone-beam computed tomography (CBCT) images. Four hundred images of mandibular and maxillary first and second molars were selected from a database of CBCT exams. The radius of curvature of curved root canals was measured using a circumcenter based on three mathematical points. Radii were classified according to the following scores: 0 - straight line; 1 - large radius (r>8 mm, mild curvature); 2 - intermediate radius (r>4 and r<8 mm, moderate curvature); and 3 - small radius (r≤4 mm, severe curvature). The frequency of curved root canals was analyzed according to root canal, root thirds, and coronal and sagittal planes, and assessed using the chi-square test (significance at α=0.05). Of the 1,200 evaluated root canals, 92.75% presented curved root canals in the apical third and 73.25% in the cervical third on coronal plane images; sagittal plane analysis yielded 89.75% of curved canals in the apical third and 77% in the cervical third. Root canals with a large radius were significantly more frequent when compared with the other categories, regardless of root third or plane. Most root canals of maxillary and mandibular first and second molars showed some degree of curvature in the apical and cervical thirds, regardless of the analyzed plane (coronal or sagittal).

Determinar a frequência de curvaturas apicais e cervicais em molares humanos usando o método do raio de curvatura e imagens de Tomografia Computadorizada de Feixe Cônico (TCFC). Quatrocentas imagens de primeiros e segundos molares superiores e inferiores foram selecionadas a partir de um banco de dados de exames de TCFC. O raio de curvatura dos canais foi medido usando um circuncentro com base em três pontos matemáticos e classificado de acordo com os seguintes escores: 0 - linha reta; 1 - raio grande (r > 8 mm, curvatura suave); 2 - raio intermediário (r > 4 e r < 8, curvatura moderada); 3 - raio pequeno (r ≤ 4 mm, curvatura severa). A frequência de curvaturas foi analisada em função do canal radicular, dos terços da raiz, e dos planos de avaliação (coronal e sagital); e avaliados usando o teste Qui-Quadrado (significância de α=0.05). Dos 1200 canais radiculares avaliados, 92,75% apresentaram curvatura no terço apical e 73,25% no terço cervical quando da análise no plano coronal; a análise do plano sagital revelou 89,75% de canais curvos no terço apical e 77% no terço cervical. Canais radiculares com curvatura suave foram significantemente mais frequentes quando comparados com as demais categorias, independentemente do terço radicular ou do plano. A maioria dos canais radiculares dos primeiros e segundos molares superiores e inferiores apresentou algum grau de curvatura nos terços apical e cervical, independentemente do plano analisado (coronal ou sagital).

Frequency of Root Canal Isthmi in Human Permanent Teeth Determined by Cone-beam Computed Tomography.

INTRODUCTION: This study evaluated the frequency of root canal isthmi (RCIs) in human permanent teeth by using cone-beam computed tomography. METHODS: A sample of 1400 teeth of 618 patients (394 women; mean age, 43.4 years) was selected. RCIs were detected longitudinally on 0.1-mm/0.1-mm axial slices of cone-beam computed tomography images of roots scanned from the pulp orifice to the apex, and findings were classified into 7 categories according to RCIs beginning and end: (1) both in the cervical third, (2) begin in the cervical third and end in the middle third, (3) begin in the cervical third and end in the apical third, (4) both in the middle third, (5) begin in the middle third and end in the apical third, (6) both in the apical third, or (7) no isthmus. A χ(2) test with Yates correction or the Fisher exact test was used to analyze categorical variables, described as frequencies (%). The Student t test was used to compare quantitative variables. RESULTS: RCI is a common anatomic structure in human permanent teeth, except in maxillary anterior teeth. CONCLUSIONS: The higher frequencies of RCIs (87.9%) were found in mandibular first molars. The frequencies of RCIs according to mean age and tooth group were not significantly different (P > .05), except in mandibular central incisors. RCIs were less frequent among older patients.

Detection of apical inflammatory root resorption associated with periapical lesion using different methods.

The aim of this study was to detect apical inflammatory root resorption (AIRR) associated with periapical lesion using cone beam computed tomography (CBCT) and scanning electronic microscopy (SEM). This clinical study evaluated AIRR in 88 root apexes, from 52 permanent teeth of 14 patients, extracted for different reasons. The patients were submitted to a clinical interview, review of dental/medical histories and clinical/imaging examinations for treatment planning. All selected teeth showed unrestorable condition because of the extensive coronal breakdown due to carious lesions, and root canal infection associated with periapical lesions. CBCT images were obtained from the patients with the aim of diagnosing the periapical diseases which showed complex or doubtful conditions. Two examiners assessed the presence or absence of AIRR. Apices were also analyzed under SEM. Chi-square test was used to compare the imaging methods for detection of AIRR. The level of statistical significance was set at 5%. AIRR associated with root canal infection and apical periodontitis was found in 61.4% of the cases studied by using SEM, and at least half of the cases by CBCT. The microscopic analysis remains as a reference standard against the imaging method to identify AIRR.

Detection of Apical Inflammatory Root Resorption Associated with Periapical Lesion Using Different Methods

The aim of this study was to detect apical inflammatory root resorption (AIRR) associated with periapical lesion using cone beam computed tomography (CBCT) and scanning electronic microscopy (SEM). This clinical study evaluated AIRR in 88 root apexes, from 52 permanent teeth of 14 patients, extracted for different reasons. The patients were submitted to a clinical interview, review of dental/medical histories and clinical/imaging examinations for treatment planning. All selected teeth showed unrestorable condition because of the extensive coronal breakdown due to carious lesions, and root canal infection associated with periapical lesions. CBCT images were obtained from the patients with the aim of diagnosing the periapical diseases which showed complex or doubtful conditions. Two examiners assessed the presence or absence of AIRR. Apices were also analyzed under SEM. Chi-square test was used to compare the imaging methods for detection of AIRR. The level of statistical significance was set at 5%. AIRR associated with root canal infection and apical periodontitis was found in 61.4% of the cases studied by using SEM, and at least half of the cases by CBCT. The microscopic analysis remains as a reference standard against the imaging method to identify AIRR.

O objetivo deste estudo foi detectar reabsorção radicular inflamatória apical (RRIA) associada à lesão periapical utilizando tomografia computadorizada de feixe cônico (TCFC) e microscopia eletrônica de varredura (MEV). Este estudo clínico avaliou RRIA em 88 ápices radiculares de 52 dentes permanentes de 14 pacientes, extraídos por diferentes motivos. Os pacientes foram submetidos a uma entrevista clínica, revisão da história médica/dental, exames clínicos e de imagem para o plano de tratamento. Todos os dentes selecionados apresentaram condição não restaurável devido à extensa perda de estrutura dental associada a lesões cariosas, e infecção do canal radicular associada a lesões periapicais. TCFC foram obtidas dos pacientes com o objetivo de diagnosticar as alterações periapicais que se mostraram complexas ou duvidosas. Dois examinadores avaliaram a presença ou ausência de RRIA. Os ápices foram também analisados por MEV. O teste do qui-quadrado foi usado para comparar os métodos de detecção de RRIA. O nível de significância foi estabelecido em 5%. RRIA associada à infecção do canal radicular e periodontite apical foi encontrada em 61,4% dos casos estudados usando MEV, e pelo menos metade dos casos utilizando TCFC. A análise microscópica continua a ser o padrão frente a métodos de imagens para a identificação de RRIA.

Effect of gutta-percha solvents on fiberglass post bond strength to root canal dentin.

The purpose of this study was to investigate the influence of gutta-percha solvents on the bond strength of fiberglass post to root canal dentin. Forty bovine incisors were decoronated, prepared, filled, and randomly distributed into four groups (n = 10) according to the gutta-percha solvent used: control, xylene, eucalyptol and orange oil. After root canal treatment, the posts were cemented into the prepared root canals using a resin-based cement. A micro push-out test was executed, and the patterns of failure were assessed with microscopy. The data were analyzed using two-way ANOVA followed by Tukey's test. The control group exhibited greater bond strength compared to the eucalyptol group in the cervical and middle thirds of the root (P < 0.05); however, it did not differ significantly from the xylene and orange oil groups (P > 0.05). No difference was observed in the values of the xylene, orange oil, and eucalyptol groups (P > 0.05). The cervical third had higher values than the apical third for all tested solvents (P < 0.05). Adhesive failure between resin cement and dentin was the most frequent type of failure. The use of xylene and orange oil as gutta-percha solvents did not influence the bond strength of fiberglass posts to root canal dentin.

Infecção endodôntica como fator de risco para doença coronariana / Endodontic infection as risk factor for coronary diseases

Objetivo: Avaliou-se em estudos longitudinais a influência da infecção endodôntica no desenvolvimento das alterações cardiovasculares. Metodologia: Empregou-se fontes de catalogação bibliográfica identificadas eletronicamente por MEDLINE, a partir de 1966 até 02 de dezembro de 2012 e Cochrane Library. Como estratégia de busca utilizou-se os termos - cardiovascular disease, coronary heart disease, periapical lesion, periapical disease, endodontic infection e root canal infection - diferentes combinações. Os estudos foram selecionados por dois revisores independentes, que também determinaram os critérios de inclusão e exclusão. Resultados: A busca apresentou 191 artigos, sendo que destes, 33 artigos eram de revisão de literatura, 58 artigos relacionavam-se com estudos in vivo (humanos ou animais), 38 estudos eram relatos de casos clínicos e 2 incluíram estudos in vitro. Dos 58 estudos in vivo, 9 estudos satisfizeram os critérios de inclusão, o que possibilitou a análise dos dados. Conclusão: Diante dos resultados obtidos, observou-se ausência de homogeneidade dos protocolos clínicos empregados nos estudos incluídos, o que inviabilizou uma meta-análise. A partir dos estudos incluídos parece oportuno maior número de pesquisas para o estabelecimento com o rigor de evidência das possíveis relações entre estas duas doenças.

Aim: Longitudinal studies about the influence of endodontic infection as a risk factor for cardiovascular disease were studied. Methodology: Bibliographic tabulation sources identified electronically by MEDLINE, since 1966 until December 2nd of 2012 and Cochrane Library, on the same period, were used. As searching strategy the following terms were used in different combinations: cardiovascular disease, coronary heart disease, periapical lesion, periapical disease, endodontic infection e root canal infection. The studies were selected by two independent reviewers, which also determined the inclusion and exclusion criteria. Results: The search presented 191 related articles, and from these, 33 articles were literature reviews, 58 articles wer related to in vivo studies (humans or animals), 38 studies were cases reports, and 2 included in vitro and/or ex vivo studies.From the 58 in vivo studies, 9 studies satisfied the inclusion criteria, what enabled the data analysis. Conclusion: Based on these results, it was observed lack of homogeneity of the clinical protocols used in the included studies, which prevented a meta-analysis. From the included studies seems appropriate to further research to establish with the rigor of evidence of possible relationships between these two diseases.

Utilização de cimento a base de MTA no tratamento de perfuração radicular: relato de caso clínico / MTA based cement in root perforation: case report

As perfurações endodônticas comunicam o canal radicular com o periodonto, em consequência de cárie, reabsorções ou causas iatrogênicas. O sucesso no tratamento está diretamente relacionado com a localização, tamanho e período entre a ocorrência e o tratamento. Os materiais utilizados no tratamento exercem função importante no selamento da área perfurada e a biocompatibilidade junto aos tecidos. A primeira via de tratamento é a não-cirúrgica. Caso o resultado não seja satisfatório, opta-se pelo acesso cirúrgico. Dos materiais para o tratamento de perfurações, na atualidade, o MTA (Agregado Trióxido Mineral) é o mais usado. É material bioativo que permite a formação de cemento, oferecendo condições para organização dos tecidos de suporte dentário. O objetivo esperado para o tratamento das perfurações é prevenir a reabsorção óssea e a perda de ligamento periodontal da região perfurada evitando a infecção. Foi objetivo desse trabalho descrever dois casos clínicos de dentes com perfuração radicular, preenchidas com cimento a base de MTA.

Endodontic perforations are accidents that communicate the internal environment with the dental periodontium. They can be caused by caries, resorption or iatrogenic factors. The successful treatment in the perforations is directly related to their location, size and time between the accident and treatment. The materials used also play important function in connection with the sealing of the perforated area and biocompatibility with human tissue. The first-line treatment is non-surgical. If the result is not positive, surgical approach should be chosen. Actually, MTA (Mineral Trioxide Aggregate) is the most used material for perforations treatment. It is a bioactive material that allows the formation of cementum and gives the conditions for the organization of the teeth supporting tissues. The expected goal for the perforation treatment is to prevent bone resorption and periodontal ligament lost in the region, avoiding the infection. The objective of this paper was to describe two case reports of dental radicular perforations filled by a MTA-based cement.