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.

In vitro analysis of the pH alteration of the dentine after using different calcium hydroxide-based pastes

Introduction: To analyze the pH increase at the external root surface after the use of different calcium hydroxide pastes (Calen, calcium hydroxide associated with 2% chlorhexidine gel, calcium hydroxide associated with saline) with and without EDTA as chelating agent before the topical application of the intracanal medication. Material and methods: One-hundred single-rooted extracted teeth were cleaned and shaped. They were randomly divided into six experimental groups (n = 15) and one control group (n = 10), according to the medication to be used. The teeth were kept immersed in saline solution and the pH measurements were weekly verified with the aid of a pH meter. Results: It was verified the pH increasing at the first week in almost all groups. Only the groups in which Ca(OH)2 was associated with 2% chlorhexidine gel exhibited a significant evolution in the pH increasing over time (p = 0.0116). The use of EDTA did not result in higher pH values (p = 0.2278). Conclusion: i) the pH increased in all associations used; ii) 2% chlorhexidine gel allowed the gradual pH increasing over time; iii) the smear layer removal did not influence on the pH increasing.

Análise da prevalência do quarto canal de primeiros e segundos molares superiores permanentes humanos: avaliação clínica versus avaliação microscópica / Analysis of the prevalence of the fourth canal in first and second molars permanent humans: clinical evaluation versus microscopic evaluation

O objetivo deste estudo foi analisar a prevalência do quarto canal em primeiros e segundos molares superiores humanos e identificar onde esses canais uniam-se. Foram avaliados 89 dentes primeiros e segundos molares superiores humanos. Primeiramente, foi realizada uma análise clínica convencional em todos os dentes, procurando identificar o 4O canal, chamado MP. Em seguida, foi realizada uma nova análise desses dentes com o auxílio do Microscópio Operatório (MO), comparando os resultados. A última etapa deste trabalho foi identificar, através de radiografias, onde os canais da raiz mésio vestibular uniam-se. Observou-se que no exame clínico o 4O canal estava presente em 47,2% (42) dos dentes examinados, já no exame microscópico houve um considerável aumento, fazendo com que 65,1% (58) dos dentes examinados apresentassem o canal MP. Em 43,2% dos dentes analisados, os canais da raiz mésio vestibular estavam independentes. O MO é um instrumento muito importante para o domínio da anatomia interna dos dentes, aumentando de forma significante a quantidade de dentes em que o canal MP foi encontrado, em relação à análise clínica

The objective of this study was to analyze the prevalence of the mesiopalatine canal present in first and second maxillary permanent molars humans and identify where the fusion of the mesiobuccal root canals occur. Eighty-nine first and second maxillary permanent human molars were selected and evaluated clinically in order to determine the location of the mesiopalatine canal. After the samples were observed under a light microscope 40X magnification with the same purpose. Finally, X-rays were taken from those teeth to determine the canal pathway. In the clinical examination, the mesiopalatine canal was present in 47.2% (42) of the teeth examined, in the microscopic examination there was a considerable increase, making 65.1% (58) of the teeth examined has the canal orifice. In 43.2% of teeth examined mesiopalatine canals were independent. Operation microscope is a very important arsenal to diagnosis of the internal anatomy of teeth, increasing significantly the number of teeth in the canal orifice was found in relation to clinical analysis

Microbiological evaluation of infected root canals and their correlation with pain

Introduction and Objective: The aim of this study was to evaluate the endodontic microbiota of human teeth without pulp vitality presenting radiographically visible periapical lesions and its correlation with pre- and postoperative pain symptomatology. Material and methods: Sixteen young adult patients, both genders, aging from 18 to 45 years, presenting 21 single-rooted teeth with pulp necrosis and needing endodontic treatment were selected in the multidisciplinary clinic at the University of Fortaleza (UNIFOR). After crown surgical access, the root canals were embedded with 0.9% saline solution and the material from root canals was collected with sterile paper point. The paper points were placed into Stuart transport medium and sent to the microbiology laboratory of the University of Fortaleza. Isolation and identification of bacteria were made by culture technique. The cleaning and shaping of root canals was performed by crown-down technique. Intra-canal medication comprised calcium hydroxide mixed with chlorhexidine and after 14 days the canals were filled. Patients were asked about the occurrence of pain before treatment and 24 hours after cleaning and shaping procedures. Results: The most prevalent microbial group was Streptococcus sp. followed by Fusobacterium nucleatum, although Gram-positive cocci, non-sporulating Gram-positive bacilli, Gram-negative bacilli, pigmented Gram-negative bacilli, Veillonella, Staphylococcus aureus, Pseudomonas sp. were also frequently isolated. Conclusion: According to the results, it can be concluded that Fusobacterium nucleatum and Gram-negative bacilli were more related to pre-operative pain. Regarding to postoperative pain, the most prevalent bacteria were Gram-positive cocci.

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.

Análise da espessura da linha de cimento após o uso de diferentes técnicas de obturação de canais radiculares / Evaluation of the film thickness of a root canal sealer following different filling techniques

Introdução: O objetivo deste estudo foi realizar uma análise quantitativa da espessura da linha de cimento endodôntico formada após o uso de três diferentes técnicas de obturação. Materiais e método: Foram utilizados sessenta pré-molares inferiores. Após os procedimentos de limpeza e modelagem, os dentes foram distribuídos aleatoriamente em três grupos, de acordo com a técnica de obturação a ser empregada: Grupo I - Compressão hidráulica; Grupo II - Condensação lateral; Grupo III - Híbrida de Tagger. Foi utilizado no experimento um cimento a base de óxido de zinco eugenol. Os espécimes foram analisados em quatro cortes: 12 mm, 9 mm, 6 mm e 3 mm aquém do ápice radicular. As imagens dos cortes transversais foram capturadas e a espessura de cimento foi mensurada utilizando-se o programa Image Tool 3.0. A análise estatística foi executada utilizando-se o teste de Wilcoxon (SPSS 12.0). Resultados: A técnica de Tagger foi superior às demais, seguida pela compressão hidráulica e condensação lateral, com os resultados mostrarando-se estatisticamente diferentes entre todos os grupos (p = 0,0109). Conclusões: Em geral, as menores espessuras de cimento foram obtidas para o Grupo III, sendo piores os resultados obtidos para o grupo da condensação lateral.

Análise da capacidade de preenchimento de canais radiculares com guta-percha promovida por três diferentes técnicas de obturação de canais radiculares / Analysis of gutta-percha's root canal filling capacity through three different obturation techniques

Introdução e objetivo: O objetivo deste estudo foi determinar a deste estudo foi determinar a capacidade de preenchimento de canais radiculares com guta-percha por meio de três diferentes técnicas de obturação endodôntica. Material e métodos: Utilizaram-se 60 dentes unirradiculados, os quais foram limpos, modelados e divididos aleatoriamente em três grupos. Recorreuse a três técnicas distintas de obturação para cada grupo de estudo: grupo I ­ condensação lateral; grupo II ­ compressão hidráulica; grupo III ­ híbrida de Tagger. Todos os procedimentos foram executados por dois operadores calibrados em momento anterior. Após os procedimentos de obturação, seccionaram-se os espécimes transversalmente em quatro medidas a partir do ápice radicular (3 mm, 6 mm, 9 mm e 12 mm), com auxílio de disco de diamante montado em IsoMet®, sob intensa refrigeração e baixa rotação. Esses cortes foram incluídos em resina plástica e lixados, e as imagens dos canais radiculares capturadas e analisadas com auxílio do programa Image Tool 3.0. Mensuraram-se as áreas dos canais radiculares e de toda a massa de guta-percha presente no interior do canal radicular, a fim de obter a porcentagem de preenchimento do canal radicular com material guta-percha para cada corte. Resultados: Os resultados foram tabulados e avaliados por intermédio do programa GMC 10.0 (Kruskal-Wallis). A análise dos resultados evidenciou que a técnica híbrida de Tagger (95,1%) foi superior às demais na capacidade de preenchimento do canal radicular com guta-percha, seguida das técnicas da compressão hidráulica (89,1%) e da condensação lateral (70,6%). Os resultados mostraram-se diferentes estatisticamente entre as técnicas empregadas (p < 0,01) para todos os cortes obtidos. Quanto às análises intragrupos, notou-se diferença estatística significante apenas no grupo I (p < 0,01), porém os cortes executados em 6 mm e 9 mm foram iguais (p > 0,05). Conclusão: Das técnicas de obturação de canais radiculares testadas, a híbrida de Tagger possui a maior capacidade de preenchimento do sistema de canais radiculares com guta-percha. Depois vêm as técnicas da compressão hidráulica e da condensação lateral

Introduction and objective: The aim of this study was to determine gutta-percha's root canal filling capacity through three different filling techniques. Material and methods: Sixty single-rooted human teeth were cleaned, shaped and randomly divided according to the filling technique: Group I: Lateral condensation; Group II: Hydraulic compression; Group III: Tagger's hybrid. All procedures were performed by two previously calibrated operators. The teeth were transversely sectioned into four cuts, starting from the root apex (at 3 mm, 6 mm, 9 mm, and 12 mm), by using an Isomet diamond blade (wafering blade, series 15 high concentration, 5 inch blade, Buehler Ltd., Lake Bluff, IL, USA), mounted in an IsoMet® Low Speed Saw (Buehler Ltd., Lake Bluff, IL, USA), and water as a cooling medium. Each group's cut was embedded in acrylic resin and polished. Root canal images were captured and then analysed by Image Tool 3.0 software (Department of Dental Diagnostic Science, University of Texas, Health Science Center, San Antonio, Texas). Measurements of root canal overall area and gutta-percha-filled area were executed, therefore, obtaining the percentage of gutta-percha's root canal filling capacity for each slice. Results: Data were analyzed by GMC software 10.0 and Kruskal-Wallis test. Tagger's hybrid technique (95.1%) was superior to the other two techniques, followed by Hydraulic compression (89.1%) and lateral condensation (70.6%). The results were statistically different among the three techniques, for all cuts (p < 0.01). Intra-group analyses showed statistically significant differences only in Group I (p < 0.01). However, slices obtained at 6 mm and 9 mm were statistically equal (p > 0.05). Conclusion: These results suggest that Tagger's hybrid technique may yield better root canal filling capacity than Hydraulic compression and lateral condensation technique, which showed the worst filling capacity of all the three techniques employed

Ex vivo evaluation of coronal and apical microbial leakage of root canal--filled with gutta-percha or Resilon/Epiphany root canal filling material.

OBJECTIVE: This ex vivo study compared coronal and apical microleakage of root canals filled with Resilon/Epiphany (RE) or gutta-percha/Grossman sealer (GP), using either lateral condensation (LC) or System B (SB) technique. MATERIALS AND METHODS: Specimens in eight experimental groups were obturated using the following materials and techniques: Groups 1 and 3--GP and LC; groups 2 and 4--GP and SB; groups 5 and 7--RE and LC; groups 6 and 8--RE and SB. Apical and coronal leakages were tested using bacterial methods. For coronal analysis, the number of days required for complete contamination of the root canals was recorded according to observation of the brain heart infusion broth turbidity for 15 weeks. For apical analysis, the teeth were cleaved and the leakage was measured at 30 days. Data were collected for each sample and analyzed statistically with the Chi-square and ANOVA tests. RESULTS: Leakage was found in all groups. The difference between filling materials, obturation techniques, and median time of leakage was not statistically significant for coronal ( P=0.847) and apical ( P=0.5789) leakages. CONCLUSION: There were no differences between the different filling materials (gutta-percha/Grossman sealer and Resilon/Epiphany) and obturation techniques (lateral condensation and system B technique) in coronal or apical leakages.