Tratamento de extensa lesão de furca associada com canal cavo inter-radicular: relato de caso / Treatment of extensive furcation defect associated with accessory foramina: case report

Introdução: o conhecimento das possíveis variações da cavidade pulpar torna-se necessário para aumentar o êxito nos tratamentos endodônticos, tornando relevante o reconhecimento do canal cavo inter-radicular (CCIR). Objetivo: relatar o caso de um primeiro molar inferior com ampla perda óssea na região de furca associada à presença de canal cavo inter-radicular. Relato de caso: paciente relatou o surgimento de "bolhas ao redor do dente". Ao exame clínico, constatou-se a presença de fístula associada à necrose pulpar do dente #36; não existiam sinais de doença periodontal. Radiograficamente, identificou- se extensa rarefação na região de furca e periapical. Após cuidadoso acesso, foi realizada radiografia na qual constatou-se a presença do FC comunicando a câmara pulpar à furca. Após a localização dos canais radiculares e seu preparo químico-mecânico, procederam-se trocas de hidróxido de cálcio após 240 dias, constatando-se franco reparo. Após 270 dias, obturaram-se os canais radiculares e procedeu-se ao selamento da embocadura desses e do CCIR com MTA. No controle de 360 dias, observou-se a ausência de sinais clínicos indesejáveis e neoformação óssea na região de furca. Conclusão: é de fundamental importância o conhecimento da existência do CCIR e sua relação com lesões de furca em dentes sem sinais clínicos de doença periodontal; nesses casos, a correta sanificação do sistema de canais é capaz de solucionar problemas endoperiodontais, mesmo de grandes proporções, restabelecendo a saúde do paciente e, assim, evitando tratamentos desnecessários.

In vivo accuracy of two electronic foramen locators based on different operation systems.

The aim of this study was to compare in vivo the accuracy of two electronic foramen locators (EFLs) based on different operation systems - Root ZX and Propex II. Ten healthy adult patients needing premolar extractions due to orthodontic reasons participated in the study, providing a sample of 17 noncarious, non-restored, vital teeth (n= 24 canals). After coronal access preparation and cervical preflaring and prior to tooth extraction, the root canal length was measured alternating the two EFLs. All measurements were performed with K-files well fitted to the canal diameter at the level that each EFL indicated the apical foramen in their display (APEX or 0.0). The last K-file were fixed in place with cyanoacrylate, the tooth was extracted, and the apical 4 mm of each root were resected to measure the distance between the file tip and the apical foramen. The mean errors based on the absolute values of discrepancies were 0.30 ± 0.29 mm (Root ZX) and 0.32 ± 0.27 mm (Propex II). Analysis by the Wilcoxon test for paired samples showed no statistically significant differences between the electronic canal measurements performed with the EFLs (p=0.587). The apical foramen was accurately located in 75% (Root ZX) and 66.7% (Propex II) of the cases, considering a ±0.5 mm error margin, with no statistically significant difference by the chi-square test. Despite having different measurement mechanisms, both EFLs were capable of locating the apical foramen with high accuracy in vivo. Under the tested clinical conditions, Root ZX and Propex II displayed similar results.

In Vivo Accuracy of Two Electronic Foramen Locators Based on Different Operation Systems

The aim of this study was to compare in vivo the accuracy of two electronic foramen locators (EFLs) based on different operation systems - Root ZX and Propex II. Ten healthy adult patients needing premolar extractions due to orthodontic reasons participated in the study, providing a sample of 17 noncarious, non-restored, vital teeth (n= 24 canals). After coronal access preparation and cervical preflaring and prior to tooth extraction, the root canal length was measured alternating the two EFLs. All measurements were performed with K-files well fitted to the canal diameter at the level that each EFL indicated the apical foramen in their display (APEX or 0.0). The last K-file were fixed in place with cyanoacrylate, the tooth was extracted, and the apical 4 mm of each root were resected to measure the distance between the file tip and the apical foramen. The mean errors based on the absolute values of discrepancies were 0.30 ± 0.29 mm (Root ZX) and 0.32 ± 0.27 mm (Propex II). Analysis by the Wilcoxon test for paired samples showed no statistically significant differences between the electronic canal measurements performed with the EFLs (p=0.587). The apical foramen was accurately located in 75% (Root ZX) and 66.7% (Propex II) of the cases, considering a ±0.5 mm error margin, with no statistically significant difference by the chi-square test. Despite having different measurement mechanisms, both EFLs were capable of locating the apical foramen with high accuracy in vivo. Under the tested clinical conditions, Root ZX and Propex II displayed similar results.

O presente estudo teve como objetivo avaliar, in vivo, a precisão de dois localizadores eletrônicos foraminais (LEFs) baseados em diferentes mecanismos de funcionamento, Root ZX e Propex II, na determinação do forame apical, sendo utilizados nos mesmos dentes. Após o acesso coronário e o pré-alargamento, e anteriormente à exodontia, os comprimentos de 24 canais radiculares foram determinados eletronicamente alternando-se os dois LEFs. As odontometrias foram realizadas até que os dispositivos apontassem o FA (APEX), utilizando-se limas tipo-K ajustadas. O último instrumento utilizado foi fixado em posição, o dente extraído e os 4,0 mm apicais de cada canal desgastados de forma a possibilitar a determinação da distância entre a ponta dos instrumentos e o forame apical. Os erros médios em função dos valores absolutos das discrepâncias foram, respectivamente, 0,30 ± 0,29 mm (Root ZX) e 0,32 ± 0,27 mm (Propex II). A análise estatística realizada por meio do teste de Wilcoxon para amostras pareadas demonstrou a semelhança entre as determinações do forame apical realizadas pelos dois LEFs (p=0,587). O comprimento radicular até o forame apical foi corretamente determinado em 75% (Root ZX) e 66,7% (Propex II) dos casos, considerando margem de ± 0,5 mm, sem diferenças estatísticas quando analisados pelo teste qui-quadrado. Os LEFs avaliados e consequentemente seus mecanismos de funcionamento, foram capazes de determinar o comprimento dos canais radiculares com precisão em condições in vivo. Nas condições do presente estudo, Root ZX e Propex II apresentaram resultados semelhantes.

Accuracy of five electronic foramen locators with different operating systems: an ex vivo study.

OBJECTIVE: The aim of this study was to evaluate, ex vivo, the precision of five electronic root canal length measurement devices (ERCLMDs) with different operating systems: the Root ZX, Mini Apex Locator, Propex II, iPex, and RomiApex A-15, and the possible influence of the positioning of the instrument tips short of the apical foramen. MATERIAL AND METHODS: Forty-two mandibular bicuspids had their real canal lengths (RL) previously determined. Electronic measurements were performed 1.0 mm short of the apical foramen (-1.0), followed by measurements at the apical foramen (0.0). The data resulting from the comparison of the ERCLMD measurements and the RL were evaluated by the Wilcoxon and Friedman tests at a significance level of 5%. RESULTS: Considering the measurements performed at 0.0 and -1.0, the precision rates for the ERCLMDs were: 73.5% and 47.1% (Root ZX), 73.5% and 55.9% (Mini Apex Locator), 67.6% and 41.1% (Propex II), 61.7% and 44.1% (iPex), and 79.4% and 44.1% (RomiApex A-15), respectively, considering ±0.5 mm of tolerance. Regarding the mean discrepancies, no differences were observed at 0.0; however, in the measurements at -1.0, the iPex, a multi-frequency ERCLMD, had significantly more discrepant readings short of the apical foramen than the other devices, except for the Propex II, which had intermediate results. When the ERCLMDs measurements at -1.0 were compared with those at 0.0, the Propex II, iPex and RomiApex A-15 presented significantly higher discrepancies in their readings. CONCLUSIONS: Under the conditions of the present study, all the ERCLMDs provided acceptable measurements at the 0.0 position. However, at the -1.0 position, the ERCLMDs had a lower precision, with statistically significant differences for the Propex II, iPex, and RomiApex A-15.

Accuracy of five electronic foramen locators with different operating systems: an ex vivo study

Objective: The aim of this study was to evaluate, ex vivo, the precision of five electronic root canal length measurement devices (ERCLMDs) with different operating systems: the Root ZX, Mini Apex Locator, Propex II, iPex, and RomiApex A-15, and the possible influence of the positioning of the instrument tips short of the apical foramen. Material and Methods: Forty-two mandibular bicuspids had their real canal lengths (RL) previously determined. Electronic measurements were performed 1.0 mm short of the apical foramen (-1.0), followed by measurements at the apical foramen (0.0). The data resulting from the comparison of the ERCLMD measurements and the RL were evaluated by the Wilcoxon and Friedman tests at a significance level of 5%. Results: Considering the measurements performed at 0.0 and -1.0, the precision rates for the ERCLMDs were: 73.5% and 47.1% (Root ZX), 73.5% and 55.9% (Mini Apex Locator), 67.6% and 41.1% (Propex II), 61.7% and 44.1% (iPex), and 79.4% and 44.1% (RomiApex A-15), respectively, considering ±0.5 mm of tolerance. Regarding the mean discrepancies, no differences were observed at 0.0; however, in the measurements at -1.0, the iPex, a multi-frequency ERCLMD, had significantly more discrepant readings short of the apical foramen than the other devices, except for the Propex II, which had intermediate results. When the ERCLMDs measurements at -1.0 were compared with those at 0.0, the Propex II, iPex and RomiApex A-15 presented significantly higher discrepancies in their readings. Conclusions: Under the conditions of the present study, all the ERCLMDs provided acceptable measurements at the 0.0 position. However, at the -1.0 position, the ERCLMDs had a lower precision, with statistically significant differences for the Propex II, iPex, and RomiApex A-15.

Alveolar mucosa necrosis induced by utilisation of calcium hydroxide as root canal dressing.

This case demonstrates the ability of calcium hydroxide to cause connective tissue necrosis. A patient with a history of trauma exhibited a large area of external inflammatory root resorption affecting the cervical and middle thirds of tooth 12. After root canal cleaning, a calcium hydroxide root canal dressing was applied to control the resorption process. After three days when the patient attended for replacement of the dressing an irregular zone of necrosis was observed on the buccal aspect of the alveolar mucosa. Careful curettage and irrigation was then performed to remove the extruded calcium hydroxide and necrotic tissue. After curettage, the root canal was accessed and irrigated with saline solution for removal of remnants of the dressing. The dressing was than replaced taking care to avoid contact with soft tissue, which might induce further damage, minimising the overflow of material. Improvement in healing was observed at 15-day follow-up, with complete closure of the lesion by soft tissue. At the 120-day follow-up, no scar was detected. At 180-day follow-up, the root canal was filled only with mineral trioxide aggregate (MTA) with aid of K files #20 and #50. At two-year follow-up, there were no symptoms and the resorption process seemed to have ceased. It is important to emphasise the damage that may occur when calcium hydroxide is in close and extended contact with the soft tissues, which could happen when dressing material is extruded through a root resorption.

Cleaning ability of chlorhexidine gel and sodium hypochlorite associated or not with EDTA as root canal irrigants: a scanning electron microscopy study

The aim of this study was to evaluate the cleaning efficacy of 2 percent chlorhexidine gluconate gel (CHX) compared to 2.5 percent sodium hypochlorite solution (NaOCl) associated or not with 17 percent EDTA used as irrigants during the biomechanical preparation. Fifty freshly extracted single-rooted human teeth with complete apex formation were randomly divided into five groups: G1 - sterile saline, G2 - 2.5 percent NaOCl, G3 - 2 percent CHX, G4 - 2.5 percent NaOCl + EDTA and G5 - 2 percent CHX + EDTA. The specimens of G1 were subdivided into two control groups. The teeth were decoronated and the coronal and middle root thirds were prepared with Gates-Glidden burs, and the apical third was reserved to manual instrumentation. All procedures were performed by a single operator. In all groups, 2 mL of irrigant was delivered between each file change. The teeth were sectioned and prepared for analyses under scanning electron microscopy (SEM). SEM micrographs were graded according to a score scale by two examiners. Data were analyzed statistically by Kruskal-Wallis and Dunn tests at 1 percent significance level. The best results were obtained in the groups in which the irrigant was used followed by the chelating agent. No statistically significant difference was observed among G4, G5 and the positive control group (p<0.01). The groups G2 and G3 were significantly different from the others, presenting the worst cleaning capacity. In conclusion, the use of the chelating agent is necessary to obtain clean canal walls, with open tubules and no heavy debris. The use of 2 percent chlorhexidine gluconate gel alone is not able to remove the smear layer.

Cleaning ability of chlorhexidine gel and sodium hypochlorite associated or not with EDTA as root canal irrigants: a scanning electron microscopy study.

The aim of this study was to evaluate the cleaning efficacy of 2% chlorhexidine gluconate gel (CHX) compared to 2.5% sodium hypochlorite solution (NaOCl) associated or not with 17% EDTA used as irrigants during the biomechanical preparation. Fifty freshly extracted single-rooted human teeth with complete apex formation were randomly divided into five groups: G1 - sterile saline, G2 - 2.5% NaOCl, G3 - 2% CHX, G4 - 2.5% NaOCl + EDTA and G5 - 2% CHX + EDTA. The specimens of G1 were subdivided into two control groups. The teeth were decoronated and the coronal and middle root thirds were prepared with Gates-Glidden burs, and the apical third was reserved to manual instrumentation. All procedures were performed by a single operator. In all groups, 2 mL of irrigant was delivered between each file change. The teeth were sectioned and prepared for analyses under scanning electron microscopy (SEM). SEM micrographs were graded according to a score scale by two examiners. Data were analyzed statistically by Kruskal-Wallis and Dunn tests at 1% significance level. The best results were obtained in the groups in which the irrigant was used followed by the chelating agent. No statistically significant difference was observed among G4, G5 and the positive control group (p<0.01). The groups G2 and G3 were significantly different from the others, presenting the worst cleaning capacity. In conclusion, the use of the chelating agent is necessary to obtain clean canal walls, with open tubules and no heavy debris. The use of 2% chlorhexidine gluconate gel alone is not able to remove the smear layer.