Apical enlargement favors endodontic irrigation ­ an in vivo study

Aim: This study evaluated the irrigation penetration during root canal instrumentation and the clinical step in which the irrigation solution can be detected in the apical region. Materials and Methods: Twenty necrotic molars were divided according to the irrigation protocol, saline solution with manual active pressure, and 2.5% sodium hypochlorite with dripping delivery. Solution penetration assessment used a radiopaque component added to each irrigant solely before a periapical radiograph. Instrumentation sequence was: #10, and #15 K-files (step 1), cervical flaring using WaveOne Small (step 2), WaveOne Small at working length (step 3), Hero-642 #35/.02 (step 4), and Hero-642 #40/.02 (step 5). The step each contrasted-irrigant reached the 2-mm-apical region was registered. Shapiro-Wilk and Fisher's exact tests were used for comparisons. Results: In step 3, both contrasted-irrigants started to be detected in the apical region, and after step 5, contrasted-irrigants penetrated in 100% of the cases, without significant difference. Conclusion: Considering distal molar roots, the apical enlargement up to an instrument #40.02 favors the irrigation to reach the 2-mm apical region.

Apical root canal cleaning after preparation with endodontic instruments: a randomized trial in vivo analysis.

OBJECTIVES: This study aimed to evaluate vital pulp tissue removal from different endodontic instrumentation systems from root canal apical third in vivo. MATERIALS AND METHODS: Thirty mandibular molars were selected and randomly divided into 2 test groups and one control group. Inclusion criteria were a positive response to cold sensibility test, curvature angle between 10 and 20 degrees, and curvature radius lower than 10 mm. Root canals prepared with Hero 642 system (size 45/0.02) (n = 10) and Reciproc R40 (size 40/0.06) (n = 10) and control (n = 10) without instrumentation. Canals were irrigated only with saline solution during root canal preparation. The apical third was evaluated considering the touched/untouched perimeter and area to evaluate the efficacy of root canal wall debridement. Statistical analysis used t-test for comparisons. RESULTS: Untouched root canal at cross-section perimeter, the Hero 642 system showed 41.44% ± 5.62% and Reciproc R40 58.67% ± 12.39% without contact with instruments. Regarding the untouched area, Hero 642 system showed 22.78% ± 6.42% and Reciproc R40 34.35% ± 8.52%. Neither instrument achieved complete cross-sectional root canal debridement. Hero 642 system rotary taper 0.02 instruments achieved significant greater wall contact perimeter and area compared to reciprocate the Reciproc R40 taper 0.06 instrument. CONCLUSIONS: Hero 642 achieved higher wall contact perimeter and area but, regardless of instrument size and taper, vital pulp during in vivo instrumentation is not entirely removed.

Análise da relação entre o assoalho do seio maxilar e as raízes dos dentes posteriores superiores por meio de tomografias Cone Beam e radiografias panorâmicas / Analysis of the relationship between the maxillary sinus floor and the posterior maxillary dental roots using cone beam tomographies and panoramic radiographies

A relação das raízes dentárias superiores com o assoalho do seio maxilar é de suma importância para o planejamento de intervenções endodônticas. Este estudo objetivou avaliar a porcentagem de raízes de pré-molares e molares superiores em íntimo contato com o seio maxilar por meio de tomografias computadorizadas e comparar a visualização da mesma região em radiografias panorâmicas, por diferentes avaliadores. Foi realizada a análise de 82 tomografias por uma radiologista (radiologista 1). Após, 41 radiografias panorâmicas correspondentes às tomografias foram analisadas tanto por um estudante de especialização em Endodontia quanto por outra radiologista (radiologista 2), buscando também analisar a relação entre as raízes e o seio maxilar. Foram utilizados os testes Qui-quadrado e Exato de Fisher, e para a concordância entre os examinadores, o teste Kappa. A análise das tomografias (p<0,001) mostrou o primeiro pré-molar significativamente mais fora do seio maxilar e a raiz palatina do primeiro molar mostrou-se mais dentro. O índice Kappa da avaliação das radiografias panorâmicas comparado à tomografia pelo estudante foi de 0,784 e da radiologista 2 foi de 0,838, obtendo, esta última, melhores resultados que o estudante de Endodontia. Quando analisado por grupo dental, a concordância entre a radiografia panorâmica e a tomografia decresceu quanto mais posterior se localiza o elemento dental. A experiência influencia no julgamento da relação da raiz com o seio maxilar. A tomografia computadorizada é o exame mais indicado para analisar a relação entre as raízes dos dentes superiores e o assoalho do seio maxilar (AU).

The relationship of the superior dental roots with the maxillary sinus floor is utterly important for endodontic interventions planning. This study aimed to evaluate the percentage of premolars and maxillary molars roots in close contact with the maxillary sinus using computed tomographies and to compare the visualization of the same region in panoramic radiographs by different examiners. The analysis of 82 tomographies was performed by a radiologist (radiologist 1). Afterwards, 41 panoramic radiographies corresponding to the tomographies were analyzed by both an Endodontics specialization student and another radiologist (radiologist 2), also aiming to analyze the relationship between the roots and the maxillary sinus. Chi-square and Fisher's exact tests were used, and for agreement between the examiners the Kappa test was used. Analysis of the tomographies (p <0.001) showed that the first premolar was significantly more outside the maxillary sinus and the first molar palatine root showed to be more inside. The Kappa index of panoramic radiographies assessment compared to the tomography by the student was 0.784 and to the radiologist 2 was 0.838, obtaining this last one better results than that of the Endodontics student. When analyzed by dental group, the concordance between panoramic radiography and tomography decreased as more posterior is located the dental element. Experience influences in the judgment of the root and maxillary sinus relationship. Computed tomography is the most appropriate test to analyze the relationship between the upper teeth roots and the maxillary sinus floor (AU).

Acute odontogenic maxillary sinusitis treated endodontically ­ two case reports and 15-day CBCT outcome

Patients presented acute recurrences from Otorhinolaryngology treatments with unilateral symptoms compatible with maxillary sinusitis with a dental origin (MSDO). Cone beam computed tomography (CBCT) showed sinus extensive membrane thickening that was not visible at periapical exam associated to the maxillary molar infection in both cases. Respiratory structures assessment was possible using a 6-inches field of view CBCT. Non-surgical endodontic treatment (case 1) performed and retreatment (case 2) showed a fast symptoms relief. Recall examination after 15 days revealed healthy soft tissues with normal periodontal probing and no dental mobility. In addition, 15-day CBCTs revealed initial maxillary sinus membrane recovery after the endodontic approaches in the reported cases. No additional medical intervention nor antibiotics administration were necessary in these MSDO cases management. Long-term follow-up in such cases is advisable to exclude other potential dental or respiratory issues. Diagnose and follow-up using CBCT presented significant sinus membrane thick reduction with no symptom's recurrence after the endodontic treatment

Endodontic retreatment: Analysis of three specialists' retreatment rates / Retratamento endodôntico: avaliação dos índices de três especialistas

Endodontic retreatment is a clinical intervention intended to correct errors that have occurred in a treatment performed previously. There are several causes of failures. The anatomical variations between root canals and the diffi culties of achieving microbial disinfection are reported as two of the main causes. However, in the dental offi ces of both general practitioners and specialists, it is very common that the causes of indications for endodontic retreatment are technical failures due to poorly executed treatment. In view of this, the objective of this study is to analyze the records of three specialists in Endodontics and analyze the causes for referral of their endodontic retreatment patients. Examination of 24,553 treatments conducted over varying periods revealed that cases of retreatment accounted for a considerable proportion of the routine work performed by these specialists, at an average of 23% of cases. The majority of retreatment indications were due to technical failure of the initial treatment, in combination with microbial factors caused by contamination of coronal restorations and poorly executed endodontic preparation and fi lling.

O retratamento endodôntico é uma intervenção clínica destinada para a correção de falhas ocorridas num tratamento anteriormente realizado. Vários são os motivos desencadeadores de insucessos. A variedade anatômica dos canais radiculares e a difi culdade de proporcionar a desinfecção microbiana são referenciadas como duas das causas principais. Entretanto, nos consultórios dentários de clínicos gerais e especialistas, é muito comum a indicação para oretratamento endodôntico por razões técnicas devido a sua mal execução. Estabelecida esta problemática, o objetivo deste estudo consiste em avaliar os prontuários de três especialistas em endodontia e verifi car quais são os motivos de encaminhamentos de seus pacientes para o retratamento endodôntico. Após o exame de 24.553 tratamentos em períodos distintos, verifi couse que os casos de retratamentos chegam a uma média relevante de 23% na rotina destes especialistas e que a maioria das indicações se deram por inabilidade no primeiro tratamento, aliadas ao fator microbiano causado por contaminações de restaurações coronárias, preparos e obturações endodônticas mal executadas.