Revascularización pulpar en diente inmaduro con periodontitis apical: ¿Alternativa al tratamiento de apicoformación? / Pulp revascularization of an immature permanent tooth with apical periodontitis: An alternative to the apexification procedure?

Los dientes con ápices inmaduros, pulpa necrótica y periodontitis apical pueden ser un reto a la hora de tratarlos exitosamente debido a varios motivos: 1. El conducto contaminado no se puede desinfectar con los protocolos estándares de endodoncia convencional, utilizando limas que son agresivas; 2. Una vez desinfectado el sistema de conductos y la carga bacteriana está controlada, estos conductos son muy complicados de obturar, debido a la compleja anatomía del diente con ápice abierto y la falta de barrera está controlada, estos conductos son muy mencionadas se logran manejar con éxito, las raíces de estos dientes son muy delgadas y por lo tanto susceptibles a fracturarse. Estos problemas se pueden solucionar utilizando un protocolo de desinfección que no implica instrumentación del conducto y que estimula el desarrollo fisiológico radicular proporcionando un ensanchamiento de las paredes dentinarias y un cierre apical de manera convencional. En un tratamiento mínimamente invasivo, pero clínicamente supone un gran desafío. El objetivo de este artículo es presentar un caso clínico donde se revisa la técnica de revascularización pulpar, poniendo énfasis en los principios biológicos y señalar las ventajas y limitaciones de este procedimiento clínico (AU)

The immature root with a necrotic pulp and apical periodontitis presents multiple challenges to successful treatment due to: 1. The infected root canal space cannot be disinfected with the standard root canal protocol with the aggressive use of endodontic files; 2. Once the microbial phase of the treatment is complete and the bacterial load is under control, filling the root canal is difficult due to the complex anatomy o the open apex teeth and the lack of apical barrier; 3.Even when the challenges described earlier are overcome, the roots of these teeth are thin with a higher susceptibility to fracture. These problems can be overcome by using a disinfection protocol that does not include root canal instrumentation, and that stimulates the physiologic root development, providing the formation of thicker dentinal walls and apical closure on a conventional mamer. It is a minimally invasive treatment but clinically can be very challenging. The purpose of this article is to present a case and review the revascularization technique with an emphasis on biologic principles and advantages and limitations of currently available clinical procedures (AU)

Revascularización pulpar en dientes permanentes inmaduros con periodontitis apical / Pulp revascularization of inmature permanent teeth with apical periodontitis

El objetivo de este artículo es hacer una revisión bibliográficade una nueva técnica para conseguir la revascularización pulpar en dientes permanentes inmaduros con periodontitis apical. Si somos capaces de lograr dicha revascularización en los dientes avulsionados, ¿sería posible conseguir unas condiciones similares en dientes inmaduros con periodontitis apical? La revascularización pulpar es la opción más favorable, ya que no sólo induce a la formación del cierre apical como en la apexificación, sino que además promueve el desarrollo de las paredes dentinarias, para que estos dientes no queden tan frágiles y ser propensos a fracturas. A continuación vamos a describir la técnica ilustrándolo con una serie de casos clínicos publicados recientemente que demuestran que es posible la revascularización pulpar

The aim of this article is to review of a new technique that could achieve the pulp revascularization of immature permanent teeth with apical periodontitis. If we are capable to obtain tbe revascularization on avulsed teeth, Could be possible to create a similar environment in immature teeth with apical periodontitis? The revascularization is the most suitable answer because although induce the apical closure, also stimulated the growth and development of the root walls, necessary to improve the prognosis of this teeth prone to fractures. On this review we will describe the technique, illustrating with some clinic cases published recently that prove that revascularization is possible

A case of unusual anatomy: a maxillary lateral incisor with three canals.

CASE REPORT: A case of an unusual maxillary lateral incisor with three root canals is presented. The patient presented with localized swelling and a sinus tract. Because of its abnormal anatomical configuration, the tooth presented diagnostic and procedural difficulties. Conventional root canal treatment was performed successfully.

Evaluation of a digital radiography to estimate working length.

The working lengths obtained with different methods in single-rooted teeth were compared. An endodontic rule in millimeters and calipers was used as a direct method of measurement (on endodontic files). As indirect methods, measurements were taken from conventional x-rays with calipers and with a digital radiological measurement system. No statistically significant differences were obtained between the direct and indirect methods. Three vertical angulations were taken for the indirect methods (0 degree, 15 degrees, and 30 degrees). No significant differences were found between results for the two indirect methods versus the standard method except for the 30 degrees angulation, which resulted in an impression of a shortened image of about 1.5 mm when using the indirect methods (significance level: alpha = 0.05).

[Vertical fractures: apropos of 2 clinical cases]. / Fracuras verticales: a propósito de dos casos clínicos.

The aim of the study is to present a clinical review of the vertical root fractures. Two clinical cases are presented to demonstrates the criteria for obtaining a correct diagnosis of vertical root fractures.

[Thermoplasticized gutta percha in apexification]. / La gutapercha termoplástica en apicoformaciones.

Filling the root canals in teeth after apexification is one useful clinical application of the thermoplasticized gutta-percha. We described 7 cases which Ultrafil was used in order to fill the canals. In all of them we made X-ray check-up.

[Nonsurgical treatment of an invaginated tooth]. / Tratamiento endodóncico no quirúrgico de un diente invaginado.

Dens invaginatus has numerous and complex forms. Endodontic treatment of only the invaginated area could result in healing of the periapical lesion and absence of symptomatology.

[Resistance and retention as critical factors in silver amalgam restoration of endodontic posterior teeth. A clinical focus]. / La resistencia y la retención como factores críticos en las reconstrucciones con amalgama de plata de piezas dentarias posteriores endodonciadas. Un enfoque clínico.

The root canal therapy does not make sense if it is not going to be restored properly. Even though we must keep in mind all the steps necessary to build up any vital tooth, we should emphasize the retention and resistency due to the fragility of endodontically treated teeth and to the destruction of these teeth. Even though the use o silver amalgam has been often questioned, we still consider amalgam as a proper material of a good half worm life to build up endodontically treated posterior teeth. Resistency and retention were considered as the essential factors to achieve the integrity of final restorations. We have analyzed the remaining tooth structure, periodontal support, biomechanics properties of the most used restorative materials and the variations of the forces. The different opinions on the concepts and technics have been reviewed and the final practical conclusions discussed.

[Nonsurgical endodontic treatment of an invaginated canine]. / Tratamiento endodóncico no quirúrgico de un canino con invaginación.

We present a case of a maxillary canine with a dens invaginatus treated successfully. The patient had pain, swelling and a sinus tract coming from the inmature apex of the canine. The canals were enlarged and cleaned and the main canal was filled with Calcium Hydroxide to allow the root development. Seven months later, the patient was asymptomatic and the tooth was obturated with guttapercha. One year later it was confirm the success in the treatment.