Systemic Profile and Periodontal Condition of Hospitalized Women with High-Risk Pregnancy: A Cross-Sectional Study.

INTRODUCTION: The physiological changes in mother-infant pairs during pregnancy increase the susceptibility to a series of infections, including those of the oral cavity. Therefore, the oral and systemic health of pregnant women is related to adverse pregnancy outcomes. OBJECTIVE: This cross-sectional study aimed to evaluate the systemic profile and periodontal status of women with a high-risk pregnancy. METHODS: Eighty-nine pregnant women at risk of preterm labor admitted to a hospital in southern Brazil were interviewed and received a periodontal examination. Data related to obstetric complications during pregnancy (pre-eclampsia, infections, medication use, and gestational diabetes) and systemic diseases were collected from medical records. The periodontal parameters of probing pocket depth, bleeding on probing, and clinical attachment level were evaluated. The data were tabulated, and statistical analysis was performed (p < 0.05). RESULTS: The mean age of participants was 24 years (SD = 5.62). Gingival bleeding was recorded in 91% of the participants. The prevalence of gingivitis was 31.46%, and periodontitis was 29.21%. No association between systemic conditions and periodontal disease was observed. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Periodontal inflammation was not associated with the systemic profile during pregnancy. However, women with high-risk pregnancies showed higher levels of gingival inflammation, emphasizing the importance of dental care during pregnancy.

Influence of rotary and reciprocating kinematics on the accuracy of an integrated apex locator.

We evaluated in vitro the influence of nickel-titanium instruments kinematics on the accuracy and variation of root canal working length measurements, performed with an integrated apex locator, at glide path and at the end of shaping. Forty-four mandibular incisors, included in an alginate model, were allocated at random to two groups: reciprocating and rotary. Working length was determined at glide path stage and at the end of shaping. Measurements given by the integrated apex locator were matched with visual measurements. The apex locator accuracy was based on inter-group comparison. The variation in working length was based on intra-group comparison. Kinematics influenced the accuracy of measurements only after shaping (p < 0.05), and not in the glide path (p > 0.05). Rotary had values closer to the visual measurements. Diminishing of measures occurred after shaping for reciprocating (p < 0.05); and at glide-path stage for rotary (p > 0.05). The integrated apex locator was more accurate with rotary kinematics.

Postoperative pain after endodontic reintervention: a randomized clinical trial

Resumo O objetivo deste ensaio clínico randomizado foi comparar a prevalência e a intensidade da dor pós-operatória em casos de retratamento endodôntico, utilizando instrumentos manuais ou reciprocantes (automatizados). O tempo necessário para desobturação e reinstrumentação do canal radicular também foi avaliado. Quarenta e oito indivíduos possuindo um dente unirradicular tratado endodonticamente e portador de periodontite apical assintomática foram incluídos no estudo. Os pacientes foram aleatoriamente distribuídos em dois grupos (n=24/grupo): retratamento com instrumentos manuais de aço inoxidável ou um sistema reciprocante de níquel-titânio (Reciproc; VDW, Munique, Alemanha). A reintervenção endodôntica foi realizada em duas consultas, sendo aplicada medicação intracanal à base de hidróxido de cálcio por 14 dias, antes da obturação. O tempo clínico gasto com os protocolos de desobturação e reinstrumentação do canal radicular foi registrado com um cronômetro digital. Após cada visita, a intensidade da dor pós-operatória foi avaliada em 12, 24, 48 horas e 7 dias por meio da escala de estimativa numérica (Numerical Rating Scale - NRS). Além do registro da dor, os pacientes foram questionados quanto ao uso de analgésicos. Os dados obtidos foram analisados por testes Qui-quadrado e Mann-Whitney (α=0.05). Não foi detectada diferença significativa entre os grupos quanto à prevalência e intensidade da dor ou uso de analgésicos em nenhum dos períodos avaliados. O tempo clínico foi significativamente menor no grupo reciprocante (18 versus 41 minutos). Pode-se concluir que os instrumentos manuais e reciprocantes foram equivalentes quanto à prevalência e intensidade de dor pós-operatória e uso de analgésicos, mas a desobturação e reinstrumentação do canal radicular foram duas vezes mais rápidas com o sistema reciprocante.

Abstract The present randomized clinical trial compared the prevalence and intensity of postoperative pain in cases of endodontic reintervention using manual or engine-driven reciprocating instruments. As secondary objectives, the analgesic intake and time required for the root canal filling removal and re-instrumentation were also evaluated. Forty-eight individuals with an endodontically treated single-rooted tooth diagnosed with asymptomatic apical periodontitis were included in the study. Patients were randomly assigned to two comparison groups (n=24/group): reintervention with stainless steel manual instruments or a nickel-titanium reciprocating system (Reciproc; VDW, Munich, Germany). The endodontic reintervention was performed in two sessions with a calcium hydroxide-based intracanal medication applied for 14 days before root canal obturation. Working time for the root canal filling removal and re-instrumentation was recorded with a digital stopwatch. After each visit, postoperative pain intensity was assessed at 12, 24, and 48 hours and seven days using the Numerical Rating Scale (NRS). The patients were also asked about analgesic intake. Data were analyzed using Pearson chi-square, T and Mann-Whitney U tests (α=0.05). No significant differences between groups were found regarding the prevalence and intensity of pain or the need for analgesic intake at any time point (P > 0.05). Working time was significantly shorter in the reciprocating group (18 versus 41 minutes). In conclusion, manual and reciprocating instruments achieved the same results in terms of prevalence and intensity of postoperative pain and analgesic intake. However, filling material removal and re-instrumentation of the root canals were more than twice as fast when using the reciprocating system.

Postoperative pain after endodontic reintervention: a randomized clinical trial.

The present randomized clinical trial compared the prevalence and intensity of postoperative pain in cases of endodontic reintervention using manual or engine-driven reciprocating instruments. As secondary objectives, the analgesic intake and time required for the root canal filling removal and re-instrumentation were also evaluated. Forty-eight individuals with an endodontically treated single-rooted tooth diagnosed with asymptomatic apical periodontitis were included in the study. Patients were randomly assigned to two comparison groups (n=24/group): reintervention with stainless steel manual instruments or a nickel-titanium reciprocating system (Reciproc; VDW, Munich, Germany). The endodontic reintervention was performed in two sessions with a calcium hydroxide-based intracanal medication applied for 14 days before root canal obturation. Working time for the root canal filling removal and re-instrumentation was recorded with a digital stopwatch. After each visit, postoperative pain intensity was assessed at 12, 24, and 48 hours and seven days using the Numerical Rating Scale (NRS). The patients were also asked about analgesic intake. Data were analyzed using Pearson chi-square, T and Mann-Whitney U tests (α=0.05). No significant differences between groups were found regarding the prevalence and intensity of pain or the need for analgesic intake at any time point (P > 0.05). Working time was significantly shorter in the reciprocating group (18 versus 41 minutes). In conclusion, manual and reciprocating instruments achieved the same results in terms of prevalence and intensity of postoperative pain and analgesic intake. However, filling material removal and re-instrumentation of the root canals were more than twice as fast when using the reciprocating system.

O objetivo deste ensaio clínico randomizado foi comparar a prevalência e a intensidade da dor pós-operatória em casos de retratamento endodôntico, utilizando instrumentos manuais ou reciprocantes (automatizados). O tempo necessário para desobturação e reinstrumentação do canal radicular também foi avaliado. Quarenta e oito indivíduos possuindo um dente unirradicular tratado endodonticamente e portador de periodontite apical assintomática foram incluídos no estudo. Os pacientes foram aleatoriamente distribuídos em dois grupos (n=24/grupo): retratamento com instrumentos manuais de aço inoxidável ou um sistema reciprocante de níquel-titânio (Reciproc; VDW, Munique, Alemanha). A reintervenção endodôntica foi realizada em duas consultas, sendo aplicada medicação intracanal à base de hidróxido de cálcio por 14 dias, antes da obturação. O tempo clínico gasto com os protocolos de desobturação e reinstrumentação do canal radicular foi registrado com um cronômetro digital. Após cada visita, a intensidade da dor pós-operatória foi avaliada em 12, 24, 48 horas e 7 dias por meio da escala de estimativa numérica (Numerical Rating Scale - NRS). Além do registro da dor, os pacientes foram questionados quanto ao uso de analgésicos. Os dados obtidos foram analisados por testes Qui-quadrado e Mann-Whitney (α=0.05). Não foi detectada diferença significativa entre os grupos quanto à prevalência e intensidade da dor ou uso de analgésicos em nenhum dos períodos avaliados. O tempo clínico foi significativamente menor no grupo reciprocante (18 versus 41 minutos). Pode-se concluir que os instrumentos manuais e reciprocantes foram equivalentes quanto à prevalência e intensidade de dor pós-operatória e uso de analgésicos, mas a desobturação e reinstrumentação do canal radicular foram duas vezes mais rápidas com o sistema reciprocante.

Endodontic treatment during pregnancy: case series and literature review / Tratamento endodôntico na gestação: série de casos e revisão da literatura

ABSTRACT The aim of this paper is to provide a scientific basis for conducting safe root canal treatment in pregnant women, illustrating with case reports treated in the extension project Maternal-Child Dental Care at the Federal University of Pelotas. The scientific bases address the main doubts of professionals when performing prenatal dental care: use of radiographic examination, local anesthetics, prescription of medications, among other essential factors in the care of pregnant women. The assisted pregnant women sought care with dental pain. In two cases symptomatic irreversible pulpitis was diagnosed, while a third was experiencing acute apical periodontitis. Endodontic procedures were performed under controlled and standardized conditions. The root canals were prepared in a single session, using mechanical instrumentation with reciprocating kinematics (Wave One® Gold Primary - Dentsply Sirona), and the root canal length was determined by an electronic apex locator FinePex (Schuster). Root canal filling was performed by the single cone technique with Wave One® gutta-percha points. After endodontic treatment, coronal sealing was performed with composite resin A2 Z350 XT (3M ESPE). The care related to the gestational condition is highlighted, and the patients remain under monitoring. It is concluded that the use of apical locators and mechanical instrumentation, using reciprocating files associated with the single cone obturation technique with a standardized cone for each system, represents advances for the accomplishment of endodontic treatment in pregnant patients due to the shorter clinical time and greater comfort of the procedure.

RESUMO O objetivo deste trabalho é fornecer embasamento científico para condução do tratamento endodôntico em gestantes através de uma revisão de literatura e série de casos clínicos conduzidos em sessão única no projeto de extensão Atenção Odontológica Materno-infantil da Faculdade de Odontologia da Universidade Federal de Pelotas. As bases científicas abordam as principais dúvidas do profissional na condução do pré-natal odontológico: uso do exame radiográfico, anestésico local, prescrição de medicamentos, entre outros fatores essenciais no atendimento da gestante. As gestantes assistidas procuraram atendimento apresentando dor de origem dentária. Em dois casos foi diagnosticado pulpite irreversível sintomática, enquanto um terceiro se travava de periodontite apical aguda. Os procedimentos endodônticos foram realizados sob condições controladas e padronizadas, sob supervisão de um professor de Endodontia. O preparo dos canais radiculares foi realizado em sessão única, através de instrumentação mecanizada de cinemática reciprocante (Wave One® Gold Primary (Dentsply Sirona), sendo o comprimento dos canais determinado por meio de localizador foraminal FinePex (Schuster). A obturação dos canais foi realizada pela técnica do cone único com cones do sistema Wave One®. Após o tratamento endodôntico foi realizada blindagem coronária com resina composta cor A2 Z350 XT (3M ESPE). Os cuidados relacionados à condição gestacional estão destacados, sendo que as pacientes permanecem em acompanhamento no projeto. Conclui-se que o uso de localizadores foraminais e da instrumentação mecanizada, utilizando limas reciprocantes associadas à técnica de obturação com cone único padronizado para cada sistema representam avanços para a realização do tratamento endodôntico em pacientes gestantes devido ao menor tempo clínico e maior conforto do procedimento.

Endodontic treatment during COVID-19 pandemic - Economic perception of dental professionals

Aim: This study evaluated, by the application of questionnaires, the impact of the COVID-19 pandemic on the clinical routine and inspection by the competent authorities, on the flow of patients in the office, as well as on possible changes in Endodontic treatment costs and the amounts charged to patients. Methods: This cross-sectional study was conducted from May 2nd, 2020 to May 6th, 2020, using an online questionnaire with a convenience sample. The inclusion criterion was professionals who perform endodontic treatments in daily clinical practice and who professional setting is private practice. The questionnaire brought questions about the impact on costs and the amount charged to the patient. Results: A total of 1042 questionnaires were answered from all the different states of Brazil, by professional who usually perform Endodontic treatment, and who is working in private practice. A total of 1010 (96.9%) respondents affirm it was necessary to modify the protective equipment in endodontic treatment due to pandemic and longer intervals between appointments was cited by 922 (88.5%), economically affecting the dental practice. There was no association between routine changes and economic impacts with gender, professional experience, area of residence or education level. Conclusion: In conclusion, most dental professionals recognized changes in the routine of endodontic treatment during the COVID-19 pandemic. They have a perception of increase in endodontic costs, and reduction in the volume of patients

Effect of number of uses and sterilization on the instrumented area and resistance of reciprocating instruments.

OBJECTIVES: This study evaluated the effect of repeated uses and autoclaving in the instrumented area, fracture resistance, and time of instrumentation of thermally treated nickel-titanium reciprocating systems. MATERIALS AND METHODS: Two hundred simulated canals were instrumented using Reciproc Blue and WaveOne Gold. Each file was used up to 10 times or until fracture. The instrumented area was measured in pre- and post-operative images, using ImageJ software. Kaplan-Meier survival analysis evaluated the number of uses of instruments before fracture. Instrumented area and time of instrumentation were analyzed by Mann-Whitney U test and Kruskal-Wallis. Correlations among the number of uses and instrumented area were measured. The level of statistical significance was set at p < 0.05. RESULTS: Reciproc Blue presented a higher estimated number of uses in comparison with WaveOne Gold (p = 0.026), but autoclaving did not affect the resistance to fracture of instruments (p > 0.05). The instrumented area was different among the evaluated groups (p = 0.039), and the instrumented area along the uses of both tested instruments was reduced. With the time of instrumentation, there was also a significant difference among the evaluated groups; the groups without sterilization cycles were faster, in comparison to those submitted to autoclaving (p = 0.010). CONCLUSIONS: Reciproc Blue was more resistant than WaveOne Gold, suffering later fracture. Additionally, the sterilization cycles did not influence the estimated number of uses of thermally treated reciprocating instruments, but the instrumented area of root canals was reduced along with the repeated uses of both instruments.

Fatores preditivos do sucesso en dodôntico em tratamentos realizados por alunos de graduação§ / Predictive factors of endodontic success in treatments performed by undergraduate / Factores predictivos del éxito endodontico en tratamientos realizados por un estudiante

Resumo Introdução e objetivo: Ainda são escassos os estudos que avaliam com exatidão o sucesso do tratamento e retratamento endodônticos e quais as falhas que realmente impactam no desfecho dos mesmos. Determinar o índice e os fatores preditivos para o sucesso de tratamentos e retratamentos endodônticos, realizados por alunos de graduação com o mesmo nível de aprendizado. Materiais e métodos: Foram verificados os registros de proservação, com pelo menos 12 meses, dos tratamentos endodônticos realizados na Faculdade de Odontologia de Pelotas, analisando o sucesso ou o fracasso endodôntico, de acordo com critérios clínicos e radiográficos. As variáveis preditivas no resultado do sucesso do tratamento foram: dente, número de canais, coroa dentária, sintomas, diagnóstico da polpa e índice periapical radiográfico. As variáveis relacionadas ao tratamento foram: técnica de instrumentação, número de sessões e limite de instrumentação apical. Resultados: 136 tratamentos endodônticos foram realizados com um acompanhamento de, pelo menos, 12 meses. A avaliação mostrou que o sucesso endodôntico foi influenciado pelo número de sessões (P = 0,015), diagnóstico inicial e grupo dentário (P= 0.014). Também foi possível observar que, quanto maior o índice periapical radiográfico inicial, pior o prognóstico endodôntico (P < 0.001). Conclusão: O índice de sucesso do tratamento endodôntico foi de 96.7% para casos de polpa vital, 87.5% para os casos de necrose pulpar e 92.9% em retratamentos. Estes índices foram influenciados pelo dente tratado, diagnóstico inicial, índice periapical radiográfico inicial e pelo número de sessões utilizadas no tratamento.

Abstract Introduction and objective: There are still few studies that accurately address endodontic success and which failures actually impact the endodontic treatment outcome. Determine success rate and predictive factors for successful endodontic treatment and retreatment by undergraduate students of the same learning level. Materials and methods: The preservation records (12 months) of the endodontic treatments performed in the Faculty of Dentistry of Pelotas were verified, indicating the success or failure of the treatment. Predictive variables in the outcome of successful endodontic treatment or retreatment were: tooth, number of channels, dental crown, symptoms, pulp diagnosis, radiographic periapical index. The treatmentrelated variables were: instrumentation technique, number of sessions and apical instrumentation limit. Results: 136 endodontic treatments were performed with a follow-up of at least 12 months. The evaluation showed that endodontic success was influenced by the number of sessions (P = 0.015), initial diagnosis and dental group (P = 0.014). It was also observed that the higher the initial radiographic periapical index, the worse the endodontic prognosis (P < 0.001). Conclusion: The success rate of endodontic treatment was 96.7% for cases of vital pulp, 87.5% for cases of pulp necrosis and 92.9% for retreatments. These indices were influenced by type tooth, initial diagnosis, initial radiographic periapical index and the number of visits used in the treatment.

Resumen Introducción y objetivo: Todavía hay pocos estudios que aborden con precisión el éxito endodóntico y cuáles fracasos realmente impactan el resultado del tratamiento endodóntico. Determinar la tasa de éxito y los factores predictivos para el tratamiento y el retratamiento exitoso de endodoncia por estudiantes universitarios del mismo nivel de aprendizaje. Materiales y métodos: Se verificaron los registros de conservación (12 meses) de los tratamientos de endodoncia realizados en la Facultad de Odontología de Pelotas, lo que indica el éxito o el fracaso del tratamiento. Las variables predictivas en el resultado de un tratamiento o retratamiento endodóntico exitoso fueron: diente, número de canales, corona dental, síntomas, diagnóstico pulpar, índice periapical radiográfico. Las variables relacionadas con el tratamiento fueron: técnica de instrumentación, número de sesiones y límite de instrumentación apical. Resultados: se realizaron 136 tratamientos de endodoncia con un seguimiento de al menos 12 meses. La evaluación mostró que el éxito endodóntico estaba influenciado por el número de sesiones (P = 0.015), el diagnóstico inicial y el grupo dental (P = 0.014). También se observó que cuanto mayor es el índice periapical radiográfico inicial, peor es el pronóstico endodóntico (P <0.001). Conclusión: La tasa de éxito del tratamiento endodóntico fue del 96.7% para casos de pulpa vital, 87.5% para casos de necrosis pulpar y 92.9% para retratamientos. Estos índices fueron influenciados por el tipo de diente, el diagnóstico inicial, el índice periapical radiográfico inicial y el número de visitas utilizadas en el tratamiento.

12-Year Follow-Up of Regenerative Endodontic Treatment of Immature Permanent Upper Incisors with Acute Abscess.

This case report discusses the endodontic treatment of a 7-year-old girl who suffered trauma (intrusion) to the immature upper central incisors secondary to a fall from a bicycle. Thirty days after the accident the patient was brought by her mother for clinical and radiographic assessment with a chief complaint of swelling and tenderness to percussion and palpation. Acute apical abscess associated with immature teeth were diagnosed. A decision was made to perform regenerative endodontic treatment. Access cavities were made and the root canals were disinfected by irrigation with 2.5% sodium hypochlorite. Final irrigation was performed with 17% EDTA. Due to pain and presence of secretions, 2% chlorhexidine gel was applied as an intracanal medicament. Seven days later, at the second visit, the root canals were once again disinfected and the canals of the right and left permanent upper central incisors were filled with double antibiotic paste (metronidazole/ciprofloxacin) and calcium hydroxide paste, respectively. Zinc oxide was mixed in both pastes. At the third visit, after 21 more days, the pastes were removed and the periapical areas were stimulated with a #80 K-file to encourage clot formation within the pulp cavities. A mineral trioxide aggregate (MTA) paste cervical plug was placed and the teeth were restored with glass ionomer cement. Radiographs and CBCT scans demonstrated complete root formations. The patient has been followed for 12 years, with evidence of clinical success throughout.

Physico-chemical and antimicrobial properties and the shelf life of experimental endodontic sealers containing metal methacrylates.

The objective of this study was to evaluate the physico-chemical and antimicrobial properties of a dual polymerization experimental endodontic sealer (E) and experimental sealers containing dibutyltin methacrylate (Sn2+) (ETs) or calcium methacrylate (Ca2+) (ECs). The pH and ion release levels of the sealers were measured. The dimensional stability was evaluated in accordance with ISO 6876. Biofilm growth inhibition was evaluated using confocal laser scanning microscopy (CLSM). Biofilm viability analysis was performed using the SYTO 9 technique. The shelf life was evaluated through the degree of conversion and film thickness tests after the sealers had been stored for different periods of time. For statistical analysis, ANOVA and Tukey's post hoc test were used, with a significance level of 5%. ETs revealed better anti-biofilm potential after 15 days than that of the controls. The degree of conversion was reduced after the shelf-life period. The addition of calcium and dibutyltin methacrylate improved the anti-biofilm properties of the experimental endodontic sealer without impairing their physico-chemical properties.

A Retrospective Brazilian Multicenter Study of Biopsies at the Periapical Area: Identification of Cases of Nonendodontic Periapical Lesions.

INTRODUCTION: The purpose of this study was to analyze the features of lesions obtained from biopsies at the periapical area of teeth with a radiographic or clinical initial diagnosis of apical periodontitis. METHODS: A retrospective study was conducted on biopsies obtained from 1953-2018 at 3 Brazilian oral and maxillofacial pathology centers. Cases of endodontic and nonendodontic periapical lesions (NPLs) with a clinical diagnosis of endodontic pathoses were retrieved. Data regarding patient age, sex, and anatomic location were obtained from patients' records. The frequency and percentage of cases with clinical diagnoses of a periapical cyst, periapical granuloma, or dentoalveolar abscess were recorded, and the final histopathologic diagnosis was documented. RESULTS: Among 66,179 oral biopsies, 7246 (10.94%) were clinically diagnosed as periapical disease, 306 (4.22%) of which were histopathologically diagnosed as NPLs. The most frequent NPLs were odontogenic keratocysts (n = 107, 34.96%) followed by dentigerous cysts (n = 48, 15.68%). The mean age at diagnosis was 39.68 years with a range of 6-80 years. A total of 159 (51.96%) cases occurred in females and 147 (48.03%) in males (female to male ratio = 1.08:1). Most lesions (137, 44.77%) were located in the posterior mandible. CONCLUSIONS: A wide variety of histopathologic diagnoses, including benign odontogenic and nonodontogenic cystic and tumorous lesions, infectious diseases, and malignant neoplasms, was reported in the present survey. The features presented in this study were consistent with previous findings reported in the literature.

Dor pós-operatória em dentes tratados endodonticamente por estudantes de Odontologia, utilizando técnicas manual e reciprocante / Postoperative pain in teeth endodontically treated by dental students, using manual and reciprocating techniques

O objetivo do presente estudo foi determinar a frequênciae/ou intensidadede dor pós-operatória e os fatores associados a esta ocorrência em tratamentos e retratamentos endodônticos realizados pelas técnicas de instrumentação manual e reciprocante, por estudantesde graduação em Odontologia da Universidade Federal de Pelotas. Para tal, utilizou-se informações dos prontuários de pacientes atendidos por estudantesdo último ano de graduação, no período compreendido entrejaneiro de 2017 ejulho de 2019, totalizando 182 tratamentos. A dor foi registrada por meiodaEscala de Avaliação Numérica da Dor (EAND). Considerou-se como variáveis preditivas no desfecho de dor pós-operatória: dente, número de canais, sintomas, coroa dentária, tratamento indicadoe índice periapical radiográfico. Como variáveis relativas aos tratamentos, técnica de instrumentação, número de sessões e limite apical de instrumentação. Havia relato de dor no momento do tratamento em 28% dos prontuários, enquanto 11,5% não reportaram dor prévia. Em 149 casos (81,9%) incluídos neste estudo não foi relatada a ocorrência de dor pós-operatória, enquanto dor leve foi relatada em 17 casos (9,3%), moderada em 6(3,3%)e intensa em 10(5,5%). Em 67,4% dos casos dos dentes foram tratados até a marcação 0 do localizador apical,enquanto em 32,6% o comprimento foi estabelecido a 1mm desta marcação. Não houve associação entre o tipo de tratamento realizado e a ocorrência de dor pós-operatória (p=0,206). Conclui-se que, entreos fatores avaliados, apenas a sintomatologia prévia apresentou associação com a maior frequência de dor pós operatória (AU).

This study determined the frequency and/or intensity of postoperative pain and factors associated with such occurrence in endodontic treatments and retreatments performed by manual and reciprocating techniques, by undergraduate dental students at the Federal University of Pelotas. For that purpose, data were collected from the records of patients treated by last-term undergraduate students, in the period between January 2017 and July 2019, adding up to 182 treatments. Pain was recorded by the Numerical Pain Rating Scale (NPRS). The following predictive variables were considered in the outcome of postoperative pain: tooth, number of canals, symptoms, dental crown, indicated treatment and radiographic periapical index. The variables related to the treatments included the instrumentation techniques, number of sessions and apical limit of instrumentation. There was report of pain during treatment in 28% of records, while 11.5% did not report previous pain. In 149 cases (81.9%) included in this study there were no reports of postoperative pain, while mild pain was reported in 17 cases (9.3%), moderate in 6(3.3%)and intensive in 10(5.5%). In 67.4% of cases, the teeth were treated up to mark "0"of the apex locator, while in 32.6% the length was established at 1mm from this mark.There was no association between the type of treatment performed and the occurrence of postoperative pain (p=0.206). It was concluded that, among the evaluated factors, only the previous symptomatology was associated with higher frequency of postoperative pain (AU).

Influence of Pregnancy on the Inflammatory Process Following Direct Pulp Capping: a Preliminary Study in Rats.

The purpose of this study was to evaluate the inflammatory process following direct pulp capping during pregnancy. This experimental study involved 48 maxillary first molars of female Wistar rats. The procedures were performed in pregnant and non-pregnant animals (n =20 each). Direct pulp capping with mineral trioxide aggregate (MTA) and restoration with a light-cured resin composite was performed in half of exposed pulp specimens. In the other half of specimens, light-cured composite was placed directly on the exposed pulp. In the control groups (n=4 each), no intervention was performed. Animals were euthanized at 3 and 7 days. All sections (three per slide) were viewed under an optical microscope. One previously calibrated pathologist performed descriptive analysis and assigned scores for inflammatory response and tissue organization adjacent to the pulp exposure. The Kappa value for intra-examiner variability was 0.91. At 3 days, in animals treated with MTA, inflammatory infiltrate was absent in non-pregnant animals while mild inflammatory infiltrate was observed in some pregnant animals. The inflammatory response ranged from mild to severe in both groups treated with composite alone. At 7 days, the inflammatory response was more intense in pregnant than in non-pregnant animals treated with MTA; while this difference were not evident in animals treated with composite alone. In conclusion, pregnancy may not influence the inflammatory process following direct pulp capping with light-cured resin composite, which was always harmful to the pulp; while the tissue response after the direct pulp with MTA were more favorable in non-pregnant animals.

Influence of pregnancy on the inflammatory process following direct pulp capping: a preliminary study in rats

Abstract The purpose of this study was to evaluate the inflammatory process following direct pulp capping during pregnancy. This experimental study involved 48 maxillary first molars of female Wistar rats. The procedures were performed in pregnant and non-pregnant animals (n =20 each). Direct pulp capping with mineral trioxide aggregate (MTA) and restoration with a light-cured resin composite was performed in half of exposed pulp specimens. In the other half of specimens, light-cured composite was placed directly on the exposed pulp. In the control groups (n=4 each), no intervention was performed. Animals were euthanized at 3 and 7 days. All sections (three per slide) were viewed under an optical microscope. One previously calibrated pathologist performed descriptive analysis and assigned scores for inflammatory response and tissue organization adjacent to the pulp exposure. The Kappa value for intra-examiner variability was 0.91. At 3 days, in animals treated with MTA, inflammatory infiltrate was absent in non-pregnant animals while mild inflammatory infiltrate was observed in some pregnant animals. The inflammatory response ranged from mild to severe in both groups treated with composite alone. At 7 days, the inflammatory response was more intense in pregnant than in non-pregnant animals treated with MTA; while this difference were not evident in animals treated with composite alone. In conclusion, pregnancy may not influence the inflammatory process following direct pulp capping with light-cured resin composite, which was always harmful to the pulp; while the tissue response after the direct pulp with MTA were more favorable in non-pregnant animals.

Resumo O objetivo deste estudo foi avaliar o processo inflamatório do tecido pulpar após o capeamento pulpar direto, realizado durante a gestação. Este estudo experimental envolveu 48 primeiros molares superiores de ratos Wistar fêmeas. Os procedimentos foram realizados em animais prenhes e não prenhes (n=20). Após as exposições pulpares, o capeamento pulpar direto foi efetuado com agregado trióxido mineral (MTA) ou restauração direta com resina composta. Nos grupos controle (n=4), nenhuma intervenção foi realizada. Os animais foram submetidos à eutanásia após 3 e 7 dias. Todos os cortes foram avaliados através de um microscópio ótico. Um patologista previamente calibrado realizou analise histológica descritiva e estabeleceu escores para intensidade da resposta inflamatória e para o grau de organização tecidual na região adjacente à exposição pulpar. O valor de Kappa intra-examinador foi 0,91. No período experimental de 3 dias, nos animais tratados com MTA, o infiltrado inflamatório estava ausente nos não prenhes, enquanto infiltrado inflamatório moderado estava presente nos animais prenhes. A resposta inflamatória variou de moderada a severa em ambos os grupos tratados apenas com resina composta. Após o periodo experimental de 7 dias, a resposta inflamatória foi mais intensa nos animais prenhes que nos não prenhes do grupo do MTA, enquanto esta diferença não foi tão evidente nos animais que receberam capeamento pulpar direto com resina composta. Pode-se concluir, que a gestação pode não exercer influência no processo inflamatório do tecido pulpar após proteção pulpar direta com resina composta; a qual foi sempre danosa aos tecidos pulpares. No entanto, a resposta tecidual ao capeamento pulpar com MTA foi mais favorável nos animais não prenhes.

Maternal periodontal disease and adverse perinatal outcomes: is there an association? A hospital-based case-control study.

Objectives: The association between maternal periodontal disease and adverse perinatal outcomes although extensively studied remains unclear. The aim of this study was to evaluate, by a case-control study, conducted in three hospitals the association between preterm birth and/or low birth weight (PTB/LBW) and clinical parameters of maternal periodontal disease. Material and methods: Postpartum women who gave birth to a newborn PTB/LBW (case group), and postpartum women who had babies at full term with normal weight (control group) were included, in 1:2 ratio. Data were collected through medical records, interview, and periodontal clinical parameters. Bivariate analysis was performed to assess the PTB/LBW proportion relative to independent variables and multiple logistic regression analysis to assess the association between adverse perinatal outcomes and independent variables. Results: The sample consisted of 148 cases and 296 controls. By the 148 postpartum women with PTB/LBW in case group, 126 (87.5%) had preterm birth, and 75 (50.7%) had PTB and LBW. The periodontal status and generalized periodontitis presence were not associated with any adverse pregnancy outcomes. Having made four or more prenatal visits was a protective factor for all outcomes. The history of previous PTB/LBW was a risk factor for new cases of PTB and PTB and/or LBW. The presence of systemic disease was associated with preterm and low birth weight (PTLBW). Preeclampsia and cesarean delivery were associated with all outcomes. Conclusions: The clinical parameters of maternal periodontitis were not considered as a risk factor for the studied adverse perinatal outcomes. Clinical relevance: The present study demonstrated no association between maternal periodontitis and PTB/LBW.

Alternative to Avoid Tooth Discoloration after Regenerative Endodontic Procedure: A Systematic Review.

This systematic review aimed to evaluate whether alternative materials to conventional triple antibiotic paste (TAP - metronidazole, ciprofloxacin, and minocycline) and grey mineral trioxide aggregate (GMTA) could avoid tooth discoloration in teeth submitted to Regenerative Endodontic Procedure (REP). It was also investigated if dental bleaching is able to reverse the color of darkened teeth due to REP. The search was conducted in four databases (Medline via PubMed, Scopus, ISI Web of Science and BVS - Virtual health library), following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The retrieved papers were uploaded in the software EndNoteTM and two reviewers independently selected the studies and extracted the data. Only studies in humans (case reports, case series, clinical trials) were included in the review. From 1,122 potentially eligible studies, 83 were selected for full-text analysis, and 38 were included in the review. The included studies were mainly case reports (76.3 %). The studies described a total of 189 teeth submitted to REP. From these, about 54% of teeth presented some degree of discoloration. Most teeth presenting color alteration were treated with TAP, especially when combined with GMTA. Only three studies performed dental bleaching to restore the color of teeth and neither bleaching technique was able to restore the original color of the crowns. The use of alternative materials to TAP and GMTA, such as double antibiotic paste or Ca(OH)2 pastes and white mineral trioxide aggregate or BiodentineTM, reduces the occurrence of tooth discoloration.

Fatores maternos relacionados à alta frequência de consumo de sacarose por crianças acompanhadas por um programa de atenção odontológica materno-infantil nos dois primeiros anos de vida / Maternal factors related to the high frequency of sucrose intake by children followed-up by a maternal and child dental care program in the first two years of life

Objetivo: avaliar se os hábitos alimentares maternos relatados durante a gestação influenciam a ingestão de sacarose das crianças nos primeiros dois anos de vida. Sujeitos e método: participaram da pesquisa 204 díades mãe-filho acompanhadas por um programa de atenção odontológica materno-infantil em uma cidade no sul do Brasil. As variáveis independentes foram obtidas por meio dos prontuários odontológicos disponibilizados pelo programa. Os hábitos alimentares maternos foram coletados durante a gestação e a ingestão diária de sacarose pelas crianças foi baseada em um questionário alimentar de frequência, dicotomizado em < 4 vezes/ dia e ≥ 4 vezes/dia. A análise multivariada foi realizada com modelos de regressão de Poisson, com variância robusta para estimar a razão de prevalência e os intervalos de confiança de 95%. Resultados: a prevalência do consumo de sacarose nos primeiros dois anos de vida, com uma elevada ingestão de sacarose (≥ 4 vezes/dia), foi detectada em 90,69% das crianças. Após o ajuste, o desfecho (alta ingestão de sacarose) foi 10% maior para as crianças cujas mães relataram beber bebida açucarada para satisfazer sua sede durante a gestação [RP = 1,10 (IC95%: 1,02-1,18)]. Conclusões: a maioria das crianças apresentou alta ingestão de sacarose em idade precoce. A triagem de mulheres grávidas para consumo de bebidas açucaradas pode ser uma maneira possível de reconhecer crianças em risco futuro de alta ingestão de sacarose na primeira infância. (AU)

Objective: to assess whether maternal eating habits reported during pregnancy influence their children's sucrose intake in the first two years of life. Subjects and method: a total of 204 mother-child dyads followed-up by a maternal and child oral care program in southern Brazil participated in the study. The independent variables were obtained from dental records provided by the program. The maternal eating habits were collected during pregnancy and the daily sucrose intake of the children was based on a frequency food questionnaire dichotomized in <4 times/day and ≥4 times/day. The multivariate analysis was performed using Poisson regression models with robust variance to estimate the prevalence ratio and the 95% confidence intervals. Results: the prevalence of sucrose intake in the first two years of life was high. A high sucrose intake (≥4 times/ day) was detected in 90.69% of the children. After adjustment, the outcome (high sucrose intake) was 10% higher for children whose mothers reported drinking sugar-sweetened beverages to satisfy their thirst during pregnancy [PR = 1.10 (95%CI: 1.02-1.18)]. Conclusion: most of the children presented a high sucrose intake at an early age. Screening pregnant women for sugar- -sweetened beverage intake may be a potential way to recognize the children at risk for future high sucrose intake in early childhood. (AU)

Alternative to avoid tooth discoloration after regenerative endodontic procedure: a systematic review

Abstract This systematic review aimed to evaluate whether alternative materials to conventional triple antibiotic paste (TAP - metronidazole, ciprofloxacin, and minocycline) and grey mineral trioxide aggregate (GMTA) could avoid tooth discoloration in teeth submitted to Regenerative Endodontic Procedure (REP). It was also investigated if dental bleaching is able to reverse the color of darkened teeth due to REP. The search was conducted in four databases (Medline via PubMed, Scopus, ISI Web of Science and BVS - Virtual health library), following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The retrieved papers were uploaded in the software EndNoteTM and two reviewers independently selected the studies and extracted the data. Only studies in humans (case reports, case series, clinical trials) were included in the review. From 1,122 potentially eligible studies, 83 were selected for full-text analysis, and 38 were included in the review. The included studies were mainly case reports (76.3 %). The studies described a total of 189 teeth submitted to REP. From these, about 54% of teeth presented some degree of discoloration. Most teeth presenting color alteration were treated with TAP, especially when combined with GMTA. Only three studies performed dental bleaching to restore the color of teeth and neither bleaching technique was able to restore the original color of the crowns. The use of alternative materials to TAP and GMTA, such as double antibiotic paste or Ca(OH)2 pastes and white mineral trioxide aggregate or BiodentineTM, reduces the occurrence of tooth discoloration.

Resumo Esta revisão sistemática teve como objetivo avaliar se materiais alternativos à pasta tri-antibiótica convencional (TAP, em Inglês - metronidazol, ciprofloxacina e minociclina) e ao agregado trióxido mineral cinza (MTA cinza) poderiam evitar a descoloração dentária em dentes submetidos ao procedimento endodôntico regenerativo (REP, em Inglês). Também foi investigado se o clareamento dental é capaz de reverter a cor dos dentes escurecidos devido ao REP. A busca foi realizada em quatro bases de dados (Medline via PubMed, Scopus, ISI Web of Science e BVS - Biblioteca Virtual de Saúde), seguindo os Principais Itens para Relatar Revisões Sistemáticas e Meta-análises. Os artigos obtidos foram carregados no software EndNoteTMe dois revisores independentes selecionaram os estudos e extraíram os dados. Apenas estudos em humanos (relatos de casos, séries de casos, ensaios clínicos) foram incluídos na revisão. De 1.122 estudos potencialmente elegíveis, 83 foram selecionados para análise do artigo completo, e 38 foram incluídos na revisão. Os estudos incluídos foram principalmente relatos de casos (76,3%). Os estudos descreveram um total de 189 dentes submetidos ao REP. Destes, cerca de 54% dos dentes apresentaram algum grau de descoloração. A maioria dos dentes com alteração de cor foi tratada com TAP, principalmente quando combinada com MTA-cinza. Apenas três estudos realizaram o clareamento dental para restaurar a cor dos dentes e nem a técnica de clareamento conseguiu restaurar a cor original das coroas. O uso de materiais alternativos à TAP e ao MTA cinza, como a pasta bi-antibiótica, pasta de Ca(OH)2e MTA branco ou BiodentineTM, reduz a ocorrência de descoloração dentária.

The effect of EDTA on the antibacterial activity of sodium hypochlorite.

The combination of ethylenediaminetetraacetic acid (EDTA) and sodium hypochlorite (NaOCl) has been suggested as an irrigant for root canal therapy. However, the chemical interaction between these agents is a complex subject that is not completely understood. The aim of this study was to evaluate the interference of an EDTA chelating agent in the antibacterial ability of NaOCl, while also considering variations in methodology. Various concentrations of NaOCl and EDTA solutions were prepared from 6% and 17% solutions, respectively. The antibacterial potential of pure solutions and their combinations was assessed using a direct contact test against Enterococcus faecalis. In the first experiment, NaOCl and EDTA solutions were mixed 5 minutes before the addition of the E faecalis bacterial suspension. In the second experiment, both solutions were simultaneously put in contact with the bacterial suspension. Data were submitted to a Spearman correlation coefficient and chi-square test. Results indicated that growth of E faecalis was significantly dependent on the solution-mixing method. In the first experiment, high concentrations (17% and 8.5%) of EDTA prevented the complete killing of E faecalis by 6% NaOCl at all experimental timepoints. In the second experiment, all concentrations of NaOCl were able to eliminate E faecalis, even in the presence of EDTA. In conclusion, when NaOCl and EDTA were added simultaneously to a bacterial suspension without premixing, NaOCl was able to exert its full bactericidal action.

Physicochemical and Biological Evaluation of Endodontic Filling Materials for Primary Teeth.

This study assessed the pH, radiopacity, antimicrobial effect, cytotoxicity and biocompatibility of endodontic filling materials for primary teeth. Zinc oxide eugenol (ZOE), Vitapex and Calen paste thickened with zinc oxide (ZO) were evaluated in comparison to an experimental MTA-based material. Radiopacity was tested using a graduated aluminum stepwedge with a digital sensor (n=5). The materials pH was recorded at 1, 4, 12 h; 1, 3, 7, 15 and 30 days (n=5). Direct contact test was used to assess the antimicrobial efficacy against Enterococcus faecalis after 1, 4, 12, 24 h (n=5). Cytotoxicity assay used MTT test for cell viability after incubation for 1, 3 and 7 days (n=5). For biocompatibility test, Wistar rats had received implants containing each material (n=5). The biopsied tissues were histologically analyzed after 15, 30 and 60 days. The results of radiopacity, pH, antimicrobial capacity and cytotoxicity were analyzed using ANOVA and Tukey tests. The histological data were submitted to Kruskal-Wallis test. The experimental material presented the lowest radiopacity (3.28 mm Al) and had a pH>12.0 throughout the test period. The experimental material showed the highest antibacterial effect, killing over 99.97% bacteria in 4 h. Vitapex presented the highest cell viability. Initially, biocompatibility test showed moderate to severe inflammation in all groups. After 60 days, Calen+ZO group showed moderate inflammation, while the others showed predominantly mild inflammatory reaction. The present results demonstrated that the experimental MTA-based material exhibited satisfactory behavior regarding the studied properties. Additional in vivo studies are necessary for a better evaluation of the material.