Factors associated with decision-making for replacing the temporary coronal restoration after endodontic treatment

Aim: This study aimed to evaluate the decision-making by patients to replace temporary restorations with permanent restorations after endodontic treatment and to verify the associated factors and evaluate the quality/integrity of the temporary restorative material within one month. Methods: This is a cross-sectional study using non-probabilistic sampling which analyzed patients after one month of endodontic treatment. The self-administered questionnaire contained sociodemographic, treatment decision-making and endodontic treatment questions. The restoration present in the mouth was evaluated in the clinical oral examination. The Poisson Regression test was used to verify the prevalence ratio. Results: The prevalence failure to perform permanent restorations was 61.1% of patients, and 42.7% reported not having adhered. The reasons are lack of time and not knowing the importance of replacing the restoration with a definitive one. The glass ionomer temporary restorative frequency was higher among those who chose not to replace the temporary restoration with a permanent one (PR=5.19; 95%CI 2.10-12.33). In addition, there was an association between the quality of the restorative material and the type of material, and the best clinical quality of the restoration was statistically associated with glass ionomer and composite resin. Conclusions: The findings show the importance of guidance by the dental surgeon in helping patients decide to replace their temporary restoration

Postoperative Pain in Endodontically Treated Teeth: A Cross-sectional Study of Retrospective Data.

AIM: This study aimed to assess the occurrence of postoperative pain and associated factors in patients treated endodontically at a Postgraduate Center in Endodontics in Southern Brazil. MATERIALS AND METHODS: The evaluation was performed using the medical records of 658 patients. Pulp conditions, postoperative pain, pain intensity, edema, number of sessions (single or multiple), and medication administration in the postoperative period were analyzed. For data analysis, descriptive analyses and univariate and multiple regressions were performed. In the multiple analyses, odds ratios (OR) and their respective 95% confidence intervals were estimated, crude and adjusted for exposure variables in a binary logistic regression model (p-value < 0.05). RESULTS: To perform the adjusted logistic regression, all variables associated with p-value <0.10: gender, edema, and pulp condition (bio- and necropulpectomy) entered the crude model. After the multivariate analysis, a statistically significant association was found between the outcome variable of the presence of postoperative pain and the independent variable of pulp condition, and the presence of pain was associated with patients who underwent endodontics on teeth with live pulp and edema with greater chances of postoperative pain. CONCLUSION: It was concluded that the pulp condition and edema affected postoperative pain. CLINICAL SIGNIFICANCE: The occurrence of postoperative pain was around 30% in both single and multiple sessions, and it was considered relevant for the dental clinic. Pulp condition affected postoperative pain, and the presence of pain was associated with patients who underwent endodontics on teeth with live pulp.

Reference values for pulp oxygen saturation as a diagnostic tool in endodontics: a systematic review and meta-analysis.

OBJECTIVES: This systematic review aimed to identify mean oxygen saturation values (SpO2) using pulse oximetry in permanent maxillary anterior teeth. MATERIALS AND METHODS: The MEDLINE, Scientific Electronic Library Online, Cochrane Central Register of Controlled Trials, EMBASE, and Literatura Latino Americana em Ciências da Saúde electronic databases were searched. Combinations and variations of "oximetry" AND "dental pulp test" were used as search terms. Studies reporting means and standard deviations of SpO2 values were included. Two reviewers independently extracted data following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Heterogeneity was assessed using the I 2 statistic, and all analyses were performed using R software. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool and the Newcastle-Ottawa scale. RESULTS: Of the 251 studies identified, 19 met the eligibility criteria and were included (total sample, 4,541 teeth). In the meta-analysis, the mean SpO2 values were 84.94% (95% confidence interval [CI], 84.85%-85.04%) for the central incisors, 89.29% (95% CI, 89.22%-89.35%) for the lateral incisors, and 89.20% (95% CI, 89.05%-89.34%) for the canines. The studies were predominantly low-quality due to the high risk of bias associated with the index test, unclear risk regarding patient selection, and concerns about outcome assessment. CONCLUSIONS: Although most studies were low-quality, the oxygen saturation levels in normal pulp could be established (minimum saturation, 77.52%). Despite the risk of bias of the included studies, the reference values reported herein are clinically relevant for assessments of changes in pulp status. TRIAL REGISTRATION: International Prospective Register of Systematic Reviews Identifier: CRD42018085598.

Assessment of Apical Extrusion using Rotary and Reciprocating Systems during Root Canal Retreatment.

AIM: The objective of this study was to assess apical extrusion after filling material removal using two systems, one rotary and one reciprocating. MATERIALS AND METHODS: A total of 34 extracted mandibular premolars with single roots were selected and, posteriorly, prepared and filled. Following material aging for 60 days, teeth were divided into two groups, according to the method used to remove root filling material: group I, ProTaper® Universal Retreatment instruments plus refining with the Hero 642® sequence and group II, WaveOne® instruments. The teeth were fixed in an apparatus designed to collect the extruded material during removal procedure. Data on the amount of debris extruded (mg/weight) were analyzed using the Student's t test with a significance level of 5%. RESULTS: No significant differences were found between the groups with regard to the amount of material extruded during root canal retreatment. CONCLUSION: The present findings suggest that the extrusion of debris during apical root canal retreatment does not depend on the instrument design or the protocol employed. CLINICAL SIGNIFICANCE: Regardless of root canal clearance techniques, debris extrusion eventually occurs during endodontic retreatment and may be related to postoperative pain.

Effect of At-Home Bleaching on Oxygen Saturation Levels in the Dental Pulp of Maxillary Central Incisors.

The present study assessed oxygen saturation (SaO2) levels before, during, and after at-home bleaching treatment in the pulps of healthy maxillary central incisors. SaO2 levels were measured in 136 healthy maxillary central incisors using a pulse oximeter. The bleaching protocol consisted of 10% carbamide peroxide gel placed in individual trays and used for four hours daily for 14 days. SaO2 levels were assessed before bleaching (T0), immediately after the first session (T1), on the 7th day of treatment (T2), on the 15th day (the day following the last session) (T3), and 30 days after completion of the bleaching protocol (T4). Data were statistically analyzed using generalized estimating equations (GEE), Student's t test (p<0.05) and Pearson's correlation. Mean pulp SaO2 levels were 85.1% at T0, 84.9% at T1, 84.7% at T2, 84.3% at T3, and 85.0% at T4. Gradual reductions in SaO2 levels were observed, with significant differences (p<0.001) during the course of home bleaching treatment. However, 30 days after the end of the bleaching protocol, SaO2 levels returned to baseline levels. Home bleaching caused a reversible transient decrease in SaO2 levels in the pulps.

Effect of at-home bleaching on oxygen saturation levels in the dental pulp of maxillary central incisors

Abstract The present study assessed oxygen saturation (SaO2) levels before, during, and after at-home bleaching treatment in the pulps of healthy maxillary central incisors. SaO2 levels were measured in 136 healthy maxillary central incisors using a pulse oximeter. The bleaching protocol consisted of 10% carbamide peroxide gel placed in individual trays and used for four hours daily for 14 days. SaO2 levels were assessed before bleaching (T0), immediately after the first session (T1), on the 7th day of treatment (T2), on the 15th day (the day following the last session) (T3), and 30 days after completion of the bleaching protocol (T4). Data were statistically analyzed using generalized estimating equations (GEE), Student's t test (p<0.05) and Pearson's correlation. Mean pulp SaO2 levels were 85.1% at T0, 84.9% at T1, 84.7% at T2, 84.3% at T3, and 85.0% at T4. Gradual reductions in SaO2 levels were observed, with significant differences (p<0.001) during the course of home bleaching treatment. However, 30 days after the end of the bleaching protocol, SaO2 levels returned to baseline levels. Home bleaching caused a reversible transient decrease in SaO2 levels in the pulps.

Resumo Este estudo verificou o grau de saturação de oxigênio (SaO2) pulpar antes, durante e após o clareamento dental caseiro em incisivos centrais superiores hígidos. O nível de SaO2 foi verificado em 136 incisivos centrais superiores hígidos usando oxímetro de pulso. A técnica de clareamento empregou peróxido de carbamida 10% em moldeira individual por quatro horas diárias durante 14 dias. Os níveis de SaO2 foram analisados antes do clareamento (T0), imediatamente após a primeira sessão (T1), no sétimo dia de tratamento (T2), no décimo quinto dia (um dia após a última sessão) (T3) e 30 dias após o término do clareamento dental (T4). A análise estatística utilizou o modelo de equações de estimações generalizadas (GEE), teste t de Student (p<0,05) e correlação de Pearson. Os níveis médios de SaO2 pulpar foram 85,1% em T0, 84,9% em T1, 84,7% em T2, 84,3% em T3 e 85,0% em T4. Foi observada uma redução gradual dos níveis de SaO2, com diferenças significantes (p<0,001) durante o clareamento dental caseiro. No entanto, 30 dias após o término do clareamento dental, houve retorno aos valores iniciais. O clareamento dental caseiro provocou uma diminuição transitória reversível no grau de SaO2 pulpar.

A importância do perfil emergencial em prótese fixa: revisão de literatura e relato de caso / The importance of emergency profile in fixed prosthesis: literature review and case report

Respeitando os aspectos anatômicos e biológicos do elemento dental e de suas estruturas de suporte e proteção, alguns princípios devem ser respeitados na confecção de próteses fixas, dentre eles o perfil emergencial. Objetivo: o presente trabalho teve como objetivo analisar, através de uma revisão de literatura e representar através de um relato de caso a importância do perfil emergencial no sucesso das próteses fixas. Para tanto, foram verificados: a influência do perfil emergencial no alcance de uma higienização oral satisfatória e a consequente relação com a possibilidade de doença periodontal; e o nível estético obtido através de uma condição favorável entre a estrutura da prótese fixa e o tecido gengival. Método: esta revisão de literatura foi realizada através da pesquisa em artigos científicos, indexados na base de dados Pubmed, buscando as seguintes palavras chave: fixed prosthesis, restoration, gingival and periodontal health. Considerações finais: desse modo, observou-se que o perfil emergencial é fator chave para o sucesso de próteses fixas, pois sua correta relação com o tecido de suporte e proteção proporciona condições para que o paciente realize uma correta higiene, sendo também fator de suma importância na estética final da peça protética(AU)

Respecting the anatomical and biological aspects of the dental element and its structures of support and protection, some principles must be respected in the manufacture of fixed prostheses, among them the emergency profile. Objective: This study aimed to analyze, through a literature review, the importance of the emergency profile in the success of fixed prostheses. The influence of the emergency profile on the achievement of satisfactory oral hygiene and the consequent relationship with the possibility of periodontal disease were verified; and the aesthetic level obtained through a favorable condition between the fixed prosthesis structure and the gingival tissue. Method: This review of the literature was carried out through research in scientific articles, indexed in the Pubmed database, searching for the following key words: fixed prosthesis, restoration, gingival health and periodontal. Final considerations: Thus, it was observed that the emergency profile is a key factor for the success of fixed prostheses, because its correct relation with the support and protection fabric provides conditions for the patient to perform a correct hygiene, being also a factor of addition importance in the final aesthetics of the prosthetic piece(AU)

Mesiolingual Canal Prevalence in Maxillary First Molars assessed through Different Methods.

AIM: Evaluate the prevalence of mesiolingual canal prevalence orifice in mesiobuccal roots of maxillary first molars using five methods of visualization. MATERIALS AND METHODS: About 73 first permanent maxillary molars were analyzed. Visual clinical analysis of the presence of the fourth canal was performed using a straight end-odontic exploratory probe (EXDG16®) and a K10 manual file (SybronEndo®). Dental elements that were not located on the fourth canal were analyzed with the aid of a magnifying glass (Zeiss®) with a 2.5-fold increase and those teeth in which the fourth canal was not found went through the examination with clinical surgical microscope (OPTO®) with magnification of 20 times with both the explorer and endodontic file. Next, a periapical radiography of the teeth was performed in the teeth in which the mesiolingual canal was not yet found to observe the presence or absence of the fourth canal. Afterward, the teeth in which the canal was not yet located were scanned using the microtomography equipment (SkyScan®), at 100 kV and 100 µA, with an isotropic resolution of 16 µm. RESULTS: The mesiolingual canal was located in 70 teeth (95.8%) and in only 3 teeth it was not identified. CONCLUSION: The visual method in the fourth canal search has limitations, whereas the composite magnifying glass, the clinical surgical microscopy, and the computerized microtomography are efficient methods for locating the fourth canal in the upper first molars. CLINICAL SIGNIFICANCE: The anatomical complexity of the first maxillary molars is one of the factors that leads to high failure rates in the endodontic treatments of this group of teeth. In most clinical situations, the mesiolingual canal goes unnoticed by professionals, since conventional radiographs do not always allow the visualization of all root canals. Determining an effective method for locating the mesiolingual canal is of paramount importance to the success of endodontic treatment.

Regaining Apical Patency with Manual and Reciprocating Instrumentation during Retreatment.

INTRODUCTION: Different techniques have been proposed to help achieving apical patency during endodontic treatment and retreatment. The objective of this in vitro study was to compare reestablishment of apical patency in teeth previously subjected to root canal treatment using manual and reciprocating instruments. METHODS AND MATERIALS: A total of 40 single-rooted extracted human mandibular incisors were selected and prepared using the Hero 642 sequence to 45/0.02 and obturated using Tagger's hybrid technique to 1 mm short of the apex. Teeth were divided into two groups according to the type of instrument used to regain patency: group 1, hand K-files and group 2, reciprocating WaveOne Primary files (25/0.08). Fisher's exact test was used in the statistical analysis. Result: In group1, apical patency was regained in 9 of the 20 teeth tested (46%), compared to 20 teeth (100%) in group 2. The difference between the groups was significant (P<0.0001). CONCLUSION: Our study shows that reciprocating instrumentation is more successful in regaining apical patency in single-rooted, previously treated teeth.

Prevalência de fraturas de instrumentos endodônticos de NiTi durante o tratamento endodôntico / Fracture prevalence of NiTi endodontic instruments during endodontic treatment

A limpeza do sistema de canais radiculares é realizada com instrumentos de aço inoxidável e mais recentemente com instrumentos de níquel-titânio (NiTi), estes possuem maior flexibilidade e resistência. Porém, durante este processo pode ocorrer a separação dos instrumentos no interior dos canais radiculares. O presente trabalho objetivou avaliar por meio das anotações e radiografias periapicais dos prontuários quais elementos dentários, raízes e terços radiculares são mais susceptíveis para ocorrência de fratura de instrumentos rotatórios ou reciprocantes de NiTi. Para tanto, procedeu-se análise de dados recolhidos junto a 500 prontuários em atendimento odontológico no curso de especialização em Endodontia da IMED cujas radiografias foram avaliadas e quando visualizado um fragmento de instrumento este era identificado e registrado em planilha específica. Sobre o total de 500 prontuários atendidos 5,2% dos molares tratados apresentaram fratura de instrumento de NiTi, destes, 1,2% pertence a molares superiores e 4,0% a molares inferiores. Em relação ao canal radicular mais envolvido com a fratura do instrumento, nos molares superiores foi o mésio-vestibular (MV) com 83,33% e nos molares inferiores o mésio-lingual (ML) em 70% dos casos, em ambos os casos o terço apical foi o mais envolvido: 66,67% nos superiores e 80% nos inferiores. Desta forma os molares inferiores representaram o grupo dentário mais envolvido com fratura de instrumentos onde no seu canal mésio-lingual foi registrado a maior incidência de fraturas e o terço apical representou a totalidade da posição da fratura dentro do canal radicular(AU)

The cleaning of the root canal system is performed with stainless steel instruments and more recently with nickel-titanium (NiTi) instruments, these have greater flexibility and resistance. However, during this process separation of the instruments can occur within the root canals. The present work aimed to evaluate by means of the records and periapical radiographs of the charts which dental elements, roots and thirds of the root are more susceptible to fracture of rotary or reciprocating NiTi instruments. To do so, we analyzed data collected from 500 medical records in dental care in the endodontic specialization course of IMED whose radiographs were evaluated and when visualized an instrument fragment was identified and recorded in a specific worksheet. Of the 500 patients treated, 5.2% of the treated molars presented a fracture of the NiTi instrument. Of these, 1.2% belong to upper molars and 4.0% to lower molars. In relation to the root canal more involved with the fracture of the instrument, in the upper molars was the mesio-vestibular (MV) with 83.33% and in the molars inferior the mesio-lingual (ML) in 70% of the cases, in both cases the apical third was the most involved: 66.67% in the upper and 80% in the lower ones. In this way the lower molars represented the dental group most involved with fracture of instruments where in their mesio-lingual canal the highest incidence of fractures was registered and the apical third represented the entire position of the fracture within the root canal(AU)

Medicamentos comumente prescritos na odontologia e suas principais interações medicamentosas: revisão de literatura / Usual medications used in dentistry and its major medicals interactions: a literature review

Este artigo trata de uma revisão bibliográfica sobre a avaliação dos medicamentos comumente prescritos na odontologia e suas principais interações medicamentosas. Os objetivos incluíram avaliar os medicamentos comumente prescritos pelo cirurgião-dentista e observar como suas possíveis interações medicamentosas podem influenciar no atendimento dos pacientes na clínica odontológica. A metodologia utilizada foi uma pesquisa bibliográfica, por meio da consulta de livros e de busca em bases de dados eletrônicos. Diariamente o cirurgião-dentista depara-se com casos de infecção, dor e processos inflamatórios na clínica odontológica, devendo sanar os problemas que acometem a cavidade oral e causam esses desconfortos ao paciente. Sendo assim, o profissional necessita de amplo conhecimento sobre farmacologia e interações medicamentosas para que o tratamento seja efetivo e não ocorra piora do estado clínico do paciente. O conhecimento dessas interações capacita o cirurgião-dentista a minimizar o risco de interações medicamentosas através de um ajuste da dosagem ou mudança do esquema posológico. Concluiu-se que é de extrema importância o conhecimento do cirurgião-dentista sobre as medicações que prescreve em sua prática clínica, a fim de evitar as possíveis interações medicamentosas e tornar, dessa forma, suas prescrições medicamentosas seguras para o paciente(AU)

This article deals with a literature review on the evaluation of commonly prescribed medications in dentistry and its main drug interactions. The objectives included evaluating the medications commonly prescribed by the dental surgeon and observing how their possible drug interactions may influence patient care in the dental clinic. The methodology used was a bibliographical research, through the search of books and search in electronic databases. Every day the dental surgeon is faced with cases of infection, pain and inflammatory processes in the dental clinic, and must cure the problems that affect the oral cavity and cause these discomforts to the patient. Therefore, the professional needs extensive knowledge about pharmacology and drug interactions so that the treatment is effective and does not worsen the patient's clinical status. Knowledge of these interactions enables the dental surgeon to minimize the risk of drug interactions by adjusting the dosage or changing the dosing schedule. It was concluded that it is extremely important the surgeon-dentist's knowledge about the medications that he prescribes in his clinical practice, in order to avoid possible drug interactions and thus, make his medication prescriptions safe for the patient(AU)

Avaliação radiográfica de três métodos de inserção de cimento endodôntico / Radiographic evaluation of three endodontic sealer insertion methods

O cimento é um material indispensável no tratamento endodôntico, com a finalidade de preencher e selar os espaços entre os cones de guta-percha, unindo-os às paredes do canal radicular, promovendo o selamento na região apical, não permitindo que os fluídos provenientes dos tecidos periapicais possam gerar uma recontaminação do sistema de canais. Objetivo: Este trabalho teve como objetivo avaliar radiograficamente a capacidade de penetração do cimento endodôntico AH Plus em canais laterais simulados em relação às técnicas de inserção com lima, cone de guta-percha principal e inserto ultrassônico. Material e método: Trinta pré-molares unirradiculares humanos com forames patentes foram preparados com brocas Gates- Glidden e Largo, e, logo a seguir, com sistema mecanizado e limas de níquel titânio K3. Seis canais laterais foram simulados em cada dente com brocas LN, dois em cada terço, com posterior irrigação ultrassônica passiva. Com os canais secos, os dentes foram divididos em três grupos de acordo com modo de inserção do cimento AH Plus ao canal. Ao término do preenchimento, radiografaram-se os dentes para posterior análise radiográfica. Conclusão: Concluiu-se que o preenchimento dos canais laterais simulados com o cimento AH Plus mostrou melhores resultados com a utilização de inserto ultrassônico.

The cement is an indispensable material in endodontic treatment, in order to fill and seal the spaces between the guta-percha points, linking them to the root canal, providing sealing in the apical region, not allowing the fluids from the tissue periapical can cause a recontamination of the channel system. Aim: This study aims to evaluate the radiographic penetration ability of AH Plus sealer in simulated lateral canals regarding insertion techniques with lime, cone guta-percha master point and ultrasonic insert. Material and method: Thirty human premolars unirradicular with patent foramen were prepared with Gates Glidden and Largo drills, followed by mechanized system files nickel-titanium K3. Six lateral canals were simulated in each tooth with LN drills, two in each third, followed by passive ultrasonic irrigation. With dry channels, three groups were created according to the method of insertion of the AH Plus sealer. At the end of root filling, teeth were radiographed for subsequent analysis. It was concluded that the filling of simulated lateral canals with AH Plus sealer showed better results with the use of ultrasonic insert.

Unhas das mãos como biomarcador para fluorose dentária / Fingernails as a biomarker for dental fluorosis

INTRODUCTION: Biomarkers indicate levels of a particular chemical agent in the environment studied, which may be useful for monitoring health status, and nails may be major indicators of fluoride. OBJECTIVE: To evaluate fluoride concentration in the fingernails of children as a biomarker for fluoride exposure. METHODS: Twenty students were selected, aged 4-5 years old. Their nails were cut at 15 and 45 days (two collections), and the fluoride concentration in the nails was analyzed with the ion-specific electrode (Orion 9409) after rapid diffusion with HDMS. RESULTS: The total fluoride mean of the samples was 3.68 μg F/g (sd 1.44), ranging from 1.39 μg F/g to 7.81 μg F/g. Eleven children (55%) brush their teeth three times a day, but only three children (15%) swallow toothpaste. CONCLUSION: There is a high prevalence of fluoride exposure in the fingernails of the children studied, presenting risk of developing dental fluorosis in permanent teeth.

INTRODUÇÃO: Os biomarcadores indicam níveis de determinado agente químico no meio estudado, os quais podem ser úteis ao monitoramento do estado de saúde, podendo as unhas serem importantes indicadores de flúor. OBJETIVO: Avaliar a concentração de flúor nas unhas das mãos de crianças como biomarcador de exposição ao flúo.r MÉTODO: Foram selecionadas 20 escolares, com idade entre 4 e 5 anos. As unhas foram cortadas aos 15 e 45 dias (duas coletas) e a concentração de flúor nas unhas foi analisada com o eletrodo íon específica (Orion 9409), após difusão facilitada por HDMS RESULTADOS: A média total de flúor das amostras foi de 3,68 µg F/g (dp 1,44), variando de 1,39 µg F/g a 7,81 µg F/g. Onze crianças (55%) escovam os dentes três vezes por dia, porém, somente três crianças (15%), engolem dentifrício. CONCLUSÃO: Há uma alta prevalência de exposição ao flúor nas unhas das mãos das crianças investigada com risco de desenvolver fluorose dentária nos dentes permanentes.

Análise retrospectiva do reparo clínico e radiográfico em cirurgias paraendodônticas / Retrospective analysis of clinical and radiographic repair in paraendodotic surgeries

Este estudo avaliou o índice de sucesso em cirurgias paraendodônticas executadas pelos alunos do Curso de Especialização em Endodontia do Centro de Estudos Odontológicos Meridional - CEOM, Passo Fundo/RS, através de controle clínico e radiográfico em um período de até três anos de proservação. Os pacientes que realizaram as cirurgias paraendodônticas foram rechamados e avaliados com um exame clínico e radiográfico da região operada para determinar o grau de reparo radiográfico de acordo com Rud et al.19 (1972) que classificam em Grupo I - Reparo Completo, Grupo II - Reparo Incompleto (cicatriz fibrosa), Grupo III - Reparo Incerto e Grupo IV - Reparo Insatisfatório (fracasso/insucesso). Após coleta dos dados, as radiografias de proservação de cada caso foram observadas por cirurgiões dentistas que definiram se houve ou não regressão das lesões através da análise das radiografias pré e pós- -cirúrgicas associadas aos dados clínicos. Do total de 43 pacientes submetidos à cirurgia no período de 3 anos, 15 pacientes retornaram para exame clínico e radiográfico. Dos 15 pacientes, um total de 17 dentes foram incluídos na amostra. Enquadraram-se no Grupo I - 11 dentes (64,7%), no Grupo II - 3 dentes (17,6%), no Grupo III - 2 dentes (11,8%) e no Grupo IV - 1 dente (5,9%). A taxa de sucesso agrupando-se os Grupos I e II foi 82,35%. O índice de insucesso foi 17,65%. Concluiu-se que o tratamento cirúrgico como complementar ao tratamento endodôntico pode ser uma alternativa na manutenção dos dentes com saúde e função, apresentando boas taxas de sucesso (AU).

This study evaluated the success rate in paraendodontic surgeries performed by students of the Endodontic Specialization Course of the Center for Southern Dental Studies - CEOM, Passo Fundo/RS, through clinical and radiographic control in a period of up to three years of proservation. Patients who underwent paraendodontic surgeries were recalled and evaluated with a clinical and radiographic examination of the operated region to determine the degree of radiographic repair according to Rud et al.19 (1972), which classify as Group I - Complete Repair, Group II - Incomplete Repair (fibrous scar), Group III - Uncertain Repair, and Group IV - Unsatisfactory Repair (failure/failure). After data collection, the radiographs of each case were reviewed by dental surgeons who defined whether or not there was regression of the lesions through the analysis of pre and post-surgical radiographs associated with the clinical data. Of the 43 patients who underwent surgery within 3 years, 15 patients returned for clinical and radiographic examination. Of the 15 patients, total of 17 teeth were included in the sample. Group I - 11 teeth (64.7%), Group II - 3 teeth (17.6%), Group III - 2 teeth (11.8%), and Group IV - 1 tooth (5.9%). The success rate grouping Groups I and II was 82.35%. The failure rate was 17.65%. It was concluded that the surgical treatment as a complement to the endodontic treatment can be an alternative in the maintenance of the teeth with health and function, presenting good success rates (AU).

Presence of Metallic Microfragments on Dentinal Walls and Instrument Defects following Root Canal Preparation.

AIM: To determine the presence of metallic microfragments and their elemental composition in the dentinal walls of root canals following preparation using different endodontic instruments and to assess the active cutting edges of instruments with regard to structural defects. MATERIALS AND METHODS: A total of 108 molar teeth were selected and prepared using different endodontic instruments. Teeth were randomly divided into nine groups of 12 teeth each, according to the instruments employed: Manual systems -K-FlexoFile, K-File, and Hedstroem; rotary systems - ProTaper Next, Mtwo, BioRaCe; and reciprocating systems - Reciproc, Unicone, and WaveOne. Both root canals and instruments were assessed using scanning electron microscopy, and the elemental composition of metallic microfragments was determined using energy-dispersive X-ray spectroscopy. RESULTS: Metallic microfragments were found in the groups prepared with both manual and reciprocating instruments, with no statistically significant differences between groups, thirds, or presence of metallic microfragments (p ≥ 0.05). Moreover, all groups presented structural defects in both new and used instruments; however, rotary instruments (ProTaper Next, Mtwo 702, BioRaCe) were the ones with the lowest number of defects, at statistically significant differences in comparison with other instruments (p < 0.05). CONCLUSION: The presence of metallic microfragments on dentinal walls following root canal preparation was associated with manual and reciprocating instrumentation. Furthermore, rotary instruments were the ones with the lowest number of defects. Considering the outcomes measured in this study, rotary instruments performed better than the other two groups, as they were associated with the lowest number of metallic microfragments and structural defects. CLINICAL SIGNIFICANCE: During root canal preparation, operative procedures may induce changes to the root canal shape, as well as the release of metallic fragments resulting from the action of instruments on dentinal walls. Therefore, it is important to determine, among the different techniques used for this purpose, which ones are least susceptible to this occurrence.

Avaliação do número de foraminas e diâmetro da foramina maior nas raízes de molares inferiores / Assessment of foramina number and largest foramina diameter in mandible molar roots

O conhecimento da anatomia e da grande variação na morfologia dental interna é imprescindível para uma boa resolução das etapas do tratamento dos canais radiculares. Em virtude disso, a anatomia dental interna deve ser compreendida desde a câmara pulpar até a região apical, a qual irá abrigar estruturas de suma importância para o tratamento: o forame e as foraminas apicais. Dessa forma, o presente estudo teve como objetivo avaliar o número de foraminas presentes nas raízes mesial e distal de molares inferiores e medir o diâmetro da foramina maior encontrada. Para tal procedimento, realizou-se uma pesquisa in vitro, na qual foram avaliados 91 dentes molares inferiores. Esses elementos foram limpos com peróxido de hidrogênio na cuba ultrassônica e tiveram sua porção apical corada com azul de metileno 1%. O corante dos ápices foi limpo e a região apical, avaliada em microscopia óptica com magnificação de 40 vezes e a análise do número de foraminas, bem como o diâmetro da maior foramina encontrada, foi mensurada no programa Image J versão 1.46R. A análise dos resultados foi feita no programa Excel e, posteriormente, foi feita análise estatística com o programa SPSS. A maioria das raízes mesiais dos primeiros molares inferiores apresentou uma (23,07%) e duas foraminas (23,07%). A maioria das raízes distais (31,86%) apresentou uma foramina (p<0,05). A média do diâmetro da foramina maior encontrada na raiz mesial foi de 0,251 mm e na raiz distal 0,268 mm, sem diferença estatisticamente significante (p= 0,3359) (AU).

The awareness of anatomy and wide shape range of the internal dental morphology is extremely important to achieve good performance in all root canal treatment stages. Due to this, the internal dental anatomy must be known from pulp to the apical region, because meaningful structures are placed in: foramina and apical foramen. So this study aims to assess the number of foramen in mesial and distal mandibular root teeth and measure the largest foramen diameter found. For this procedure, in vitro research was performed, which evaluated 91 molar teeth. The teeth were cleaned with hydrogen peroxide in an ultrasonic cleaner, then their apex portion was colored with 1% methylene blue. Once the dye was taken out from the apical region it was evaluated by a microscopy with 40 times magnification, an analysis of foramen number was performed and the largest foramen was found and measured through Image J versão 1.46R software. The results assessment was done by Excel program and later statistical analysis with SPSS. The majority of the first mandible molar mesial root showed one (23.07%) and two foramen (23.07%). The majority of the distal roots showed one foramen. The diameter average of the largest foramen found were 0.251 mm on mesial root and 0.268 mm on distal root, showing no statistically significant difference (p = 0.3359) (AU).

Avaliação ex Vivo do Desgaste Promovido Pelos Sistemas Protaper®, Biorace® e Instrumentos Manuais no Preparo de Canais Radiculares Curvos / Ex Vivo Evaluation of Wear Promoted By Protaper® Systems, Biorace® and Hand Instruments in Preparation of Curved Root Canals

O preparo do canal radicular constitui-se em uma fase importante do tratamento endodôntico, por possibilitar a limpeza e a desinfecção do sistema de canais, além da modelagem, que permite a adequada acomodação do material obturador e o selamento endodôntico. Com o advento dos instrumentos de níquel-titânio, de reconhecida flexibilidade, tem-se observado considerável facilidade na realização do preparo e menor índice de desvio apical em canais curvos. Sendo assim, o objetivo deste estudo foi avaliar o desgaste produzido nas paredes dos canais mésio-vestibulares de primeiros molares inferiores pelos sistemas ProTaper®, BioRaCe® e instrumentos manuais, nos terços cervical, médio e apical. Para tal, foram utilizados trinta e nove primeiros molares inferiores, divididos em três grupos. Cada dente foi inicialmente radiografado nos sentidos vestíbulo-lingual e proximal, por meio de raio x digital. Após o preparo dos canais mésio-vestibulares, os dentes foram novamente radiografados. Por meio do programa Adobe Photoshop®, as radiografias iniciais e finais de ambas as incidências foram digitalmente sobrepostas e, através da subtração das imagens, o desgaste foi evidenciando nas três dimensões. Foram atribuídos escores relativos à quantidade de desgaste gerado nos terços cervical, médio e apical do canal radicular. Os resultados mostraram diferença estatisticamente significativa apenas no terço apical, onde os instrumentos ProTaper® produziram um desgaste significativamente menor do que os instrumentos manuais. Para os instrumentos BioRa-Ce® não foram encontradas diferenças significativas. Também foi possível observar que os sistemas ProTaper® e BioRaCe® deixaram áreas do canal radicular não instrumentadas principalmente no terço apical, seguido pelo terço médio.

The root canal preparation has been considered one of the most important phases of the endodontic treatment because it allows cleaning and disinfection of the canal system and its modeling, it also allows the proper accommodation of the filling material and endodontic sealing. With the advent of nickel-titanium instruments, which are known for their flexibility, there has been reasonably improvement in the quality of the preparation. In that way, goal of this paper is to evaluate the wear produced in the walls of mesiobuccal canals of first mandibular molars by ProTaper® system, BioRaCe® and hand instruments at the cervical, middle and apical thirds. Thirty-nine mandibular first molars divided into three groups were used. Each tooth was initially x-rayed in buccolingual and proximal direction through a digital x-ray. After preparation of mesiobuccal canals, they were x-rayed again. Through Adobe Photoshop software, the initial and final x-rays of both incidences were digitally superimposed and by subtraction of the images, canal wear was shown in three dimensions. Scores were given to the root canal related to the amount of wear generated in the cervical, middle and apical thirds of root canal. The results showed statistically significant differences only in the apical third, where Pro-Taper® instruments produced a significantly lower wear than the hand instruments. For BioRaCe® instruments, no significant differences were found. It was also possible to observe that ProTaper® BioRaCe® systems left non-instrumented areas in the root canal, mainly in the apical third, followed by the middle third.

Information gaps on oral cancer and how should we fill them: proposals based on a survey of southern brazilians / Lacunas de informação sobre o câncer bucal e como preenchê-las: propostas enbasadas em pesquisa com sul brasileiros

The purpose of this research was to ascertain the population's knowledge about oral cancer and propose permanent actions incorporated to the Primordial Prevention Measures. Materials and Methods: There were apply questionnaires in 120 patients of a Basic Health Unit, and most the sample were female and the aged was between 18-82 years. Results: The results showed that most of users don't know adequately about the oral cancer, of which, some believe it's a communicable disease, others believe it's not even a disease. Users know some of the risk factors, but they don't know how to perform self-examination of the mouth. Conclusions: It is suggested the incorporation of three new actions to Prevention Primordial Measure, including the creation of a permanent program in Elementary and Secondary Education Schools, encouraging in favor of self-examination of the mouth and against the use of tobacco and alcohol; the training of dentists from the public care about the actions of measures in Primary and Secondary Prevention; and the integration of effective communication about the actions of measures in Primary and Secondary Prevention.

O objetivo desta pesquisa foi verificar o conhecimento da população sobre o câncer bucal e propor ações permanentes incorporados às medidas de prevenção primárias. Foram aplicados questionários em 120 usuários de uma Unidade Básica de Saúde, sendo a maioria da amostra do sexo feminine, com idade entre 18-82 anos. Os resultados mostraram que a maioria dos usuários não possui conhecimento adequado acerca do câncer bucal, dos quais, alguns acreditam que é uma doença transmissível, outros acreditam que não é uma doença. Os usuários demonstraram conhecer alguns dos fatores de risco, mas eles não sabem como realizar o auto-exame da boca. Sugere-se a incorporação de três novas ações para a prevenção Medida Primordial, incluindo a criação de um programa permanente nas Escolas em nível fundamental e Médio, incentivando a realização do auto-exame da boca e contra o uso de tabaco e álcool; a formação de dentistas do atendimento público sobre as ações de medidas em prevenção primária e secundária; e a integração de uma comunicação eficaz sobre as ações de medidas em prevenção primária e secundária.

A influência da experiência do operador para atingir o comprimento de trabalho durante o retratamento endodôntico / Influence of operator experience to accomplish working length during endodontic retreatment

Frente ao insucesso endodôntico, a primeira opção de tratamento é a reintervenção ou retratamento do canal radicular. Poucos estudos têm trabalhado a temática da experiência do operador no tempo dessa intervenção. Diante dessa lacuna, o presente estudo objetivou avaliar o tempo para atingir o comprimento de trabalho na desobturação de canais radiculares por três operadores. Foram selecionados quarenta e cinco dentes humanos extraídos, uniradiculares, previamente preparados e obturados e, após o envelhecimento do material obturador, submetidos ao método de desobturação com os instrumentos ProTaper Universal Retratamento por diferentes operadores, levando em consideração a sua experiência - um especialista em Endodontia, um aluno de especialização em Endodontia e um aluno de graduação. Os resultados obtidos mostraram que o tempo foi significativamente diferente entre os grupos (p = 0,02); e que o CT não teve diferença estatisticamente significativa no tempo obtido para desobturação (p = 0,05). Como conclusão, houve diferença no tempo para a obtenção do comprimento de trabalho entre os operadores, sendo que o especialista e o aluno de especialização levaram menos tempo para chegar ao comprimento de trabalho do que o aluno de graduação (AU).

When facing endodontic treatment failure, the first treatment option is the reintervention or retreatment of the root canal. Few studies have worked with the issue related to operator experience in the intervention timeline. Due to this gap, this study evaluated the time to accomplish working length of root canals desobturation by three operators. Forty-five extracted uniradiculars human teeth were selected, previously prepared and filled and after aging of the filling material, they were submitted to the desobturation method with ProTaper Universal Retreatment instruments by different operators, taking into account their experience - an Endodontics specialist, a student of Endodontics specialization and an undergraduate student. The results showed that the time was significantly different between groups (p = 0.02); and WL had no statistically significant difference in the time obtained for desobturation (p = 0.05). In conclusion, there was difference in the time to obtain the working length between the operators, as the specialist and the specialization student took less time to reach the working length than the graduate student (AU).

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.