Avaliação histopatológica da influência da obturação do canal radicular no reparo da periodontite apical em animais: uma revisão sistemática / Histopathological evaluation of the influence of root canal obturation in the repair of apical periodontitis in animals: a systematic review

Introdução: A obturação do canal radicular tem sido considerada um fator decisivo no sucesso do tratamento endodôntico. Objetivo: O objetivo da presente revisão sistemática foi avaliar estudos em animais que utilizaram parâmetros histopatológicos para determinar a influência da obturação do canal radicular no processo de reparo da periodontite apical. Métodos: As buscas foram realizadas nas bases de dados PubMed, Lilacs, Scielo, Science Direct e BBO, utilizando palavras-chave indexadas e não indexadas. Foram considerados artigos publicados no período de 2003 a 2019, e aplicados critérios de inclusão e exclusão para seleção dos artigos. Resultados: Cinco artigos atenderam aos critérios de elegibilidade e foram incluídos para análise qualitativa na revisão sistemática. Conclusão: A obturação do canal radicular, no que diz respeito ao seu limite apical, pode influenciar o reparo da periodontite apical, quando há presença de bactérias remanescentes no interior do canal. O uso de cimentos endodônticos com propriedades antimicrobianas não foi efetivo na eliminação de bactérias residuais do canal radicular e na reparação completa da periodontite apical.

Introduction: Root canal fillings are a decisive factor in the success of endodontic treatment. This systematic review evaluated animal studies using histopathological parameters to determine the effect of root canal filling on the healing of apical periodontitis. Methods: A search was conducted in PubMed, Lilacs, Scielo, Science Direct and BBO using indexed and non-indexed keywords. Studies published from 2003 to 2019 were selected according to inclusion and exclusion criteria. Results: Five animal studies met eligibility criteria and were included in the systematic review for a qualitative analysis. Conclusion: The extension of the root canal filling may affect the healing of apical periodontitis when bacteria remain in the canal. Root canal sealers with antimicrobial properties were not effective in eliminating bacteria remaining in the root canal, nor in promoting the complete healing of apical periodontitis (AU).

The Pulp Stones: Morphological Analysis in Scanning Electron Microscopy and Spectroscopic Chemical Quantification.

Background and objectives: Pulp stones are hard tissue structures formed in the pulp of permanent and deciduous teeth. Few studies have evaluated their morphology and chemical composition. However, their formation, composition, configuration and role played in overall health status are still unclear. Clinically, they may be symptomatic; technically, they impede access during endodontic therapy, increasing the risk of treatment errors. Thus, this study aimed to morphologically analyze pulp stones and present their chemical quantification, identifying their main chemical elements. It also correlates the results with their possible induction mechanisms. Materials and Methods: Seven pulp nodules were collected from molar teeth needing endodontic treatment. The morphology of the stones was analyzed by scanning electron microscopy (SEM), and their chemical composition was determined by X-ray dispersive energy spectroscopy (EDX). Results: These structures varied considerably in shape, size and topography. The site of the stones in the pulp cavity was the factor that most affected the morphology. The majority of the stones found in the pulp chambers presented nodular morphology, while those in the root canals presented a diffuse shape, resembling root canal anatomy. The topography of the nodules showed heterogeneous relief, revealing smooth and compact areas contrasting with the rugged and porous ones. The chemical composition varied depending on the location of the nodule in the pulp cavity and the relief of the analyzed area. Radicular stones presented considerably lower calcium and phosphorus content than coronary nodules. Conclusions: The high cellularity rate of the coronal pulp predisposes this region to nodular mineralizations around injured cells. The presence of larger caliber vascular bundles and higher collagen fiber content in radicular pulp determines a diffuse morphological pattern in this region. Understanding the morphology and chemical composition of the pulp stones allows future translational pathways towards the prevention or treatment of such conditions.

Correction to: Influence of foraminal enlargement on the healing of periapical lesions in rat molars.

Figures 2 and 3 in the published version of this article contained a mistake. CCP and DCP should have been FEG and NFEG. Correct figures are presented here.

Influence of foraminal enlargement on the healing of periapical lesions in rat molars.

OBJECTIVES: The aim of this study was to evaluate the influence of foraminal enlargement on the healing of induced apical periodontitis in a rat model. MATERIAL AND METHODS: Periapical lesions were bilaterally induced in mandibular first molars of 24 Wistar rats, through root canals exposure to the oral environment during 3 weeks. Endodontic treatment was performed in the mesial canal of right molars, which were separated into two experimental groups (n = 12/group). The foraminal enlargement group (FEG) received instrumentation in the entire root canal length, including the cemental canal, while in the non-foraminal enlargement group (NFEG), instrumentation was carried out 1 mm short of the apical foramen. Root canals were filled with gutta-percha and AH Plus sealer, in the same visit, 1 mm short of the apical foramen in both experimental groups. Left molars were not treated and served as a baseline control group. The animals were killed after 4 weeks, and their hemi-mandibles were prepared for radiographic and histological analysis. Data were analyzed by Student's t test and ANOVA. RESULTS: Only FEG presented lower areas of periapical radiolucency compared to the control (p < .05). Both FEG and NFEG allowed decreased inflammation intensity (p < .0001 and p < .01) and higher scores of cementum neoformation when compared to non-treated samples (p < .0001). FEG was more effective than NFEG in promoting biological seal, i.e., apical closure with cementum (p < .01). FEG, but not NFEG, showed lower scores of root resorption than the control. CONCLUSIONS: Foraminal enlargement during root canal preparation improved periapical healing in rat molars. CLINICAL SIGNIFICANCE: Foraminal enlargement has been suggested to improve disinfection at the apical portion of root canals. This procedure may favor the healing of chronic periapical lesions.

Incidência de dor pós-operatória após instrumentação do canal cementário em canais com necrose pulpar / Incidence of postoperative pain after instrumentation of the cemental canal canals with pulp necrosis

Introdução: tem sido sugerida a instrumentação do canal cementário em casos de necrose pulpar; porém, a possibilidade de aumento de incidência de dor pós-operatória ainda é motivo de polêmica. Métodos: após tratamento endodôntico com instrumentação do canal cementário de 90 canais com necrose pulpar, avaliou-se a dor pós-operatória por meio de uma escala visual analógica, e os dados obtidos foram analisados pelo teste qui-quadrado, com nível de significância de 5%. Resultados: os resultados mostraram ausência de dor em 86 (95,5%) tratamentos, e presença de dor leve em 4 (4,5%) casos, com diferença estatisticamente significativa (p < 0,05). Conclusão: conclui-se que a incidência de dor pós-operatória após a instrumentação do canal cementário no tratamento endodôntico de canais com necrose pulpar é muito baixa, e que, quando ocorre, é de intensidade leve

Apical third enlargement of the root canal and its relationship with the repair of periapical lesions.

OBJECTIVE: The purpose of this study was to evaluate if the apical third enlargement of root canal is the determinant factor for the repair of periapical lesions in endodontic treatment. METHODS: Eighty upper and lower incisors, canines and premolars with periapical lesions were randomly divided in 2 groups and were treated by undergraduate students. Canals were instrumented with up to 3 files in group I (n = 40) and up to 4 files in group II (n = 40) 1 mm short of the apex and were filled with a calcium hydroxide dressing. After removing calcium hydroxide 14 days later, both groups were filled using the lateral condensation technique. In the 2-year follow-up, a few patients did not return, and some cases did not present conditions for accurate comparisons. Therefore, only 43 patients (24 in group I and 19 in group II) presented conditions for radiographic comparisons. Data were statistically analyzed using Fisher's exact test. RESULTS: Comparison of the initial and follow-up radiographs showed that 22 out of 24 (91.67%) patients in group I and 17 out of 19 patients (89.47%) in group II showed repair. Statistical analysis revealed no significant differences between the groups (P>.05). CONCLUSION: The results of this study show that the apical third enlargement did not alter the outcome of endodontic treatment of teeth with periapical lesion performed by undergraduate students.

Healing of a tooth with an overinstrumented apex, extensive transportation and periapical lesion using a 5 mm calcium hydroxide apical plug: an 8-year follow-up report

Besides the risk of filling material extrusion throughout the apex, a satisfactory apical seal can be difficult to achieve in canals with open apices or iatrogenic enlargements of the apical constriction. These situations pose a challenge to root canal filling. This paper describes the root canal filling of a maxillary right canine with an overinstrumented apex, complete loss of the apical stop, extensive canal transportation and apical periodontitis. A 5 mm calcium hydroxide apical plug was placed before root canal filling. The plug was made by soaking paper points with saline, dipping the points in calcium hydroxide powder and then applying it to the apex several times, until a consistent apical plug was obtained. The canal was then irrigated with saline in order to remove any residual calcium hydroxide from the root canal walls, dried with paper points and obturated with an inverted #80 gutta-percha cone and zinc oxide-eugenol based sealer by the lateral condensation technique. An 8-year radiographic follow-up showed formation of mineralized tissue sealing the apical foramen, apical remodeling and no signs of apical periodontitis.

Além do risco de extrusão periapical de material obturador pelo ápice, pode ser difícil conseguir um bom selamento apical em dentes com rizogênese incompleta ou alargamentos iatrogênicos da constrição apical. Casos assim representam um desafio durante a obturação do canal. Este caso clínico descreve a obturação de um canino superior direito com perda total da constrição apical por sobreinstrumentação, transporte excessivo e lesão periapical. Antes da obturação foi feito um tampão apical de hidróxido de cálcio com 5 mm de extensão. Para a realização do tampão, pontas de papel absorvente foram umedecidas em soro fisiológico, levadas ao pó do hidróxido de cálcio para absorvê-lo e aplicadas várias vezes no ápice até se conseguir um tampão apical consistente. Em seguida o canal foi irrigado com solução salina para a remoção de eventuais resíduos de hidróxido de cálcio das suas paredes, secado com pontas de papel absorvente e obturado com um cone #80 de guta percha invertido e cimento obturador à base de óxido de zinco e eugenol pela técnica da condensação lateral. O acompanhamento radiográfico de 8 anos mostrou selamento apical por tecido mineralizado, remodelação do ápice e reparo da lesão periapical.

Influence of apical foramen lateral opening and file size on cemental canal instrumentation.

Since instrumentation of the apical foramen has been suggested for cleaning and disinfection of the cemental canal, selection of the file size and position of the apical foramen have challenging steps. This study analyzed the influence of apical foramen lateral opening and file size can exert on cemental canal instrumentation. Thirty-four human maxillary central incisors were divided in two groups: Group 1 (n=17), without flaring, and Group 2 (n=17), with flaring with LA Axxess burs. K-files of increasing diameters were progressively inserted into the canal until binding at the apical foramen was achieved and tips were visible and bonded with ethyl cyanoacrylate adhesive. Roots/files set were cross-sectioned 5 mm from the apex. Apices were examined by scanning electron microscopy at ×140 and digital images were captured. Data were analyzed statistically by Student's t test and Fisher's exact test at 5% significance level. SEM micrographs showed that 19 (56%) apical foramina emerged laterally to the root apex, whereas 15 (44%) coincided with it. Significantly more difficulty to reach the apical foramen was noted in Group 2. Results suggest that the larger the foraminal file size, the more difficult the apical foramen instrumentation may be in laterally emerged cemental canals.

Influence of apical foramen lateral opening and file size on cemental canal instrumentation

Since instrumentation of the apical foramen has been suggested for cleaning and disinfection of the cemental canal, selection of the file size and position of the apical foramen have challenging steps. This study analyzed the influence of apical foramen lateral opening and file size can exert on cemental canal instrumentation. Thirty-four human maxillary central incisors were divided in two groups: Group 1 (n=17), without flaring, and Group 2 (n=17), with flaring with LA Axxess burs. K-files of increasing diameters were progressively inserted into the canal until binding at the apical foramen was achieved and tips were visible and bonded with ethyl cyanoacrylate adhesive. Roots/files set were cross-sectioned 5 mm from the apex. Apices were examined by scanning electron microscopy at ×140 and digital images were captured. Data were analyzed statistically by Student’s t test and Fisher’s exact test at 5% significance level. SEM micrographs showed that 19 (56%) apical foramina emerged laterally to the root apex, whereas 15 (44%) coincided with it. Significantly more difficulty to reach the apical foramen was noted in Group 2. Results suggest that the larger the foraminal file size, the more difficult the apical foramen instrumentation may be in laterally emerged cemental canals.

Tendo em vista que a instrumentação do forame apical tem sido sugerida para a limpeza e desinfecção do canal cementário, a seleção do calibre do instrumento e a posição do forame apical representam passos desafiantes. Este estudo analisou a influência que a saída lateral do forame apical e o calibre do instrumento podem exercer na instrumentação do canal cementário. Trinta e quatro incisivos centrais superiores foram divididos em dois grupos: Grupo 1 (n=17), sem preparo cervical, e Grupo 2 (n=17), com preparo cervical com brocas LA Axxess. Limas K com aumentos de diâmetro foram progressivamente inseridas no canal até ajustar no forame apical e as pontas ficarem visíveis e foram fixadas com adesivo de etil cianoacrilato. Os conjuntos raízes/limas foram seccionados transversalmente a 5 mm aquém do ápice. Os ápices foram examinados por microscopia eletrônica de varredura com aumento de 140x e imagens digitais foram capturadas. Os dados foram examinados estatisticamente pelo teste t de Student e teste exato de Fischer com nível de significância de 5%. A microscopia eletrônica de varredura mostrou que 19 (56%) dos forames apicais saíram lateralmente em relação ao ápice radicular, enquanto que 15 (44%) coincidiram com ele. Dificuldade significantemente maior para chegar ao forame apical foi observada no Grupo 2. Os resultados sugerem que quanto mais calibroso for o instrumento foraminal, mais difícil poderá ser a instrumentação do forame apical em canais cementários que apresentam saída lateral.

Healing of a tooth with an overinstrumented apex, extensive transportation and periapical lesion using a 5 mm calcium hydroxide apical plug: an 8-year follow-up report.

Besides the risk of filling material extrusion throughout the apex, a satisfactory apical seal can be difficult to achieve in canals with open apices or iatrogenic enlargements of the apical constriction. These situations pose a challenge to root canal filling. This paper describes the root canal filling of a maxillary right canine with an overinstrumented apex, complete loss of the apical stop, extensive canal transportation and apical periodontitis. A 5 mm calcium hydroxide apical plug was placed before root canal filling. The plug was made by soaking paper points with saline, dipping the points in calcium hydroxide powder and then applying it to the apex several times, until a consistent apical plug was obtained. The canal was then irrigated with saline in order to remove any residual calcium hydroxide from the root canal walls, dried with paper points and obturated with an inverted #80 gutta-percha cone and zinc oxide-eugenol based sealer by the lateral condensation technique. An 8-year radiographic follow-up showed formation of mineralized tissue sealing the apical foramen, apical remodeling and no signs of apical periodontitis.

Relationship between files that bind at the apical foramen and foramen openings in maxillary central incisors--a SEM study.

Considering that instrumentation of the apical foramen has been suggested for root canal infection control, this study analyzed the relationship between the files that bind at the apical foramen and the foraminal openings in 50 maxillary central incisors. After preparation of the pulp chamber, access to the canal was obtained with #1 and 2 LA Axxess and K-files with tip cut were inserted up to the apical foramen until binding was felt. The files were fixed with methyl cyanoacrylate and the tooth-file sets were cross-sectioned 10 mm short of the apex. Scanning electron microscopic analysis was carried out and files and foraminal areas were measured using Image Tool software. Statistically significant difference (p<0.0001) was found between files and the apical foraminal areas. The mean foraminal area was 3.8 times larger than the mean file area. The results of this study suggest that it would require 4 files of greater size beyond the one that bound to the foramen in order to allow a better relationship between files and apical openings of maxillary central incisors.

Apical limit of root canal filling and its relationship with success on endodontic treatment of a mandibular molar: 11-year follow-up.

OBJECTIVE: This article discusses the relationship between apical limit of root canal filling and success on endodontic treatment of a mandibular molar. STUDY DESIGN: A mandibular right first molar with vital pulp was endodontically treated, and 3 years later periapical lesions on mesial and distal roots were detected. The canals were retreated and obturated to the same levels as in the previous treatment. RESULTS: An 8-year radiographic follow-up showed repair of the periapical lesions on both roots. CONCLUSIONS: Results suggest that the apical limit of obturation seems to have no influence in the repair of periapical tissues in mandibular molars.

Relationship between files that bind at the apical foramen and foramen openings in maxillary central incisors - a SEM study

Considering that instrumentation of the apical foramen has been suggested for root canal infection control, this study analyzed the relationship between the files that bind at the apical foramen and the foraminal openings in 50 maxillary central incisors. After preparation of the pulp chamber, access to the canal was obtained with #1 and 2 LA Axxess and K-files with tip cut were inserted up to the apical foramen until binding was felt. The files were fixed with methyl cyanoacrylate and the tooth-file sets were cross-sectioned 10 mm short of the apex. Scanning electron microscopic analysis was carried out and files and foraminal areas were measured using Image Tool software. Statistically significant difference (p<0.0001) was found between files and the apical foraminal areas. The mean foraminal area was 3.8 times larger than the mean file area. The results of this study suggest that it would require 4 files of greater size beyond the one that bound to the foramen in order to allow a better relationship between files and apical openings of maxillary central incisors.

Uma vez que a instrumentação do forame apical tem sido sugerida para o controle de infecção do canal radicular, este estudo analisou a relação entre as limas que se ajustam no forame apical e a abertura foraminal em cinquenta incisivos centrais superiores. Após o preparo da câmara pulpar, foi feito o acesso radicular com as brocas LA Axxess #1 e 2 e limas K com a ponta cortada foram inseridas até que oferecessem a sensação tátil de ajuste no forame apical. Foram fixadas com cianoacrilato de metila e o conjunto dente-lima foi seccionado a 10 mm aquém do ápice. Foi feita a microscopia eletrônica de varredura e as áreas das limas e dos forames foram medidas por meio do Image Tool software. A análise estatística demonstrou diferença significante entre as áreas das limas e dos forames (p<0,0001). A média da área dos forames apicais foi 3,8 vezes maior que a das limas. Os resultados deste estudo sugerem que seriam necessários 4 instrumentos de calibre maior além do que se ajustou para que haja melhor relação entre as limas e as aberturas foraminais nos incisivos centrais superiores.

Posição do forame apical e sua relação com o calibre do instrumento foraminal / Location of the apical foramen and its relationship with foraminal file size

Introdução: o objetivo deste trabalho foi analisar a posição do forame apical e sua relação com o calibre do instrumento foraminal nos incisivos centrais superiores. Métodos: oitenta e quatro incisivos centrais superiores foram usados neste estudo. Limas K foram introduzidas com aumento sequencial de calibres no canal radicular até a ponta ficar visível no forame e oferecer a sensação tátil de ajuste no canal cementário. Foram retiradas,os dentes foram seccionados transversalmente a 10mm aquém do ápice radicular e as limas reintroduzidas até o forame, quando foram fixadas com cianoacrilato de metila.Após a polimerização do cianoacrilato de metila, as limas foram seccionadas no mesmo nível do corte da raiz.Os ápices foram examinados por meio de microscópio eletrônico de varredura sob aumento de 140x, as imagens foram capturadas digitalmente e os resultados submetidos ao teste do qui-quadrado com nível de significância de 5%. Resultados: observou-se que 63 (75%) forames apresentaram saída lateral em relação ao ápice radicular e 21 (25%) coincidiram com ele. Os resultados demonstraram haver significância estatística ( 2ג =22,1; p=0,00).Para testar a diferença de proporção, foi utilizado o testedo qui-quadrado com nível de significância de 5%,que demonstrou haver significância estatística ( 2ג =22,1;p=0,00). Conclusão: a saída lateral do forame apical é mais frequente do que a saída no ápice radicular nos incisivos centrais superiores, e essa característica anatômica pode interferir no calibre do instrumento foraminal

Aim: This article analyzed the location of the apical foramenand its relationship with foraminal file size in maxillarycentral incisors. Methods: Eighty four human maxillarycentral incisors were used in this study. K-files of progressivelyincreasing diameters were inserted into the root canaluntil it got snugly fit and the tip was visible at the apicalforamen. The files were removed and teeth were crosssectioned10 mm from the root apex. The files were thenreinserted, fixed with a cyanoacrylate-based adhesive, andsectioned at the same level as the root. The root apiceswere examined using a scanning electron microscope set at140x magnification, the images were captured digitally andthe results were subjected to Chi-square test. Results: Itwas observed that 63 (75%) of the apical foramen emergedlaterally to the root apex and 21 (25%) coincided with theapex. The results presented statistically significant differences( 2ג =22.1; p=0.00). Conclusions: Lateral emergenceof the apical foramen is more common than coincidence ofthe foramen with the apex in maxillary central incisors. Thisanatomical characteristic may have influence on determinationof the foraminal file size.

Influência do paramonoclorofenol canforado na dor pósoperatória em casos de abscesso periapical agudo / Influence of paramonochlorophenol camphorated on the pain of acute apical periodontitis

O objetivo desse trabalho foi verificar se o uso do Paramonoclorofenol Canforado (PMCC) comomedicação após o atendimento de urgência em casos de abscesso periapical agudo é o fator determinanteda ausência de dor pós-operatória dos pacientes. O tratamento de urgência em 33 pacientes com abscessoperiapical sintomático foi dividido em dois grupos. Nos pacientes do grupo I, após o atendimento foi colocadauma bolinha de algodão embebida em PMCC na câmara pulpar e no grupo II foi colocada uma bolinha dealgodão seca, sem nenhum medicamento. Os resultados mostram que não houve diferença significanteentre os dois grupos.

The aim of this work was to verify if PMCC, as a local medication after emergency treatment, exertsany influence on patient pain after treatment. To do so, 33 teeth with acute periapical abscess were treatedand divided in two groups. In teeth of group I, a cotton pellet with PMCC was puted in pulp chamber and ingroup II a dry cotton pellet was used without any medicament. Results show that there was no significantdifference between the two groups.

O uso de corante na avaliação do selamento apical das obturações endodônticas em função do contato e período de exposição do forame apical a um meio úmido / Use of dye for evaluation of root canal filling apical seal as a result of contact and exposition period of apical foramen to a wet environment

Os objetivos desse estudo foram: (1) avaliar se a presença do soro fisiológico em contato com o forame apical, simulando o fluido tecidual periapical, e o seu tempo de contato com a porção apical da obturação interferem na qualidade do selamento apical das obturações dos canais radiculares, e (2) avaliar a validadedo uso de um corante como metodologia de avaliação da microinfiltração apical. Após o preparo e remoção da camada residual, 20 canais foram obturados pela técnica da condensação lateral e divididos em dois grupos. As raízes do Grupo I foram mantidas imersas em soro fisiológico, renovado a cada sete dias, por 60 dias. Findo esse prazo, foram revestidas com duas camadas de esmalte de cor vermelha para unhas, exceto a 1 mm apical, e colocadas no azul de metileno a 2% por sete dias. As raízes do Grupo II foram de imediato revestidas com esmalte para unhas, comforme descrito para o Grupo I, e mantidas no azul do metileno a 2% também por sete dias. A análise dos resultados mostrou que houve infiltração maior de corante no Grupo I, o que faz crer que a avaliação do selamento apical pode mostrar resultados diferentes em função do tempo de contato das raízes com um ambiente úmido e do período de observação.

Importance of the diagnosis in the pulpotomy of immature permanent teeth.

Pulpotomy is a conservative therapy performed to remove the inflamed coronal portion of the pulp and preserve the vitality of the remaining radicular pulp. This article reports two cases of immature permanent mandibular molars with clinical signs of pulp vitality and radiographic images of periapical bone rarefaction, which were treated with calcium hydroxide pulpotomy. In Case 1, pulpotomy was performed in a single session, while in Case 2 two sessions were required to complete the treatment. Clinical and radiographic follow up within 13 and 9 months, respectively, showed hard tissue barrier and new bone formation as well as progression of root development. These outcomes are confirmatory that an accurate clinical/radiographic assessment of pulp vitality is of paramount importance for the correct diagnosis and indication of pulpotomy in cases of young permanent teeth with incomplete root formation.

Importance of the diagnosis in the pulpotomy of immature permanent teeth

Pulpotomy is a conservative therapy performed to remove the inflamed coronal portion of the pulp and preserve the vitality of the remaining radicular pulp. This article reports two cases of immature permanent mandibular molars with clinical signs of pulp vitality and radiographic images of periapical bone rarefaction, which were treated with calcium hydroxide pulpotomy. In Case 1, pulpotomy was performed in a single session, while in Case 2 two sessions were required to complete the treatment. Clinical and radiographic follow up within 13 and 9 months, respectively, showed hard tissue barrier and new bone formation as well as progression of root development. These outcomes are confirmatory that an accurate clinical/radiographic assessment of pulp vitality is of paramount importance for the correct diagnosis and indication of pulpotomy in cases of young permanent teeth with incomplete root formation.

A pulpotomia é uma terapia conservadora indicada para dentes vitais com alterações inflamatórias da polpa dental coronária. Esse artigo relata dois casos de molares inferiores com rizogênese incompleta e imagem radiográfica de rarefação periapical que, clinicamente, apresentavam vitalidade pulpar e foram tratados pela técnica da pulpotomia com hidróxido de cálcio. No caso 1 a pulpotomia foi realizada em sessão única e no caso 2 em duas sessões. A proservação clínica e radiográfica com 13 e 9 meses, respectivamente, evidenciou formação de barreira mineralizada, neoformação óssea e desenvolvimento radicular. Conclui-se que a avaliação clínica da vitalidade pulpar, complementada pela análise radiográfica, é fundamental para o correto diagnóstico e indicação de pulpotomia em casos de dentes permanentes jovens com rizogênese incompleta.

The importance of apical patency and cleaning of the apical foramen on root canal preparation.

The apical limit of root canal instrumentation has always been a matter of great controversy. Despite the large number of published studies on this subject, a consensus has not yet been reached. In fact, the recent discussion on apical patency and cleaning of the apical foramen, as well as the incorporation of these procedures to the endodontic treatment, seem to have raised even more polemics. It is likely that all this polemics has its roots in the lack of interrelation between the theoretical knowledge of pulp stump and periapical tissues and the real clinical practice. By addressing the most important aspects of this theme, this paper aims to present news concepts about the importance of apical patency and cleaning of the apical foramen during root canal preparation.

Estudo comparativo da formação do tampão apical de dentina com e sem patência do forame usando a técnica de rotação alternada / Comparative study of dentin apical plug formation with and whiout foramen patency using reciprocating technique

A literatura endodôntica tem colocado que as raspas de dentina produzidas durante o preparo do canal podem se acumular nas suas porções finais formando um tampão apical de dentina. Verificou-se se esse fenômeno ocorre com o uso da técnica automatizada de rotação alternada. Vinte canais palatinos de molares superiores humanos extraídos foram preparados com o Endo-Gripper (Moyco Union Broach) e divididos em dois grupos. No Grupo I, a instrumentação foi realizada sem a manutenção da patência do fora me. No Grupo 11, a instrumentação foi feita intercalando-se a cada mudança de instrumento a lima K#10, com 1,O mm além do comprimento de trabalho, para manutenção da patência do fora me. Os resultados demonstram que o Grupo 11 promoveu menor formação de tampão apical.