Root perforating internal replacement resorption: a case report clinical with 10-year follow-up

This study aims to report a root perforating internal replacement resorption treated and followed up for ten years. A 19-years female showed in periapical tomography enlargement of the entire length of the root canal of tooth 11. The cone-beam computed tomography (CBCT) showed a hypodense area with jagged edges involving the pulp cavity space and communication with the periodontium. After being accessed and prepared, the canal and its resorption defect were obturated with mineral trioxide aggregate. The cervical third was sealed with glass ionomer, and the tooth was restored with composite resin. Ten years later, the tomography showed intact root canal filling and periapical and periodontal injury absence. The use of repair cement for root canal obturation with perforating internal replacement resorption is an alternative for these cases, being fundamental to have a clinical, radiographic and tomographic follow-up to evaluate the treatment success.

Bioactivity and biocompatibility of bioceramic sealers in endodontics: an integrative review

Introduction: Bioceramic sealers have been gaining prominence in endodontics, meaning a great advance for endodontic therapy, mainly due to their biocompatibility and bioactivity. Objectives: research and discuss the literature about the bioactivity and biocompatibility of bioceramic sealants. Materials and methods: An integrative review was performed. The systematic plan consisted of four steps. In the first stage, a bibliographic survey was carried out in the Capes Periódicos Portal database. The search criteria were articles published between 2017 and 2022, found in the "advanced search" mode, using cross-references with the following keywords: bioceramics sealers AND endodontology AND root canals AND endodontic sealer AND bioactivity AND biocompatibility. Only documents found and published in full were evaluated. In the second stage, the titles and abstracts of the articles were read. In the third stage, a selection was made of those containing 3 to 5 keywords and a wording equal to or close to the proposed keywords. The fourth step consisted of reading the texts in full, followed by checking for duplicity and building a table with the collected information. Results: In view of the research carried out, 23 articles were obtained in the first stage. After reading the titles and abstracts, 21 articles were obtained. After selecting those containing 3 to 5 keywords, 10 articles met the criteria. One article was deleted due to duplicates. 9 articles met the exclusion and inclusion criteria and were selected to be part of the integrative review. Discussion: The selected studies in this literature review showed that bioceramic endodontic sealants perform well in endodontic therapy. Conclusion: To advance in its clinical application, more in vivo and in vitro studies with precise methods are needed to obtain more reliable data about its properties.

Final irrigation protocols may affect intraradicular dentin ultrastructure.

OBJECTIVES: The aim of this study was to evaluate the effect of different irrigation protocols on the root dentin structure using scanning electron microscopy (SEM) and transmission electron microscopy (TEM). MATERIALS AND METHODS: Thirty-nine lower bovine incisors were hemisected longitudinally and randomly divided into 13 groups (n = 3). After the root halves were reassembled, it was applied a specific irrigation protocol for each group, as following: G1, distilled water (control); G2, 0.9% saline; G3, saline + 17% EDTA; G4, saline + PUI; G5, saline + PUI + EDTA; G6 to G9 received the same protocol as above replacing 0.9% saline by 2.5% NaOCl; and G10 to G13 by 2% CHX. One-half of each sample was prepared and evaluated using SEM and the other one by TEM observations. RESULTS: TEM descriptive analysis showed modifications in dentin organic ultrastructure, characterized by the thinning of dentin collagen fibrils, caused by NaOCl, enhanced by EDTA and/or PUI. SEM analysis showed that NaOCl with PUI caused significantly larger erosion of the peritubular dentin than in all the other groups (P < 0.05), followed by NaOCl + EDTA and NaOCl + EDTA + PUI. CONCLUSIONS: NaOCl caused ultrastructural alterations in the dentin collagen, and enhanced by EDTA and/or PUI, promoted peritubular and intertubular erosion. CLINICAL RELEVANCE: The effect of irrigating solutions on dentin ultrastructure was still unclear. The acknowledgment about the kind of solution, concentrations, application time, and sequence of use was important to achieve the right sanitization without jeopardizing the dentin ultrastructure quality.

Adhesion of real seal to human root dentin treated with different solutions

The aim of this study was to evaluate the effects of different irrigants on sealer-dentin bond strength when using Real Seal. Thirty single-rooted teeth were divided into 3 groups. In one group, the teeth were irrigated with 3 mL of 2.5% NaOCl after each file change, flushed with 17% EDTA for 3 min and finally rinsed with 3 mL of 2.5% NaOCl. In the other two groups, rinse with NaOCl was replaced with 2% chlorhexidine gluconate (CHX) and 0.9% saline, respectively. Each root was sectioned transversally into apical, middle and coronal thirds to obtain 2-mm-thick slices. Each slice was filled with Real Seal and Resilon. Push-out test was used to analyze bond strength and failure modes were classified as adhesive, cohesive or mixed, according to SEM observations. The push-out test did not reveal any statistically significant difference (p>0.05) between the irrigants. However, the groups exhibited significantly different (p<0.05) bond strengths in terms of the root canal third. Higher bond strength was observed at the apical third when compared with coronal third, while middle third presented intermediary values. Fifteen specimens were analyzed by SEM (5 per group). Eleven specimens exhibited adhesive failures (5 in saline, 4 in NaOCl and 2 in CHX group); 2 cohesive failures were observed in the CHX group, and 1 mixed failure each was observed in the CHX and NaOCl groups. The tested irrigants did not influence the bond strength of Resilon and Real Seal to dentin. The apical third exhibited higher mean bond strengths and adhesive failures were predominant.

O objetivo deste estudo foi avaliar os efeitos de diferentes soluções irrigadoras na resistência adesiva do Real Seal à dentina radicular. Trinta dentes monorradiculares foram divididos em 3 grupos: Grupo 1 - os dentes foram irrigados com 3 mL de NaOCl 2,5% após cada troca de instrumento, irrigados com EDTA 17% por 3 min e lavagem final com NaOCl 2,5%. Nos Grupos 2 e 3, o NaOCl foi substituído por digluconato de clorexidina 2% (CHX) e solução salina 0,9%, respectivamente. Cada raiz foi seccionada transversalmente nos terços apical, médio e cervical para obter fatias de 2 mm de espessura. Cada slice foi obturado com Real Seal e Resilon. Teste de push-out foi usado para analisar a resistência adesiva e os padrões de falha foram classificados como adesiva, coesiva e mista de acordo com MEV. O teste de push-out não revelou diferença estatisticamente significante entre os irrigantes (p<0,05). Porém, os grupos exibiram diferentes valores de resistência adesiva de acordo com o terço radicular (p>0,05). Maior resistência adesiva foi observada na região apical quando comparado com o terço cervical, enquanto que o terço médio apresentou valores intermediarios. Quinze espécimes foram analisados através de MEV (5 por grupo). Onze espécimes exibiram falhas adesivas (5 no grupo da solução salina, 4 no grupo NaOCl e 2 na CHX); duas falhas coesivas foram observadas no grupo CHX e uma falha mista foi observada no grupo da CHX e uma no NaOCl. Os irrigantes testados não influenciaram a resistência adesiva do Resilon e do Real Seal à dentina radicular. O terço apical apresentou maior resistência adesiva e falhas adesivas foram predominantes para todos os grupos.

Evaluation of epoxy resin sealer after three root canal filling techniques by confocal laser scanning microscopy.

The aim of this study was to evaluate the penetration of endodontic sealer into the dentin tubules, the integrity of the sealer layer perimeter, and the sealer area at the apical third after different filling techniques by confocal laser scanning microscopy (CLSM). Forty-five mandibular premolars were mechanically prepared with ProTaper files, until F5 file. Thereafter, they were filled with an epoxy-resin sealer (AH Plus) mixed with Rhodamine B dye (0.1% proportion) and allocated in three groups: Group 1, single master cone; Group 2, cold lateral compaction; and Group 3, Thermafil. For confocal laser scanning microscopy analysis, the specimens were transversely sectioned at 4 mm from the apex. The images at ×10 and ×40 were analyzed by Imagetool 3.0 software. Significant differences were not found among the three experimental groups according the dentin-impregnate area by the sealer (P = 0.68) and between the sealer and root canal perimeter (P = 0.18). However, root canal filling techniques were significantly different when apical sealer areas were compared (P = 0.001). Thermafil group showed smaller sealer areas (8.09%) while cold lateral compaction and gutta-percha master cone showed similar areas (17.37 and 21.18%, respectively). The dentin-impregnated area was not dependent on the root canal filling technique. Single master cone, cold lateral condensation and Thermafil techniques presented integrity of the sealer perimeter close to 100% and Thermafil resulted in a significantly thinner sealer layer.

Avaliação da eficácia da instrumentação manual x automatizada durante o retratamento endodôntico em canais radiculares obturados com guta-percha e cimento à base de hidróxido de cálcio / Effectiveness evaluation of manual x rotary instrumentation during endodontic retreatment in root canals filled with gutta-percha and calcium hydroxide based-sealer

Introdução: o objetivo desta pesquisa consiste em avaliar a eficácia da instrumentação manual e automatizada na remoção da guta-percha e cimento à base de hidróxido de cálcio dos canais radiculares. Metodologia: foram avaliadas, ex vivo, trinta raízes palatinas de molares superiores no que se refere à eficácia dos instrumentos manuais de aço inox e rotatórios de níquel-titânio (ProTaper Universal®, Dentsply-Maillefer, Ballaigues, Suíça) na desobturação e repreparo do canal radicular obturado com guta-percha e um cimento à base de hidróxido de cálcio (Sealapex®, SybronEndo Corporation, Orange, CA, EUA). A presença de material obturador foi observada através de um microscópio clínico operatório, as imagens obtidas foram fotografadas com câmera digital. Os remanescentes da obturação foram mensurados através do programa AutoCAD 2004, calculada a porcentagem por terços radiculares e a área total. Resultados: para a técnica manual, o teste de Kruskal-Wallis não revelou diferença entre o terço cervical, médio e apical (p = 0,253). Para a técnica rotatória, o teste de Kruskal-Wallis revelou existir diferença estatisticamente significativa entre o terço cervical, médio e apical (p < 0,0001). O teste de comparações múltiplas de Tukey a 5% identificou maior percentual de material obturador no terço apical do que no cervical e médio. Conclusão: a quantidade total de guta-percha e cimento endodôntico remanescente após ambas as técnicas foi similar. Após a técnica manual, não houve diferença entre os terços radiculares, porém, quando o sistema rotatório foi utilizado, o terço apical apresentou maior quantidade de remanescente de material obturador que o terço cervical e médio. Entretanto, nenhuma das técnicas empregadas foi capaz de remover completamente o material obturador do interior dos canais radiculares.

Adhesion of Real Seal to human root dentin treated with different solutions.

The aim of this study was to evaluate the effects of different irrigants on sealer-dentin bond strength when using Real Seal. Thirty single-rooted teeth were divided into 3 groups. In one group, the teeth were irrigated with 3 mL of 2.5% NaOCl after each file change, flushed with 17% EDTA for 3 min and finally rinsed with 3 mL of 2.5% NaOCl. In the other two groups, rinse with NaOCl was replaced with 2% chlorhexidine gluconate (CHX) and 0.9% saline, respectively. Each root was sectioned transversally into apical, middle and coronal thirds to obtain 2-mm-thick slices. Each slice was filled with Real Seal and Resilon. Push-out test was used to analyze bond strength and failure modes were classified as adhesive, cohesive or mixed, according to SEM observations. The push-out test did not reveal any statistically significant difference (p>0.05) between the irrigants. However, the groups exhibited significantly different (p<0.05) bond strengths in terms of the root canal third. Higher bond strength was observed at the apical third when compared with coronal third, while middle third presented intermediary values. Fifteen specimens were analyzed by SEM (5 per group). Eleven specimens exhibited adhesive failures (5 in saline, 4 in NaOCl and 2 in CHX group); 2 cohesive failures were observed in the CHX group, and 1 mixed failure each was observed in the CHX and NaOCl groups. The tested irrigants did not influence the bond strength of Resilon and Real Seal to dentin. The apical third exhibited higher mean bond strengths and adhesive failures were predominant.

Back-scattered electron imaging for leakage analysis of four retrofilling materials.

This study aimed to evaluate, ex vivo, the nanoleakage in dentinal tubules, the linear infiltration of silver nitrate in the dentin wall/root-end filling material interface, and the presence of gaps in this interface in root-end cavities filled with 4 filling materials. Forty-eight disto-buccal root canals of maxillary molars were instrumented and filled. Retrograde cavities were prepared with ultrasonic points (apical 2 mm). The samples were divided into 2 control groups (n = 4) and 4 experimental groups (n = 10): Group I--white mineral trioxide aggregate (MTA); Group II--Super EBA; Group III--Portland cement; and Group IV--Sealer 26. After 1 week, the specimens were subjected to silver nitrate and prepared for SEM (backscattered electrons). In the apical-apical segment, an area with significantly higher leakage was observed for Super EBA, followed by Portland cement, MTA, and Sealer 26 (P = 0.0054). In the medium and cervical segments, all materials showed the same leakage behavior (P = 0.1815 and P = 0.1723, respectively). The linear infiltration at the dentin wall/root-end filling material interface was higher with Super EBA than the other groups. No differences in the percentage of gaps along the 3 mm of dentin wall/root-end filling material interface between the 4 materials were evident (P > 0.05). Nanoleakage occurred mainly in the apical segment of the samples, and Super EBA showed the highest values. The area and linear leakage were lower in the middle and coronal segments, regardless of the root-end filling material. No material perfectly sealed the root-end cavities, which allowed for the leakage occurrence.

Atividade antimicrobiana in vitro de uma suspensão de própolis frente ao Enterococcus faecalis / Antimicrobial in vitro activity of a propolis suspension against Enterococcus faecalis

Objetivos: O objetivo deste estudo foi avaliar, in vitro, a atividade antimicrobiana da suspensão de própolis a 5 e 10% sobre Enterococcus faecalis (ATCC 29212). Métodos: O teste de difusão em ágar e a técnica do disco foram empregados para as seguintes substâncias: (n = 19) extrato seco de própolis a 5 e 10%, clorexidina (controle positivo) e propilenoglicol (controle negativo). O diâmetro dos halos de inibição bacteriana foi medido após 24 horas. Resultados: Diferenças estatisticamente significantes foram observadas através do teste Anova (1 via) e post hoc de Tukey com nível de significância de 5% (p < 0,001). O grupo da clorexidina mostrou halos de inibição de crescimento bacteriano com média de 6,631 mm, ao passo que a própolis a 5 e 10% e o propilenoglicol não apresentaram halos. Conclusão: O extrato de própolis a 5 e 10% suspenso em propilenoglicol não evidenciou atividade antimicrobiana, in vitro, em comparação com o Enterococcus faecalis.

Endodontic treatment of a 36-mm long upper cuspid: clinical case report / Tratamento endodôntico de canino superior medindo 36 mm de comprimento: relato de um caso clínico

Purpose: To report a clinical case of a 36 mm long upper cuspid submitted to root canal treatment, with emphasis on the alternative technique employed. Case description: A 32 years old, male patient had suffered subluxation of teeth 12 and 13 and coronal fracture involving enamel and dentin, as well as pulp exposition, of tooth 14 because of a motorcycle accident. The man was given dental assistance and a semi-rigid splinting of teeth numbers 12 and 13 was carried out followed by the root canal treatment in a single visit on tooth no. 14. At 30-day follow-up pulp necrosis was detected in teeth 12 and 13 and the root canal treatment was implemented. The tooth 13 was 36 mm long and since the longest possible file (31 mm) was already in use, the cervical limit of the access cavity was considered as the reference point. Conclusion: This technique not only provided adequate disinfection, preparation and filling of the root canal, but it also allowed preservation of the remaining tooth structure.

Objetivo: Descrever o tratamento endodôntico de um canino superior medindo 36 mm de comprimento, mostrando a técnica empregada no preparo do canal radicular e obturação. Descrição do Caso: Paciente do sexo masculino, com 32 anos de idade, sofreu subluxação dos dentes 12 e 13 e fratura coronária envolvendo esmalte e dentina, com exposição pulpar do dente 14, devido a um acidente de moto. No atendimento de urgência, foi realizada a contenção semirrígida dos dentes 12 e 13, seguida da endodontia em sessão única do dente 14. Trinta dias após, foi diagnosticada necrose pulpar dos dentes 12 e 13 e sua endodontia foi, então, iniciada. O comprimento aparente do dente 13 foi estabelecido em 36 mm e como o instrumento mais longo que dispomos no mercado possui 31 mm, o limite cervical da cavidade de acesso foi usado como bordo de referência. Conclusão: Além de garantir uma correta sanificação, modelagem e obturação do canal, esta técnica também permitiu a preservação da estrutura dental remanescente.

Microscópio operatório na Endodontia: magnificação visual e luminosidade / Operating microscope in Endodontics: visual magnification and luminosity

Introdução: O microscópio operatório vem sendo utilizado na Endodontia com o intuito de minimizar a obscuridade do campo operatório, pois proporciona alta magnificação e luminosidade, favorecendo os procedimentos realizados e proporcionando um resultado de maior qualidade. Objetivo e revisão de literatura: O objetivo deste trabalho foi revisar a literatura discorrendo sobre a situação atual da microscopia operatória na Endodontia, com ênfase em suas vantagens e limitações. Apesar de ser um instrumento tecnológico de custo relativamente elevado e necessitar de um período de aprendizagem e adaptação, o uso desse aparato tem se difundido gradativamente. Conclusão: A importância da magnificação está embasada cientificamente na Odontologia, de tal forma que o seu uso proporcionou à Endodontia uma melhora significativa na visão e na iluminação do campo operatório, oferecendo trabalhos de melhor qualidade com proporcionais índices de sucesso nos tratamentos, além de melhorar a comunicação entre profissionais e entre profissionais e pacientes e auxiliar na documentação legal para fins jurídicos.

Introduction: The surgical microscope has been used in Endodontics in order to minimize the obscurity of the surgical , because it provides a high magnification and luminosity, thereby enhancing the procedures performed and providing a final result of higher quality. Objective and literature review: The objective of this study was to review the literature by addressing the current situation of the operating microscope in Endodontics, emphasizing its advantages and limitations. Despite being a technological tool that is relatively costly and that requires a period of learning and adaptation, the use of this apparatus has been spreading gradually. Conclusion: The importance of magnification is scientifically based in Dentistry, in such a way that its use has provided significant improvement to Endodontics with regards to vision and lighting of the operative , by offering better quality of work with proportional success rates in treatments, besides improving communication between professionals and patients and assisting in the documentation for legal purposes.

NSK reciprocating handpiece: in vitro comparative analysis of dentinal removal during root canal preparation by different operators.

The purpose of this study was to assess dentin removal during root canal preparation by different operators using a NSK reciprocating handpiece. Eighty-four human single-rooted mandibular premolars were hand instrumented using Triple-Flex stainless-steel files (Kerr) up to #30, weighed in analytical balance and randomly assigned to 4 groups (n=21). All specimens were mechanically prepared at the working length with #35 to #45 Triple-Flex files (Kerr) coupled to a NSK (TEP-E10R, Nakanishi Inc.) reciprocating handpiece powered by an electric motor (Endo Plus; VK Driller). Groups 1 to 4 were prepared by a professor of Endodontics, an endodontist, a third-year dental student and a general dentist, respectively. Teeth were reweighed after root canal preparation. The difference between weights was calculated and the means of dentin removal in each group were analyzed statistically by ANOVA and Tukey's test at 5 % significance level. The greatest amount of dentin removal was found in group 4, followed by groups 2, 3 and 1. Group 4 differed statistically from the other groups regarding dentin removal means [p<0.001 (group 1); p=0.005 (group 2); and p=0.001 (group 3)]. No statistically significant difference was found between groups 1 and 2 (p=0.608), 1 and 3 (p=0.914) and 2 and 3 (p=0.938). In conclusion, although the group prepared by a general dentist differed statistically from the other groups in terms of amount of dentin removal, this difference was clinically irrelevant. The NSK reciprocating handpiece powered by an electric engine was proved an effective auxiliary tool in root canal preparation, regardless of the operator's skills.

NSK reciprocating handpiece: in vitro comparative analysis of dentinal removal during root canal preparation by different operators

Este estudo avaliou a perda de massa dentinária durante o preparo do canal radicular por 4 diferentes operadores utilizando o sistema de rotação alternada NSK (TEP-E10R, Nakanishi Inc.). Após a instrumentação manual de 84 pré-molares inferiores humanos com limas de aço inoxidável Triple-Flex (Kerr) até a lima #30, os espécimes foram pesados e divididos aleatoriamente em 4 grupos (n=21). Os canais foram preparados mecanicamente até o comprimento de trabalho com limas Triple-Flex #35 a #45 acopladas ao sistema de rotação alternada NSK acionado por motor elétrico (Endo Plus; VK Driller). Os grupos 1 a 4 foram preparados por professor de Endodontia, um endodontista, um estudante do 3º ano de Odontologia e um clínico geral, respectivamente. Após o preparo mecânico, os espécimes foram novamente pesados. A diferença entre o peso inicial e o peso final foi obtida e as médias de perda de massa dentinária em cada grupo foram submetidas à análise estatística por meio da ANOVA e Teste de Tukey com nível de significância de 5%. A maior quantidade de perda de massa dentinária foi observada no grupo 4, seguido pelos grupos 2, 3 e 1. Houve diferença estatisticamente significante o grupo 4 e os outros três grupos [p<0,001 (grupo 1); p=0,005 (grupo 2) e p=0,001 (grupo 3)]. Não houve diferença estatisticamente significante entre os grupos 1 e 2 (p=0,608), 1 e 3 (p=0,914) e 2 e 3 (p=0,938). Conclui-se que embora o grupo preparado pelo clínico geral tenha diferido estatisticamente dos demais grupos em termos de quantidade de dentina removida, essa diferença não foi clinicamente relevante. O sistema de rotação alternada NSK mostrou-se um recurso auxiliar eficiente no preparo do canal radicular, independentemente da experiência do operador.

Avaliação da determinação do comprimento de trabalho através do localizador apical eletrônico NOVAPEX / Evaluation about precision of the eletronic apex locator NOVAPEX in working lenght measurement

Introdução: A correta determinação do comprimento de trabalho durante a terapia endodôntica constitui fator fundamental para o sucesso do tratamento. Um erro durante a odontometria acarretará uma situação adversa à cicatrização dos tecidos, dificultando o reparo e, conseqüentemente, reduzindo o percentual de êxito dos tratamentos. Considerando-se como um dos objetivos fundamentais para o sucesso do tratamento endodôntico manter o comprimento de trabalho dentro de um limite adequado, ou seja, o mais próximo possível do limite CDC, fica muitas vezes difícil de obter-se essa correta delimitação. O objetivo do presente estudo é avaliar a determinação do comprimento de trabalho através do localizador apical eletrônico NOVAPEX. Método: Para tal, foram realizadas 54 aferições eletrônicas em dentes anteriores de pacientes entre 15 e 65 anos de idade, na disciplina de Endodontia da Universidade de Santa Cruz do Sul - RS, sendo que 27 dentes apresentavam-se com polpa viva e 27 com polpa mortificada. Após esse procedimento, foram realizadas tomadas radiográficas pela técnica da bissetriz. Em posse da radiografia, foi efetuada a medição da ponta do instrumento até o vértice apical radiográfico da raiz com o auxílio de um paquímetro digital. As medidas compreendidas entre 0,5mm e 2mm foram consideradas como sucesso na utilização do aparelho. Resultados e conclusão: Após a análise dos resultados, observaram-se índices percentuais de confiabilidade de 77,8% em dentes vitalizados e 85,2% em dentes com polpa mortificada, sendo possível considerar que o localizador apical eletrônico NOVAPEX constitui-se em excelente recurso na determinação do comprimento de trabalho de instrumentação durante a terapia endodôntica.

Introduction: The working length right determination during root canal treatment is a fundamental factor for a successful therapy. Any mistake during working length determination will difficult the apical tissues healing, compromising the treatment prognosis. Considering as some of the principal objectives in a successful treatment, to keep the working length in an appropriate limit, near the CDC limit, is many times difficult. The aim of this research was to evaluate the working length determination by the electronic apical locator, NOVAPEX. Method: In patients with 15 to 65 years old, at the Endodontics Clinic Discipline, University of Santa Cruz do Sul - RS, there were made 54 electronic checks from that, 27 were vital and 27 were non-vital teeth. After this procedure, radiographs were taking by the Bissetriz technique, with the file calibrated at NOVAPEX limit, in the root canal. On the radiograph, with a digital paquimeter, was measured the length from the file tip to the radiograph apex. Results and conclusion: The measurements between 0,5 to 2,0mm were considered successful. The results analysis shows a confidingly index at 77,8% in vital tooth and 85,2% in non vital tooth, making possible consider that the electronic apical locator NOVAPEX constitute an excellent resort for working length determination at endodontic therapy.