The Efficacy of Different Antibiotic Compounds in Regenerative Treatment of Immature Necrotic Teeth.

Objectives: Endodontic treatment of immature teeth poses a significant challenge, especially in achieving a proper seal using traditional obturation methods. Revascularization presents itself as an alternative approach to this problem, and the application of triple antibiotic paste (TAP) has been suggested as a means to achieve disinfection during the procedure. This study aims to compare the antibacterial properties of three different antibiotic combinations to assess their effectiveness on root canal disinfection. Materials and Methods: Eighty samples were employed to assess the impact of three antibiotic combinations on Enterococcus faecalis, Escherichia coli, Streptococcus mutans, and a combination thereof. The antibiotics included metronidazole, ciprofloxacin, and cefaclor (CCM), the commonly used TAP, and a double antibiotic paste (DAP) composed of metronidazole and ciprofloxacin. Dentin shavings collected using Gates-Glidden drills were placed in microtubes containing a 2ml standard bacterial suspension. Microtube contents were diluted and cultured on BHI agar plates, with colony counts calculated based on dentine shavings' weight in CFU/mg. Kruskal-Wallis and Dunn's post-hoc tests were used for statistical analysis and P<0.05 was considered significant. Results: A significant difference in mean CFU was observed among all bacterial groups (P<0.05). Dunn's post-hoc analysis showed a significant difference only between the control group (methylcellulose) and the other antibiotic groups. There was no significant difference between the other antibiotic groups in two-by-two comparisons. Conclusion: There was no significant difference in the antimicrobial properties of DAP, TAP and CCM. Therefore, DAP and CCM may be used during regenerative treatment.

Restoring an Extremely Destructed Tooth with Flared Root Canal Walls: A Case Report.

Reconstructing severely damaged teeth has always presented a challenge when the remaining crown structure is limited, often requiring retention from the root canal using intracanal posts. However, the real challenge is when the root canal walls are also weak, and there is a high risk of vertical root fracture due to the wedging forces of a rigid post. This case report presents a tooth with extremely flared (0.3mm) root canal walls, successfully restored with a newly introduced polymer made of polyether ether ketone (PEEK), with one-year follow-up. Due to its close elastic modulus to dentin, capacity to bond effectively to tooth structure, shock-absorbing properties, and thereby facilitating favorable stress distribution, utilizing this material for an intracanal post has the potential to mitigate the risk of fractures often associated with cast metal posts. It combines the good fitness of cast posts with the low modulus of elasticity and optical properties of prefabricated fiber posts.

The effectiveness of EDTA 17% as a cleaning solution for the fiber post space after filling with cements

Aim: To evaluate the resistance of the union between a glass fiber post and radicular dentine after cleaning the root with 17% EDTA and filling with different endodontic cements. Methods: Forty uniradicular bovine incisors were removed to obtain root lengths of 18 mm. Endodontic treatment was performed on all roots using different filling cements (zinc oxide and eugenol-based, OZE; cement based on epoxy resin, AH) and cleaning solutions (saline, SA or EDTA), which made it possible to obtain four groups: OZESA, OZEEDTA, AHSA and AHEDTA. Subsequently, 12 mm of filling material was removed from the roots, and they were prepared to receive fiber posts luted with resin cement. To execute the mechanical cycles (2x106 cycles, 90 N, 4 Hz), coronal reconstruction was performed with a silicon matrix. The roots were then sliced (2-mm thick) to perform the push-out test. The results were analyzed using analysis of variance (one factor and two factors) and Tukey's test (α=0,05). Results: Bond strength (Mpa) was significantly higher for OZEEDTA (9,18) and AHEDTA (8,70) than for OZESA (6,06) AHSA (8,7). OZEEDTA also presented the highest values in the cervical region (15,18) but was significantly lower in the apical region (2,99). However, AHEDTA had a homogeneous bond strength in all thirds. Conclusion: Regardless of the endodontic cement used, EDTA was used as an irrigating solution, culminating in a higher bond strength between the glass fiber post and dentin

Pinos de fibra de vidro ­ aspectos gerais, propriedades e considerações biomecânicas ­ uma revisão de literatura / Fiberglass posts ­ general aspects, properties, and biomechanical considerations ­ a literature review

Introdução: A dentística a cada dia demonstra grandes avanços nas técnicas e materiais, sendo eles aplicados de forma a preservar a estrutura dentária. Neste sentido, os pinos de fibra de vidro (PFVs) se destacam como uma alternativa de pinos intrarradiculares para a reabilitação de dentes endodonticamente tratados com perdas estruturais superiores a 50%. Objetivo: Realizar uma revisão de literatura sobre os pinos de fibra de vidro enfatizando seus aspectos gerais, propriedades e considerações biomecânicas. Materiais e métodos: Realizou-se uma revisão bibliográfica de estudos publicados nos últimos 21 anos (2000-2021), por meio de busca nas bases de dados: PubMED/MEDLINE, SciELO (Scientific Eletronic Library) e Google Acadêmico. Para a pesquisa, foram utilizados os seguintes descritores: Dente não Vital (Tooth, Nonvital), Pinos Dentários (Dental Pins) e Técnica para Retentor Intrarradicular (Post and Core Technique). Após criteriosa filtragem, foram selecionados 30 trabalhos para inclusão no estudo, além de 10 livros considerados relevan-tes para esta revisão. Resultado:Os PFVs demonstram excelentes propriedades estéticas, facilidade de execução da técnica e baixo custo, biocompatibilidade com tecidos dentais e perirradiculares, além de características biomecânicas vantajosas, o que resulta na trans-missão de menos tensão para a estrutura dentária, diminuindo a probabilidade de fratu-ras. Conclusão: As inúmeras vantagens e o excelente comportamento biomecânico desses pinos explicam seu destaque frente aos demais retentores intrarradiculares, sendo esses, quando bem indicados, a primeira opção para a reabilitação de dentes tratados endodonti-camente com extensas perdas coronárias.

Introduction: Every day, dentistry demonstrates great advances in techniques and materials applied to preserve the tooth structure. In this sense, fiberglass posts (FGPs) attract attention as an alternative to intraradicular posts for the rehabilitation of endodontically treated teeth with structural losses greater than 50%. Objective: Review the literature on aesthetic fiberglass posts, emphasizing their general aspects, properties, and biomechanical considerations. Material and Methods: A literature review of studies published in the last 21 years (2000-2021) through a search on the databases: PubMED / Medline, Scielo (Scientific Electronic Library), and Google Academic. The following descriptors were used: Tooth, Nonvital, Dental Pins, and Post and Core Technique. After careful filtering, 30 articles were selected for inclusion in the study, in addition to 10 books considered relevant to this review. Results: The FGPs demonstrate excellent aesthetic properties, eas-iness of execution and low cost, biocompatibility with dental and periradicular tissues, in addition to advantageous biomechanical characteristics, which result in the transmission of less stress to the tooth structure, reducing the probability of fractures. Conclusion: The numerous advantages and excellent biomechanical behavior of these pins explain their prominence concerning other intraradicular retainers, which, when properly indicated, are the first option for the rehabilitation of endodontically treated teeth with extensive coronary loss. Keywords: Tooth, Nonvital. Dental Pins. Post and Core Technique.

Success Rate of Contemporary Regenerative Endodontic Therapy and the Expected Outcomes of the Endodontic Microsurgery: A Systematic Review and Meta-Analysis

ABSTRACT Objective: To examine the level of the accumulating success of the modern Resin-Based Endodontic Surgery (RES) and comparison with Endodontic Microsurgery (EMS) and finally offer a replacement at the predicted final results of EMS. Material and Methods: MEDLINE, PubMed, Cochrane Library, Embase, ISI, Google Scholar have been utilized as electronic databases for systematic literature until 2019. Therefore, Endnote X9, which can be provided in the market, has been applied to manage the electronic titles. Searches have been made with keywords "Endodontic Microsurgery OR EMS", "Resin-Based Endodontic Surgery OR RES", "Regenerative Endodontic Therapy", "Root-End Filling", "Root-End Surgery", "Periapical Surgery" and "Endodontics". Thus, this systematic review has been conducted concerningthe basic investigation of the PRISMA Statement-Preferred Reporting Items designed for the Meta-analyses and Systematic Reviews. Results: A total of RES =19 and EMS =31 with potential pertinent abstracts and topics were discovered in manual and electronic searches. Then, three articles for RES and four studies for EMS publications satisfied our inclusion criteria necessary for systematically reviewing the studies. The analysis showed the success rate for EMS as equal to 1.16 times the probability of the success rate for RES. Conclusion: Micro-surgical procedures superiorly achieved the predictable high success rate for the Root-end surgery compared to conventional methods.

Novas perspectivas para reabilitação de dentes tratados endodonticamente / Novel perspectives for the rehabilitation of endodontically treated teeth

Vários fatores podem influenciar o desempenho clínico de dentes com tratamento endodôntico (DTE). Além disso diversas são as opções restauradoras indicadas em respeito a este cenário, em especial com o notório avanço de novas técnicas e tecnologias para uso clínico. Dentre estas corriqueiramente envolvem-se o uso de restaurações diretas (confeccionadas com resina composta), pinos metálicos ou de fibra de vidro, pinos pré-fabricados ou fresados, assim como restaurações indiretas compostas de coroas cerâmicas, inlays, onlays ou endocrowns; sempre com o foco na reabilitação funcional e estética do caso em tela. Neste trabalho, através de uma revisão narrativa, foram expostos conceitos relativos às modalidades restauradores que se advêm do uso de novas tecnologias na reabilitação de dentes tratados endodonticamente(AU)

Several factors may influence the clinical performance of endodontically treated teeth (ETT). In addition, there are several restorative options indicated regarding this scenario, especially with the notable advance of new techniques and technologies for clinical use. These routinely involve the use of direct restorations (made of composite resin), metal or fiberglass posts, prefabricated or milled posts, as also indirect restorations composed of ceramic crowns, inlays, onlays or endocrown; always focusing on functional and aesthetic rehabilitation of the case in hand. In this study, through a narrative review, concepts related to the restorative modalities that were introduced with the use of new technologies in the rehabilitation of endodontically treated teeth were discussed(AU)

Clinical performance of whitening on devitalized teeth: a retrospective observational study / Desempenho clínico do clareamento em dentes desvitalizados: estudo observacional retrospectivo

Objective: This retrospective observational study evaluated the clinical performance of intracoronal whitening and correlated the main factors that interfere with its stability and patient satisfaction. Material and Methods: The paper was designed following the STROBE statement. Patients from the Institute of Science and Technology - ICT/UNESP database who underwent nonvital tooth whitening from August 2010 to July 2015 were selected. Data collection was performed by researching the institution records, patients interview, clinical and radiographic examination. Data were analyzed using MannWhitney test and Spearman's correlation (p < 0.05). Results: The initial search on 1275 records resulted in 43 patients, of whom 18 were selected according to eligibility criteria. There was positive correlation only between the degree of patient's satisfaction and the perception of color difference after whitening treatment (p < 0.05). Color relapse was observed in all conditions, independently of the period of followup (p > 0.05). There was no case of external cervical root resorption. Conclusion: Color changes after whitening influenced patient's satisfaction. There was no correlation among the color relapse and height of gutta-percha, return interval or cause of darkening (AU)

Objetivo: Este estudo observacional retrospectivo avaliou o desempenho clínico do clareamento interno e correlacionou os principais fatores que interferem em sua estabilidade e satisfação do paciente. Material e Métodos: O artigo foi elaborado seguindo o STROBE. Pacientes do banco de dados do Instituto de Ciência e Tecnologia ­ ICT/UNESP que foram submetidos ao clareamento dental em dentes desvitalizados entre agosto de 2010 e julho de 2015 foram selecionados. A coleta de dados foi realizada por meio de pesquisa em prontuários da instituição, entrevista com os pacientes, exames clínico e radiográfico. Os dados foram analisados usando o teste de Mann-Whitney e correlação de Spearman (p < 0,05). Resultados: A pesquisa inicial em 1275 registros resultou em 43 pacientes, dos quais 18 foram selecionados de acordo com os critérios de elegibilidade. Houve correlação positiva apenas entre o grau de satisfação do paciente e a percepção da diferença de cor após o tratamento clareador (p < 0,05). A recidiva da cor foi observada em todas as condições, independentemente do tempo de acompanhamento (p > 0,05). Não houve nenhum caso de reabsorção cervical externa. Conclusão: As mudanças de cor após o clareamento influenciaram a satisfação do paciente. Não houve correlação entre a recidiva da cor e a altura do guta-percha, o intervalo de retorno ou a causa do escurecimento. (AU)

Effect of Glass Fiber Post Diameter on Fracture Resistance of Endodontically Treated Teeth

Abstract Objective: To determine the fracture resistance of endodontically treated teeth restored with three different diameters of glass fiber posts and metal-ceramic crowns. Material and Methods: Thirty human maxillary canines were selected and subjected to root canal therapy. The teeth were randomly divided into three groups of glass fiber posts with 1.4 mm diameter (Group I), 1.6 mm diameter (Group II), and 2.0 mm diameter (Group III). The teeth were restored with metal-ceramic crowns and subjected to the compressive load applied at 45º angle to the longitudinal axis until fracture. The mode of failure was determined. Data were analyzed using ANOVA, followed by Tukey's post hoc multiple comparisons test (p<0.05). Results: The mean fracture resistance of groups I, II and III was 574 ± 91.2 N, 617 ± 85.21 N and 467 ± 99.43 N, respectively. No significant difference was noted between groups I and II, while the fracture resistance was significantly different between groups I and III (p<0.05) and groups II and III (p<0.05). No case of post fracture alone occurred in any group. Conclusion: The diameter of glass fiber posts can affect the fracture resistance of teeth. Based on the results, increasing the diameter of the post up to 1.6 mm may increase the fracture resistance of root, although excessive diameters are not recommended.

Effect of Different Fiber Reinforcement Strategies on the Fracture Strength of Composite Resin Restored Endodontically Treated Premolars

Objective: To compare the effect of three different fiber reinforcement strategies on the fracture strength of composite resin restored endodontically treated premolars. Material and Methods: Seventy-two sound human premolars extracted for orthodontic reasons were divided into 6 groups (n=12) after endodontic treatment. Group 1: intact teeth (positive control); Group 2: endodontically treated teeth without restoration (negative control); Group 3: composite resin restoration; Group 4: placement of fibers at occlusal position; Group 5: splinting the buccal and palatal walls with horizontal fiber posts; Group 6: placement of fibers at the occlusal position after splinting the buccal and palatal walls with horizontal fiber posts. Then fracture strength was measured at a crosshead speed of 0.5 mm/min in a universal testing machine. Data were analyzed using one-way ANOVA and post hoc Tukey tests at α=0.05. Results: There were significant differences between the negative and positive control groups (p<0.001) and between the negative control group and all the other study groups (p<0.001). However, there were no statistically significant differences between the positive control group and all the experimental groups and between the experimental groups (p>0.05). Conclusion: Fiber insertion had no additional reinforcing effect on the fracture strength following composite resin restoration.

Reabilitação funcional e estética de dente anterior fraturado em paciente hebiátrico: relato de caso / Functional and aesthetic rehabilitation of fractured anterior teeth in a hebiatric patient: case report / Rehabilitación funcional y estética de diente anterior fracturado en paciente hebiátrico: relato de caso

Introdução: Após fratura decorrente de trauma e consequente tratamento endodôntico, os dentes têm sua resistência mecânica reduzida, sendo necessária, em alguns casos, a utilização de um retentor intrarradicular. Objetivo: Descrever um caso clínico de reabilitação de um dente anterior que apresentava fratura decorrente de trauma, de um paciente adolescente. Relato do caso: Paciente do sexo masculino, 15 anos de idade, apresentou-se com a queixa da aparência estética do dente 32. Na anamnese o paciente relatou que há cerca de 1 ano havia fraturado o referido dente enquanto brincava, e que sentiu dor apenas nas primeiras horas após o acidente, não se queixando mais de qualquer sintomatologia dolorosa desde então. Ao exame radiográfico, observou-se fratura do dente 32, além da presença de imagem radiolúcida na região periapical do mesmo dente. Assim, baseado na avaliação radiográfica e após criteriosos exames com recursos semiotécnicos empregados na Endodontia, confirmou-se o diagnóstico de necrose pulpar no referido dente. Foi instituído o tratamento endodôntico previamente ao tratamento restaurador. A reabilitação consistiu inicialmente pelo tratamento endodôntico. Na sequência optou-se pela instalação de um pino de fibra de vidro (PFV). Por fim, a reconstrução coronária foi realizada de forma direta, em resina composta e com o auxílio de uma coroa de cloreto de polivinila (PVC). Conclusão: Através do resultado final obtido, concluiu-se que esta é uma alternativa rápida e viável para casos como o apresentado, proporcionando não somente o restabelecimento funcional e estético do dente, mas também satisfação e elevação da autoestima de pacientes hebiátricos(AU)

Introduction: After fracture resulting from trauma and consequent endodontic treatment, the teeth have reduced mechanical resistance, and in some cases, the use of an intraradicular retainer is necessary. Objective: To describe a case report of rehabilitation of anterior tooth who presented a fracture due to trauma of a hebiatric patient. Case report: A 15-year-old male presented with the complaint of the aesthetic appearance of the tooth 32. During the anamnesis, the patient reported that about 1 year had fractured said tooth while playing, and who felt pain only in the first few hours after the accident, not complaining any more of any painful symptomatology ever since. Radiographic examination revealed a fracture of the tooth 32, besides the presence of a radiolucent image in the periapical region of the same tooth. Thus, based on the radiographic evaluation and after careful examinations with semiotechnical resources used in Endodontics, the diagnosis of pulp necrosis in this tooth was confirmed. Endodontic treatment was instituted prior to restorative treatment. The rehabilitation initially consisted of endodontic treatment. In the sequence, a fiberglass pin (FGP) was installed. Finally, the direct coronary reconstruction was performed, in a composite resin and with the aid of a crown of polyvinyl chloride (CPC). Conclusion: Through the final result obtained, it was concluded that this is a fast and viable alternative for cases such as the one presented, providing not only the functional and aesthetic restoration of the dental element, but also satisfaction and elevation of self-esteem of hebiatric patients(AU)

Introducción: Después de la fractura resultante de trauma y consecuente tratamiento endodóntico, los dientes tienen su resistencia mecánica reducida, siendo necesaria, en algunos casos, la utilización de un retén intrarradicular. Objetivo: Describir un caso clínico de rehabilitación de un diente anterior que presentaba fractura resultante de trauma, de un paciente adolescente. Relato del caso: Paciente del sexo masculino, 15 años de edad, se presentó con la queja de la apariencia estética del diente 32. En el anamnesis, el paciente relató que hace cerca de 1 año, había fracturado el referido diente mientras jugaba, y, en el caso de la mujer, que sintió dolor sólo en las primeras horas después del accidente, no se quejó más de cualquier sintomatología dolorosa desde entonces. En el examen radiográfico, se observó fractura del diente 32, además de la presencia de imagen radiolúcida en la región periapical del mismo diente. Así, basado en la evaluación radiográfica y después de criteriosos exámenes con recursos semiotécnicos empleados en la Endodoncia, se confirmó el diagnóstico de necrosis pulpar en el referido diente. Se ha instituido el tratamiento endodóntico previamente al tratamiento restaurador. La rehabilitación consistió inicialmente en el tratamiento endodóntico. En la secuencia se optó por la instalación de un pasador de fibra de vidrio (PFV). Por último, la reconstrucción coronaria fue realizada de forma directa, en resina compuesta y con el auxilio de una corona de cloruro de polivinilo (PVC). Conclusión: A través del resultado final obtenido, se concluyó que esta es una alternativa rápida y viable para casos como el presentado, proporcionando no sólo el restablecimiento funcional y estético del diente, sino también satisfacción y elevación de la autoestima de pacientes hebiátricos(AU)

The Influence of Post System Design and Material on the Biomechanical Behavior of Teeth with Little Remaining Coronal Structure.

PURPOSE: To evaluate the influence of different post systems on the biomechanical behavior of teeth with a severe loss of remaining coronal structure. MATERIALS AND METHODS: Fifty standardized bovine teeth (n = 10 per group) were restored with: cast post-and-core (CPC), prefabricated metallic post (PFM), parallel glass-fiber post (P-FP), conical glass-fiber post (C-FP), or composite core (no post, CC). The survival rate during thermomechanical challenging (TC), the fracture strength (FS), and failure patterns (FP) were evaluated. Finite element models evaluated the stress distribution after the application of 100 N. RESULTS: All specimens survived TC. Similar FS was observed among post-containing groups. Groups P-FP and CC presented 100% repairable fractures. The von Mises analysis showed the maximum stresses into the root canal in groups restored with metallic posts. Glass-fiber posts and CC presented the maximum stresses at the load contact point. Glass-fiber groups showed lower stresses in the analysis of maximal contact pressure; CPC led to the highest values of contact pressure. The modified von Mises (mvM) stress in dentin did not show differences among groups. Moreover, mvM values did not reach the dentin fracture limit for any group. CONCLUSIONS: The type of intracanal post had a relevant influence on the biomechanical behavior of teeth with little remaining coronal structure.

[Advantages and disadvantages of endocrown restorations of endodontically treated teeth with large coronal destruction].

The strength of endodontically treated teeth were reduced apparently because of structural damage, therefore further reduction of healthy tissue should be avoided as much as possible in restoration. Endocrown made by chair-side CAD/CAM is some kind of minimal invasive restoration, and the retention of restoration is achieved by reliable bonding and macromechanial retention forces. Without post preparation, the root structure could be resevered. Following the indications and use of biomechanical dentin-like CAD/CAM materials could reduce the adverse effect of tensile stress on cervical part.

Procedimentos de regeneração pulpar: avaliação longitudinal imune / Procedimentos de regeneração pulpar: avaliação imune / Pulpar regeneration procedures: Longitudinal imune assessment

O tratamento endodôntico em dentes com desenvolvimento radicular incompleto está relacionado a algumas dificuldades e limitações. Entretanto, apesar das dificuldades técnicas, a alta susceptibilidade à fratura de dentes com rizogênese incompleta representa o fator chave para a busca de novas modalidades terapêuticas. Adicionalmente, as deficiências estéticas e funcionais apresentadas pelas terapias reabilitadoras após a perda de um elemento dentário permanente em um paciente jovem, também são fatores importantes e estimuladores. Assim, fica evidente a necessidade de pesquisas que disponibilizem novas opções terapêuticas conservadoras, com resultados previsíveis. O estudo objetivou investigar a resposta imunoinflamatória de dentes submetidos a diferentes protocolos descritos na literatura para se executar a terapia endodôntica regeneradora. Para isso, a expressão de moléculas inflamatórias e fatores de crescimento/diferenciação celular expressos nos tecidos pulpares foram analisados em diferentes intervalos de tempo, utilizando-se um modelo murino desenvolvido para a presente pesquisa. 54 Camundongos Balb/C tiveram as câmaras pulpares de seus molares superiores abertas e, subsequentemente submetidas à pulpectomia. Os animais foram então divididos em 3 grupos: grupo Sangramento (Blood) ­ preenchimento do espaço pulpar com coágulo sanguíneo; grupo EDTA + Sangramento (EDTA + Blood) ­ irrigação dos canais com solução de EDTA a 17% por 1 min, seguido do preenchimento do espaço pulpar com coágulo sanguíneo; grupo Vazio (Empty) ­ espaço pulpar deixado vazio. Cada grupo foi composto por 18 animais. De cada grupo, 6 animais foram sacrificados nos intervalos de 7, 14 e 21 dias após os experimentos. Utilizando-se a análise da reação em cadeia da polimerase em tempo real (Real Time PCR) avaliou-se a expressão gênica das citocinas IL-1, TNF-ß, IL-10 e dos fatores de crescimento/diferenciação NGF, IGF e VEGF, comparando-se tais achados inter e extra-grupos, nos diferentes períodos de avaliação. Os resultados demonstraram as maiores expressões dos mediadores pró-inflamatórios no grupo Empty, assim como uma maior expressão de mediadores anti-inflamatórios no grupo experimental preenchido com o coágulo sanguíneo. O grupo EDTA + Blood evidenciou a maior expressão gênica de fatores de crescimento/diferenciação, em todos os períodos analisados, quando comparado aos demais grupos. Pode-se concluir que a irrigação com solução de EDTA a 17%, previamente ao preenchimento dos sistemas de canais radiculares (SCR) com o scaffold (coágulo sanguíneo), estimulou a expressão aumentada de mediadores relacionados ao sucesso da terapia endodôntica regenerativa. Adicionalmente, o modelo animal desenvolvido para a pesquisa mostrou-se eficaz para se analisar longitudinalmente a modulação imune que se processa nos tecidos pulpoperirradiculares após a instituição da terapia.(AU)

Endodontic treatment in teeth with incomplete root development is related to some difficulties and limitations. However, despite the technical difficulties, the high susceptibility to fracture of teeth with incomplete rhizogenesis represents the key factor for the search for new therapeutic modalities. Additionally, the aesthetic and functional deficits presented by rehabilitation therapies after the loss of a permanent dental element in a young patient are also important and stimulating factors. Thus, it is evident the need for research that offers new conservative therapeutic options, with predictable results. Aimed to investigate the immunoinflammatory response of teeth submitted to different protocols described in the literature to perform the regenerative endodontic therapy. For this, the expression of inflammatory molecules and cell growth/differentiation factors expressed in pulpal tissues were analyzed at different time intervals using a murine model developed for the present study. 54 Balb/C mice had the pulp chambers of their upper molars opened and subsequently submitted to pulpectomy (one tooth per animal). The animals were then divided into 3 groups: Bleeding group - filling of the pulp space with blood clot; EDTA + Bleeding group (EDTA + Blood) - irrigation of the channels with 17% EDTA solution for 1 min, followed by filling of the pulp space with blood clot; Empty - pulp space left empty (negative control). Each group consisted of 18 animals. From each group, 6 animals were sacrificed at 7, 14 and 21 day intervals after the experiments. Using real-time polymerase chain reaction (RT-PCR), the cytokines IL-1, TNF-ß, IL-10 and the growth/differentiation factors NGF, IGF and VEGF, comparing such inter and extra group findings in the different evaluation periods. The results showed the highest expressions of the pro-inflammatory mediators in the Empty group, as well as a greater expression of anti-inflammatory mediators in the Experimental group filled with the blood clot. The EDTA + Blood group evidenced the greater gene expression of growth / differentiation factors, in all periods analyzed, when compared to the other groups. It can be concluded that irrigation with 17% EDTA solution, prior to filling the root canals system with the scaffold (blood clot), stimulated the increased expression of detrimental mediators for the success of regenerative endodontic therapy. Additionally, the animal model developed for the research proved to be effective in longitudinally analyzing the immune modulation that occurs in octopus-periradicular tissues after the institution of therapy.(AU)

Advantages and disadvantages of endocrown restorations of endodontically treated teeth with large coronal destruction / 中华口腔医学杂志

The strength of endodontically treated teeth were reduced apparently because of structural damage, therefore further reduction of healthy tissue should be avoided as much as possible in restoration. Endocrown made by chair-side CAD/CAM is some kind of minimal invasive restoration, and the retention of restoration is achieved by reliable bonding and macromechanial retention forces. Without post preparation, the root structure could be resevered. Following the indications and use of biomechanical dentin-like CAD/CAM materials could reduce the adverse effect of tensile stress on cervical part.

Survival rates against fracture of endodontically treated posterior teeth restored with full-coverage crowns or resin composite restorations: a systematic review.

This systematic review aims to summarize the current clinical studies that investigated survival rates against fracture of endodontically treated posterior teeth restored with crowns or resin composite restorations. Literature search were performed using keywords. Publications from 1980 to 2016 were searched in PubMed, ScienceDirect, Web of Science, MEDLINE, and SCOPUS. Included studies were selected based on inclusion and exclusion criteria. Three clinical studies were included: 1 randomized controlled trial and 1 prospective and 1 retrospective cohort studies. Pooled survival rates ranged from 94%-100% and 91.9%-100% for crowns and resin composite, respectively. The majority of teeth had no more than 3 surface loss of tooth structure. The studies included were heterogeneous, and were not appropriate for further meta-analysis. Current evidence suggested that the survival rates against the fracture of endodontically treated posterior teeth restored with crowns or resin composites were not significantly different in the teeth with minimum to moderate loss of tooth structure.

In vitro methods to evaluate the mechanical behavior of teeth restored with post and core: a structured review

To critically assess in vitro methods used to evaluate the mechanical behavior of endodontically treated teeth restored with intra-radicular posts and cores. Literature review: a literature search of in vitro studies was conducted in PubMed database using the search terms: ("endodontic*" OR "intracanal post") AND ("fracture" OR "resistance" OR "load" OR "strength"). A filter for publication date was set to return studies from the last five years (from October 2010 to October 2015). The research strategy resulted in 1,556 studies. After the analysis of the eligibility criteria, 92 articles were included in a descriptive analysis. Human upper central incisors were used most frequently. The natural mobility of teeth was simulated using an artificial periodontal ligament in 66.7% of the studies. In 32.2% of the studies, the load to fracture was applied directly to the core. Thermocycling was performed in 27.2% of the studies. Cyclic loading was used in 38% of the studies. Final considerations: periodontal ligament simulation, thermocycling and cyclic loads are some methods that have been employed to approximate laboratory studies to the clinical conditions that teeth restored intra-radicular posts and cores are submitted. Novel test methodologies, such as step-test and staircase approach, have been used to evaluate the fatigue behavior of this systems. However, it is important do highlight that, considering the context in which most of the included studies were performed, the extrapolation of the results to the clinical practice should be made carefully

Fracture Resistance of Endodontically Treated Teeth Restored with Different Types of Intracanal Posts

Objective: To evaluate the fracture resistance of endodontically treated teeth restored with different types of intracanal posts. Material and Methods: Sixty human upper central incisors (n = 60) were divided according to the performance of different protocols for restoration with intracanal posts. Groups without endodontic treatment (NT) and with endodontic treatment (TR) without placement of intracanal posts, served as controls. The experimental groups received endodontic treatment and were restored with: fiberglass post with composite resin filling core (PFV-NP); carbon fiber post with composite resin filling core (PFC-NP); nickel-chromium metal cast and core posts (NiCr); or copper-aluminum metal cast and core posts (CuAl). The specimens were then tested to determine the maximum fracture resistance and the failure types of fracture (infra-crestal and supra-crestal). Data were analyzed by one-way ANOVA and Tukey test (α<0.05). Results: Increased fracture resistance was observed for NT group (p<0.05). Within endodontically treated teeth groups, NiCr showed higher resistance to fracture, differing statistically from groups FV+NP and FC+NP (p<0.05). Higher frequency of infra-crestal fractures was observed in NT and TR groups. Conclusion: The installation of nickel-chromium intracanal cast and core posts contributed to higher fracture resistance and lower risk of fractures difficult to repair.

Clinical performance and failure modes of pulpless teeth restored with posts: a systematic review

Abstract The aim of this systematic review was to compare the clinical performance and failure modes of teeth restored with intra-radicular retainers. A search was performed on PubMed/Medline, Central and ClinicalTrials databases for randomized clinical trials comparing clinical behavior and failures of at least two types of retainers. From 341 detected papers, 16 were selected for full-text analysis, of which 9 met the eligibility criteria. A manual search added 2 more studies, totalizing 11 studies that were included in this review. Evaluated retainers were fiber (prefabricated and customized) and metal (prefabricated and cast) posts, and follow-up ranged from 6 months to 10 years. Most studies showed good clinical behavior for evaluated intra-radicular retainers. Reported survival rates varied from 71 to 100% for fiber posts and 50 to 97.1% for metal posts. Studies found no difference in the survival among different metal posts and most studies found no difference between fiber and metal posts. Two studies also showed that remaining dentine height, number of walls and ferrule increased the longevity of the restored teeth. Failures of fiber posts were mainly due to post loss of retention, while metal post failures were mostly related to root fracture, post fracture and crown and/or post loss of retention. In conclusion, metal and fiber posts present similar clinical behavior at short to medium term follow-up. Remaining dental structure and ferrule increase the survival of restored pulpless teeth. Studies with longer follow-up are needed.

Survival rates against fracture of endodontically treated posterior teeth restored with full-coverage crowns or resin composite restorations: a systematic review

This systematic review aims to summarize the current clinical studies that investigated survival rates against fracture of endodontically treated posterior teeth restored with crowns or resin composite restorations. Literature search were performed using keywords. Publications from 1980 to 2016 were searched in PubMed, ScienceDirect, Web of Science, MEDLINE, and SCOPUS. Included studies were selected based on inclusion and exclusion criteria. Three clinical studies were included: 1 randomized controlled trial and 1 prospective and 1 retrospective cohort studies. Pooled survival rates ranged from 94%–100% and 91.9%–100% for crowns and resin composite, respectively. The majority of teeth had no more than 3 surface loss of tooth structure. The studies included were heterogeneous, and were not appropriate for further meta-analysis. Current evidence suggested that the survival rates against the fracture of endodontically treated posterior teeth restored with crowns or resin composites were not significantly different in the teeth with minimum to moderate loss of tooth structure.

Coroa total em resina composta direta: relato de dois casos clínicos / Direct composite resin total crown: two case reports

Dentes com grande destruição coronária submetidos a tratamento endodôntico devem ser reconstruídos por meio da inserção de um pino intrarradicular, com finalidade de se obter retenção para o material restaurador e melhor distribuição de forças sobre o remanescente dental. A reconstrução coronária desses elementos dentais pode ser realizada com técnicas restauradoras indiretas ou diretas. A evolução das técnicas operatórias e das propriedades físicas, mecânicas e estéticas das resinas compostas tem ampliado suas indicações clínicas, e, quando associadas a pinos intracanais cimentáveis, têm permitido avanços nas reconstruções dentárias. Muitas situações clínicas, que tradicionalmente apresentavam soluções protéticas, hoje podem ser resolvidas através de restaurações diretas com resina composta. Este trabalho apresenta dois casos clínicos onde se realizaram alternativas viáveis de reabilitação de dentes com grande destruição coronária utilizando reconstruções totais diretas com uma resina composta micro-híbrida como material de eleição, associada à utilização de um pino de fibra de vidro e um pino metálico pré-fabricado. Em ambos os casos, foram realizadas as cimentações dos pinos intracanais com cimento ionomérico modificado por resina, seguindo o protocolo tradicional para desobturação dos canais radiculares. Associada ao pino de fibra de vidro foi utilizada a técnica da matriz de silicona como meio para reconstruir a coroa dental, enquanto que junto ao pino metálico lançou-se mão da matriz de Ableh. Concluiu-se que as técnicas descritas constituem procedimentos alternativos, de baixo custo e rápida elaboração, conseguindo suprir as necessidades dos pacientes, demostrando ser uma boa opção para reabilitação de grandes destruições coronárias

Endodontic treated teeth with large coronal destruction need be restored by inserting an intracanalpost in order to obtain retention for the restorative material and a better mastigatory stress distribution along the tooth. Subsequently, dental techniques of direct or indirect restorations may be used. The constant evolution of the physical, mechanical and aesthetic properties of composite resins has expanded its clinical indications and adhesive cemented posts have enabled advances in dental reconstructions. Many clinical situations, which in the recent past had only prosthetic solution, can now be build-up with composite resin direct restorations. This paper presents two case reports where were performed viable alternatives for restoring teeth with major coronal destruction through direct total crown reconstruction, with a micro-hybrid composite resin associated with glass fiber post and prefabricated metal post. Both cases were carried out with adhesive cementation of the post, using a resin modified glass ionomer cement. Associated with the glass fiber post, a silicona matrix technique was used as a mean to reconstruct the tooth crown, while with the metallic post it was used the Ableh matrix. It was concluded that techniques described in this work are alternative low cost and fast procedures, which could meet the needs of patients, being a good option for rehabilitation of dental coronary destruction