Evaluation of 3Mix-MP and pulpectomies in non-vital primary molars.

Pulpectomies in primary molars are often hindered by several factors, including anatomical and physiological characteristics of posterior primary teeth and young patients' lack of cooperation with laborious treatments. This study was undertaken in search of easier but equally effective therapies that could eliminate infection, preserve the teeth and avoid extractions. The aim of the study was to estimate and compare clinical and radiographic success between pulp treatment with 3Mix-MP and pulpectomy with Maisto-Capurro paste in primary necrotic molars. A longitudinal prospective study was conducted at the Department of Comprehensive Pediatric Dentistry of the Faculty of Dentistry of the University of Buenos Aires (20152017). The study included 46 primary molars with necrotic pulp of children without immune or metabolic compromise. Children and their legal guardians provided assent and informed consent. Selected molars were randomly divided into 2 groups: G1: Pulpectomy treatment with Maisto-Capurro paste; and G2: Treatment with 3Mix-MP paste. Treatments were evaluated at 1, 3, 6,12 and 18 months (intra and inter-rater agreement 0.92 and 0.84). Clinical success was considered to be the absence of any of the following: pain, sensitivity to percussion or palpation, swelling, fistula and non-physiological mobility, while radiographic success was considered to be: absence of internal or external non-physiological resorption, no progression or reduction of radiolucent periapical/interradicular lesion and evidence of bone regeneration. Percentages, 95% C.I., and CHI2 were calculated for the comparison between groups. Overall clinical success was 91.5% and 87.5% (p=0.48) and overall radiographic success was 88.3% and 82.3% (p=0.31) for G1 and G2 respectively. No significant clinical or radiographic difference was found between groups. Both treatments showed similar clinical and radiographic behavior during the study periods.

Las pulpectomías en molares primarios se ven dificultadas frecuentemente por las características anatómicas y fisiológicas de éstos y por la escasa colaboración que brindan los pacientes de corta edad ante tratamientos tan laboriosos. En búsqueda de terapéuticas más sencillas, pero igualmente eficaces, que consigan eliminar la infección para conservar las piezas y evitar las exodoncias, se ha planteado como objetivo de este estudio: estimar y comparar la proporción de éxito clínico y radiográfico entre el tratamiento pulpar con 3Mix-MP y la pulpectomía con pasta de Maisto-Capurro en molares primarios con necrosis. Se realizó un estudio longitudinal y prospectivo en la Cátedra de Odontología Integral Niños de la Facultad de Odontología de la Universidad de Buenos Aires (2015 - 2017). Formaron parte del estudio 46 molares primarios con diagnóstico de necrosis pulpar, de niños sin compromiso inmunológico ni metabólico y que junto con sus responsables legales brindaron el asentimiento y el consentimiento informado. Los molares seleccionados fueron divididos aleatoriamente en 2 grupos: G1: Tratamiento de pulpectomía con pasta de Maisto-Capurro y G2: Tratamiento con pasta 3Mix-MP. Los tratamientos fueron evaluados al mes, 3, 6, 12y 18 meses (concordancia intra-examinador 0,92 e interexaminador 0,84), considerando como éxito clínico la ausencia de dolor, sensibilidad a la percusión y palpación, edema, fístula y movilidad no fisiológica; y como éxito radiográfico, ausencia de reabsorción interna o externa no fisiológica, no progresión o reducción de la lesión radiolúcida interradicular/periapical y evidencia de regeneración ósea. Se calcularon porcentajes, I.C 95% y CHI2para la comparación. El éxito clínico global fue de 91,5%y 87,5% (p=0.48) y el éxito radiográfico global de 88,3% y 82,3% (p=0.31)para G1 y G2 respectivamente, sin diferencias significativas entre ambos grupos. En los periodos estudiados ambos tratamientos mostraron comportamientos clínico y radiográfico semejantes.

Accidente con hipoclorito de sodio durante la terapia endodóntica / Accident with sodium hypochlorite during endodontic therapy

Introducción: el accidente con hipoclorito de sodio es una de las complicaciones que pueden presentarse durante la terapia endodóntica convencional. Constituye el sobrepaso del irrigante a los tejidos periapicales ya sea durante la irrigación de los conductos radiculares o por medio de la inyección accidental en los tejidos blandos. Produce al paciente una sintomatología dolorosa inmediata, con una respuesta inmunológica exacerbada y necrosis hística. Objetivo: determinar las posibles causas del accidente con hipoclorito de sodio y exponer el protocolo de manejo clínico y farmacológico establecido para esta eventualidad. Caso clínico: se informa el caso de un sobrepaso accidental de hipoclorito de sodio hacia el periápice en la raíz distovestibular del diente 17 en un paciente de 67 años de edad, con hipertensión arterial controlada, diagnóstico de pulpa sana y requerimiento de realización de endodoncia preprotésica. Se exponen la toma de medidas clínicas y farmacológicas posterior al accidente con hipoclorito de sodio, así como el suministro de corticoterapia inmediata, analgesia, manejo del dolor por bloqueo anestésico del área comprometida y para disolución del hipoclorito de sodio, para completar el esquema de manejo medicación antibiótica profiláctica. Conclusiones: los factores predisponentes para la generación de un accidente con hipoclorito son: enfermedades que causen resorción periapical, selección inadecuada del tipo de jeringa y aguja con la que se realiza la irrigación y la no determinación adecuada de la longitud radicular. El manejo de estos accidentes con corticoides y analgesia reduce la agresividad de la sintomatología presentada por el paciente, así como la profilaxis antibiótica, disminuye el riesgo de daño hístico(AU)

Introduction: sodium hypochlorite accidents are one of the complications that may arise during conventional endodontic therapy. In hypochlorite accidents, the irrigant flows into the periapical tissue either during irrigation of root canals or by accidental injection into soft tissue. This situation causes immediate pain symptoms in the patient, with an exacerbated immune response and tissue necrosis. Objective: determine the possible causes of sodium hypochlorite accidents and present the clinical and pharmacological management protocol established for these events. Clinical case: a case is reported of accidental flowing of sodium hypochlorite to the apex of the distovestibular root of tooth 17 in a 67-year-old male patient with controlled hypertension and a diagnosis of healthy pulp requiring preprosthetic endodontic therapy. A description is provided of the clinical and pharmacological actions taken after the sodium hypochlorite accident, as well as the immediate application of corticotherapy, analgesia, pain management by anesthetic block of the compromised area and for dissolution of the sodium hypochlorite, to complete the management scheme with prophylactic antibiotic medication. Conclusions: the following are predisposing factors for the occurrence of a hypochlorite accident: conditions that cause periapical resorption, inadequate choice of the type of syringe and needle to perform the irrigation, and incorrect determination of the root length. Management of these accidents with corticosteroids and analgesia reduces the aggressiveness of symptoms, whereas antibiotic prophylaxis lessens the risk of tissue damage(AU)

Accidente con hipoclorito de sodio durante la terapia endodóntica / Accident with sodium hypochlorite during endodontic therapy

Introducción: el accidente con hipoclorito de sodio es una de las complicaciones que pueden presentarse durante la terapia endodóntica convencional. Constituye el sobrepaso del irrigante a los tejidos periapicales ya sea durante la irrigación de los conductos radiculares o por medio de la inyección accidental en los tejidos blandos. Produce al paciente una sintomatología dolorosa inmediata, con una respuesta inmunológica exacerbada y necrosis hística. Objetivo: determinar las posibles causas del accidente con hipoclorito de sodio y exponer el protocolo de manejo clínico y farmacológico establecido para esta eventualidad. Caso clínico: se informa el caso de un sobrepaso accidental de hipoclorito de sodio hacia el periápice en la raíz distovestibular del diente 17 en un paciente de 67 años de edad, con hipertensión arterial controlada, diagnóstico de pulpa sana y requerimiento de realización de endodoncia preprotésica. Se exponen la toma de medidas clínicas y farmacológicas posterior al accidente con hipoclorito de sodio, así como el suministro de corticoterapia inmediata, analgesia, manejo del dolor por bloqueo anestésico del área comprometida y para disolución del hipoclorito de sodio, para completar el esquema de manejo medicación antibiótica profiláctica. Conclusiones: los factores predisponentes para la generación de un accidente con hipoclorito son: enfermedades que causen resorción periapical, selección inadecuada del tipo de jeringa y aguja con la que se realiza la irrigación y la no determinación adecuada de la longitud radicular. El manejo de estos accidentes con corticoides y analgesia reduce la agresividad de la sintomatología presentada por el paciente, así como la profilaxis antibiótica, disminuye el riesgo de daño hístico(AU)

Introduction: sodium hypochlorite accidents are one of the complications that may arise during conventional endodontic therapy. In hypochlorite accidents, the irrigant flows into the periapical tissue either during irrigation of root canals or by accidental injection into soft tissue. This situation causes immediate pain symptoms in the patient, with an exacerbated immune response and tissue necrosis. Objective: determine the possible causes of sodium hypochlorite accidents and present the clinical and pharmacological management protocol established for these events. Clinical case: a case is reported of accidental flowing of sodium hypochlorite to the apex of the distovestibular root of tooth 17 in a 67-year-old male patient with controlled hypertension and a diagnosis of healthy pulp requiring preprosthetic endodontic therapy. A description is provided of the clinical and pharmacological actions taken after the sodium hypochlorite accident, as well as the immediate application of corticotherapy, analgesia, pain management by anesthetic block of the compromised area and for dissolution of the sodium hypochlorite, to complete the management scheme with prophylactic antibiotic medication. Conclusions: the following are predisposing factors for the occurrence of a hypochlorite accident: conditions that cause periapical resorption, inadequate choice of the type of syringe and needle to perform the irrigation, and incorrect determination of the root length. Management of these accidents with corticosteroids and analgesia reduces the aggressiveness of symptoms, whereas antibiotic prophylaxis lessens the risk of tissue damage(AU)

Toxicity of irrigating solutions and pharmacological associations used in pulpectomy of primary teeth.

AIM: To evaluate the in vitro toxicity of irrigating solutions and pharmacological associations used in the pulpectomy of primary teeth. METHODOLOGY: The cell viability (MTT), lipid peroxidation (TBARS), alkaline comet assay and GEMO tests were performed to evaluate the cytotoxicity and genotoxicity of solutions: sodium hypochlorite (1% and 2.5%), 2% chlorhexidine, 6% citric acid and 17% EDTA, which were tested, individually and in association, exposing human peripheral blood mononuclear cells (MTT, TBARS and alkaline comet assay), at 24 and 72 h, and dsDNA (GEMO). After performing the Kolmogorov-Smirnov test, data were analysed by anova followed by Dunnett's post hoc test, and Kruskal-Wallis followed by Dunn post hoc test. A significance level was established at P < 0.05. RESULTS: All irrigating solutions and pharmacological associations reduced cell viability at 24 h (P < 0.05). These reductions were maintained after 72 h, except for EDTA and associations of sodium hypochlorite (1% and 2.5%) with EDTA and of chlorhexidine with EDTA. Lipid peroxidation at 24 h was caused by EDTA and by 2.5% sodium hypochlorite with EDTA; it was also caused at 72 h by sodium hypochlorite (1% and 2.5%) and the three associations with citric acid (P < 0.05). All groups caused DNA damage when assessed by the alkaline comet assay, at 24 h and 72 h (P < 0.05). In the GEMO assay, all groups caused dsDNA damage (P < 0.05), except for chlorhexidine with EDTA. CONCLUSION: All groups showed some level of toxicity. Amongst the main solutions, chlorhexidine presented less cytotoxic potential. EDTA was the least cytotoxic of the auxiliary irrigant solutions, and the association of these two solutions showed the lowest toxicity potential amongst all groups.

Ectopic eruption of permanent incisors after predecessor pulpectomy: five cases.

Pulpectomy in primary teeth is a common technique that preserves teeth in the oral environment and maintains or recovers periapical tissues to a healthy condition. This article describes the ectopic eruption of permanent incisors whose primary predecessors underwent pulpectomy using ZOE filler paste. In a group of 135 teeth that received pulpectomy therapy due to caries, 10 primary maxillary incisors had overretention and were followed for at least 3.5 years (mean time of 4.2 years), both clinically and radiographically, until the permanent teeth erupted. The proposed treatment included extraction of the overretained primary incisors based on permanent successor eruption chronology and contralateral eruption. Seven permanent teeth erupted ectopically. Autocorrection of the permanent tooth positions was observed in five cases. It can be concluded that periodic clinical and radiographic assessments are essential to verify radicular and filling paste resorptions and to avoid overretention and any subsequent malocclusion.

Zinc oxide-eugenol paste retained in gingival mucosa after primary teeth pulpectomy.

AIM: Long-term follow-up evaluations of pulpectomy in primary teeth have revealed retention of ZOE filling particles in the periapical area even after root resorption. CASE REPORT: This paper reports a case of a child submitted to pulpectomy with ZOE paste in primary teeth. After 28 months, the filling particles remained, having migrated to the alveolar bone from the gingival vestibular mucosa during permanent dentition eruption. Aesthetics required periodontal surgical removal of the paste particles. Primary teeth submitted to pulpectomy should be evaluated carefully both clinically and radiographically to verify radicular and ZOE filling paste resorption. The consequences of retained particles during permanent dentition eruption are unknown.

Avaliação de dose única de cetorolaco pré-operatório no controle de dor em biopulpectomias / Evaluation of preoperative single dose of Ketorolac tromethamine in the management of pain in pulpectomy

A utilização de anti-inflamatórios nao esteroidais previamente a atendimentos de urgência odontológica vem sendo estudada com a finalidade de proporcionar maior conforto pos-operatório ao paciente. Visando avaliar a influência de um antiinflamatório nao esteroidal administrado previamente ao procedimento endodôntico de urgência em pulpites irreversíveis, sobre a dor e sobre a quantidade de medicação consumida no pós-operatório, foi utilizado o cetorolaco de trometamina 10mg sublingual 1 hora antes do procedimento. Também foi avaliada a influência desta droga sobre a quantidade de anestésico necessária para o acesso indolor a câmara pulpar e sobre a diminuição da dor durante a espera pelo atendimento. Como em todo atendimento de urgencia em dentes com pulpite irreversivel e utilizado uma medicação intracanal a base de corticosteróide associado a antibióticos, propos-se avaliar a real necessidade da presenca do antibiotico no curativo de demora, comparando a medicação mais usada (OtosporinR) com hidrocortisona. Participaram da pesquisa 39 pacientes que procuraram o Setor de Urgência Odontológica da Faculdade de Odontologia de Bauru ou o Setor Odontologico do Pronto Socorro Central da Prefeitura Municipal de Bauru. Foram divididos em 4 grupos que receberam cetorolaco de trometamina ou placebo como medicação pós-operatória e OtorporinR ou hidrocortisona como medicação intracanal. Foram anotados os valores de intensidade de dor, em uma escala visual analógica, antes da medicação pré-operatória, antes do atendimento, após o atendimento e 1, 2, 4, 12, 24, 48 horas apos. Também foi anotada a quantidade de anestésico utilizado, o tempo de procedimento, o tempo de duração da anestesia e a quantidade de cetorolaco de trometamina e medicação socorro (paracetamol 750mg) consumida pelo paciente no pós-operatório. Dos resultados obtidos observou-se que os pacientes que receberam cetorolaco de trometamina como medicação pré-operatória tiveram uma redução da dor...

The use of nonsteroidal anti-inflammatory drugs before emergency dental treatment has been studied with the purpose to provide higher postoperative comfort to the patient. The objective of this study was to evaluate the influence of ketorolac tromethamine (10mg sublingual, taken 1 hour previously the emergency endodontic proceeding of irreversible pulpitis) in pain reduction and in the postoperative consumption of analgesic drugs. It was also analyzed the influence of this drug upon the amount of anesthetic necessary to the painless access into pulpal chamber and the pain reduction while waiting the appointment. Because an intracanal medication containing corticoid in combination with antibiotics is applied in teeth with irreversible pulpitis in every emergency treatment, it was proposed to evaluate the real necessity of the antibiotic in this intracanal medication, comparing the most popular medicine, OtosporinR, with hydrocortisone alone, in the same concentration present in this medicine. A total of 39 patients who presented either to Dental Urgency Sector from Dental School of Bauru (USP) or Emergency Dental Sector from Bauru City Hall were invited to participate. They were distributed in 4 groups that received either ketorolac tromethamine or placebo pretreatment and either OtosporinR or hydrocortisone alone as intracanal medication. It was noted the rates of pain intensity by means of a visual analogue scale, before the pretreatment medication, immediately before the appointment and 1, 2, 4, 12, 24 and 48 hours after the appointment. It was also recorded the amount of anesthetic used, the duration of proceeding, the time length of the anesthetic effect and the amount of ketorolac tromethamine and rescue medication (paracetamol 750mg) consumed by the patient at postoperative time. The patients who received ketorolac tromethamine as preoperative medication had a pain reduction between 52% and 73% during the waiting time for appointment...

Do endodontic compounds induce genetic damage? A comprehensive review.

Taking into consideration genetic damage plays an important role in carcinogenesis, the purpose of this paper is to provide an overview on the genotoxic potential of some endodontic compounds currently used in dentistry, such as formocresol, paramonochlorophenol, calcium hydroxide, resin-based sealers, phenolic compounds, chlorhexidine, mineral trioxide aggregate, and others. Some of these compounds appear capable of exerting noxious activity on the genetic material. The action mechanisms are discussed. Therefore, this is an area that warrants investigation since the estimation of risk of these substances with respect to genotoxicity will be added to those used for regulatory purposes in improving oral health and preventing oral carcinogenesis.

Histology and lysosomal cytochemistry of the postsurgically inflamed dental pulp after topical application of steroids. I. Histological study.

The purpose of this study was to histologically investigate steroid effects on the dental pulp. Three steroid preparations, hydrocortisone, betamethasone and triamcinolone, were locally applied to the exposed pulp tissue in rat incisor after pulpectomy. After 24 h, the effects on the tissues were assessed by light microscopy. The results showed that topical application of corticosteroids as an intracanal medicament reduced inflammatory changes in the pulp as compared with controls. Furthermore, triamcinolone and betamethasone demonstrated more potent anti-inflammatory effects than did hydrocortisone.

[Iatrogenic disease in pediatric dentistry. Report of a case]. / Yatrogenia en odontopediatría: Informe de un caso.

The case history of a six-year-old girl who underwent endodontic treatment by a non recommended technique. It was decided to perform integral treatment anew, this time with techniques and materials adequate for the restoration and renewal of temporary dentition.

Estudo histológico da regiäo periapical de molares de ratos / Histological study of periapical region of molars of rats

O presente estudo teve o própósito de verificar histologicamente a reaçäo inflamatória pós-pulpectomia em dentes de ratos, quando säo aplicados diferentes corticosteróides isoladamente e em iguais concentraçöes. As seguintes drogas foram testadas: hidrocortisona, prednisolona e dexametasona a 2% em soro fisiológico. os resultados evidenciaram que a utilizaçäo da substância corticosteróide näo acompanhada de um anti-microbiano, levou a necrose pulpar com formaçäo de abcesso periapical e evoluçäo para quadros de osteomielite, sendo possível verificar a presença de colônias bacterianas na regiäo periapical