Influência da presença e do tipo de retentor intrarradicular no comportamento em fadiga de incisivos centrais restaurados com coroas totais / Influence of the presence and type of post-and-core on the fatigue behavior of crowned central incisors

Este estudo avalia a influência da presença e tipo de pinos e núcleos na sobrevivência à fadiga de incisivos centrais restaurados com coroas totais. As coroas de 69 incisivos bovinos foram cortadas e as raízes tratadas endodonticamente. As raízes foram distribuídas aleatoriamente em três grupos (n = 23): núcleo de resina composta (NRC), núcleo de resina composta retido por pino de fibra de vidro (PFV) e núcleo metálico fundido (NMF). Todos receberam preparo de coroa total com férula de 2 mm, e então, uma coroa de cerâmica reforçada com leucita foi adesivamente cimentada. Três amostras de cada grupo foram testadas para determinação da carga máxima até a falha. As amostras restantes foram carregadas pelo teste acelerado de fadiga stepwise stress até a fratura ou suspensão após o término de 1,5 x 106 ciclos. A carga e o degrau em que cada espécime falhou foram analisadas pela estatística de Kaplan-Meier e Mantel-Cox (Log Rank test), seguidas por comparação múltipla aos pares, com nível de significância de 5%. O modo de falha foi analisado com estéreomicrocópio. Não houve diferença estatística entre os tratamentos quanto à carga (Mantel-Cox Log-Rank test for trend, X2=0,015, df=1, p=0,901), nem para o número de ciclos (Mantel-Cox Log-Rank test for trend, X2 =3,171, df=1, p=0,995). O modo de falha predominante foi a trinca da coroa. Fratura obliqua da raiz só foi observado nos grupos retidos por pinos. Nos incisivos tratados endodonticamente com férula de 2 mm, a presença e o tipo de pino e núcleo não influenciaram na sobrevida em fadiga. Fraturas não restauráveis ocorreram somente em dentes restaurados com pinos(AU)

This study evaluates the influence of presence and type of post-and-core systems on fatigue survival of non-vital central incisors restored with all-ceramic crowns. The crowns of 69 bovine incisors were cut and endodontically treated. The roots were randomly assigned into three groups (n=23): composite resin build-up (NRC), glass fiber post-retained-composite build-up (PFV) and cast post-and-core (NMF). All specimens received crown preparation with a 2 mm ferrule, and then a leucite-reinforced ceramic crown was adhesively cemented. Three samples from each group were tested for the determination of the maximum load to failure. The remaining samples were loaded by the accelerated fatigue stepwise stress test until fracture or suspension after the end of 1.5 x 106 cycles. The load and the step on which each specimen failed were analyzed by the Kaplan-Meier and Mantel-Cox (Log Rank test) statistics, followed by multiple paired comparisons, with a significance level of 5%. The failure mode was analyzed with stereomicroscope. There was no statistically significant difference between the treatments (Mantel-Cox Log-Rank test for trend, X2=0.015, df=1, p=0.901), nor for the number of cycles (Mantel-Cox Log-Rank test for trend, X2=3.171, df=1, p=0.995). The predominant failure mode was the crown crack. Oblique root fracture was observed only in groups retained by posts. The presence and type of post system did not influence the fatigue survival of the endodontically treated incisors with a 2 mm ferrule. Non-restorable fractures only occurred on teeth restored with post(AU)

Fracture resistance of endodontically treated teeth restored with ceramic inlays and different base materials.

This study evaluated the fracture resistance of endodontically treated teeth restored with different base materials and mesioocclusal-distal (MOD) ceramic inlays. Fifty mandibular molars were assigned into five groups (n=10 per group). Group1 (control) comprised intact molar teeth without any treatment. Teeth in other groups were subjected to root canal treatment and restored with MOD ceramic inlays on different base materials. In Group 2, base material was zinc phosphate cement; Group 3's was glass ionomer cement; Group 4's was composite resin, and Group 5's was composite resin reinforced with fiber. Finally, a continuous occlusal load was applied until fracture occurred. Mean fracture resistance of Group 1 (3,027 N) was significantly higher than the other groups (890, 1,070, 1,670, 1,226 N respectively). Fracture resistance of Group 4 was statistically comparable with Group 5 and significantly higher than Groups 2 and 3 (p<0.05; Tukey's HSD). Use of different base materials under ceramic inlay restorations could affect the fracture resistance of endodontically treated teeth.

Scaffolds to control inflammation and facilitate dental pulp regeneration.

In dentistry, the maintenance of a vital dental pulp is of paramount importance because teeth devitalized by root canal treatment may become more brittle and prone to structural failure over time. Advanced carious lesions can irreversibly damage the dental pulp by propagating a sustained inflammatory response throughout the tissue. Although the inflammatory response initially drives tissue repair, sustained inflammation has an enormously destructive effect on the vital pulp, eventually leading to total necrosis of the tissue and necessitating its removal. The implications of tooth devitalization have driven significant interest in the development of bioactive materials that facilitate the regeneration of damaged pulp tissues by harnessing the capacity of the dental pulp for self-repair. In considering the process by which pulpitis drives tissue destruction, it is clear that an important step in supporting the regeneration of pulpal tissues is the attenuation of inflammation. Macrophages, key mediators of the immune response, may play a critical role in the resolution of pulpitis because of their ability to switch to a proresolution phenotype. This process can be driven by the resolvins, a family of molecules derived from fatty acids that show great promise as therapeutic agents. In this review, we outline the importance of preserving the capacity of the dental pulp to self-repair through the rapid attenuation of inflammation. Potential treatment modalities, such as shifting macrophages to a proresolving phenotype with resolvins are described, and a range of materials known to support the regeneration of dental pulp are presented.

Pulp vitality in patients with intraoral and oropharyngeal malignant tumors undergoing radiation therapy assessed by pulse oximetry.

INTRODUCTION: The aim of this study was to evaluate pulp oxygenation levels (%SpO(2)) in patients with malignant intraoral and oropharyngeal tumors treated by radiotherapy (RT). METHODS: Pulp oxygenation levels were measured by pulse oximetry. Twenty patients were selected, and two teeth of each participant (n = 40) were analyzed, regardless of the quadrant and the area irradiated, at four different time points: TP1, before RT; TP2, at the beginning of RT with radiation doses between 30 and 35 Gy; TP3, at the end of RT with radiation doses between 60 and 70 Gy; and TP4, 4 to 5 months after the beginning of cancer treatment. RESULTS: Mean %SpO(2) at the different time points were 93% (TP1), 83% (TP2), 77% (TP3), and 85% (TP4). The Student's t test showed statistically significant differences between TP1 and TP2 (P < .01), TP3 (P < .01), and TP4 (P < .01). TP3 was also statistically significantly different when compared with TP2 (P < .01) and TP4 (P < .01). No statistically significant difference could be observed between TP2 and TP4. CONCLUSIONS: Because the mean %SpO(2) before RT was greater than during and after therapy and values obtained 4 to 5 months after the beginning of RT were close to the initiation of RT, pulp tissue may be able to regain normal blood flow after RT. If the changes in the microcirculation of the dental pulp were indeed transitory, preventive endodontic treatment or extraction in patients who are currently undergoing or recently received RT and who show negative signs of pulp sensitivity may not be necessary for pulpal reasons.

The use of MTA in the modern management of teeth affected by dens invaginatus.

Dens invaginatus is a dental anomaly that can result in loss of tooth vitality and the need for root canal treatment. The pulpal morphology of these teeth can be complex which makes successful root canal treatment difficult to achieve. To maintain vitality attempts have been made to prophylactically treat these teeth by sealing the invagination with a variety of materials. This paper describes the use of mineral trioxide aggregate (MTA) in both the prophylactic treatment of teeth with minor invaginations and the incorporation of MTA in the final obturation of non-vital teeth with invaginations with grossly atypical morphology.

Dens evaginatus from an orthodontic perspective: report of several clinical cases and review of the literature.

The anomaly of dens evaginatus manifests itself as an innocuous-looking tubercle of enamel on the occlusal surface of a premolar tooth. Problems can arise when the tubercle is either worn, ground, or fractured off, resulting in pulpal exposure and possible loss of vitality of the tooth. Orthodontists should be particularly aware of this dental anomaly, which occurs in at least 2% of the Asian and Native Indian population. Premolar extraction cases should be planned to include extraction of the anomalous premolars instead of the normal ones. In addition, the orthodontist should be wary of occlusal changes during treatment or occlusal equilibration that might jeopardize the vitality of teeth with dens evaginatus. Pulp-capping or partial pulpotomy has been postulated as the most reliable form of treatment to prevent loss of vitality of the affected teeth and to allow continued root maturation where necessary.