Gerenciamento de urgências endodônticas: conhecimentos de acadêmicos de odontologia / Management of endodontic emergencies: knowledge of dental students

Objetivo: avaliar do conhecimento dos alunos de odontologia sobre os protocolos de atendimento para as urgências endodônticas. Método: 182 alunos dos últimos anos do curso de Odontologia do Centro Universitário Doutor Leão Sampaio, responderam a um questionário contendo perguntas referente ao protocolo adotado em casos de urgência de origem endodôntica. Os dados foram analisados pelo teste de Qui-quadrado de Pearson (p<0,05). Resultados: foram observadas diferenças entre a conduta relata pelos alunos do quarto e quinto ano de graduação quanto a indicação da incisão para drenagem em abscesso periapical agudo submucoso (evoluído), indicação de antibióticos nos casos de flare-up e indicação de antibióticos na dor com edema póstratamento endodôntico. A prescrição de antibióticos foi excessiva para os casos de dor entre consultas (flareup) e dor no pós-operatória. Para as patologias da polpa, a maioria dos alunos indicou protocolos de urgência recomendados na literatura. Conclusão: os resultados indicam a necessidade de melhoria dos programas de treinamento dos alunos em urgências endodônticas, principalmente quanto aos protocolos farmacológicos. (AU)

Objective: to evaluate the knowledge of dentistry students about care protocols for endodontic emergencies. Method: 182 students from the last years of the Dentistry course at Doctor Leão Sampaio University Center answered a questionnaire containing questions regarding the protocol adopted in urgent cases of endodontic origin. Data were analyzed using Pearson's Chi-square test (p<0.05). Results: differences were observed between the conduct reported by fourth- and fifth-year undergraduate students regarding the indication of incision for drainage in submucosal acute periapical abscess (evolved), indication of antibiotics in cases of flare-up and indication of antibiotics in pain with edema after endodontic treatment. The prescription of antibiotics was excessive for cases of pain between appointments (flare-up) and postoperative pain. For pulp pathologies, most students indicated emergency protocols recommended in the literature. Conclusion: the results indicate the need to improve student training programs in endodontic emergencies, especially regarding pharmacological protocols. (AU)

What ultimately matters in root canal treatment success and tooth preservation: A 25-year cohort study.

AIM: There are currently no prospective studies evaluating the long-term outcomes of non-surgical root canal treatments beyond 5 years, both in terms of treatment success and tooth preservation, and identifying factors predictive of treatment outcome. The aim of the present work was therefore to fill this gap by assessing these outcomes over time and identifying predictive variables based on systematic data collection over a 25-year period. METHODOLOGY: Data concerning the treatments (N = 2500) were systematically collected since 1990. Information was recorded among clinical, technical, radiographic and patient-related characteristics, i.e., approximately 150 variables for each treatment. The data were analysed regarding both treatment success and tooth preservation by multivariable Cox proportional hazards model, and survival curves were generated. The statistical significance level was set at 0.0125. RESULTS: In total, 56.4% of the treatments could be followed over time (0-25 years, mean = 6.5 years, median = 5 years). Survival probability decreased almost linearly for treatment success, with about 85% after 5 years and 60% after 20 years, and for tooth preservation, with about 90% at 5 years and 50% at 20 years. The variables significantly associated with treatment failure were: pre-operative pain (Hazard Ratio-HR = 1.56 [95% CI 1.23-1.97]), persistent pain (HR = 2.63 [95% CI 1.44-4.80]), good operator rating of treatment prognosis (HR = 0.46 [95% CI 0.36-0.58]), size of periapical bone radiolucency (HR = 1.88 [95% CI 1.67-2.11]), and tooth type (p = .0006). For tooth extraction, they were: combined endodontic-periodontal lesion (HR = 3.37 [95% CI 1.88-6.05]), pre-existing complication before treatment (HR = 1.67 [95% CI 1.26-2.21]), good operator rating of treatment prognosis (HR = 0.45 [95% CI 0.33-0.60]), clinical failure of root canal treatment (HR = 2.78 [95% CI 1.98-3.89]) and tooth type (p = .0012). CONCLUSION: Root canal treatment success and tooth preservation on the arch are not static outcomes, but evolve with time. Among a substantial set of potential predictors, only a small proportion was significantly predictive of treatment success and tooth preservation, most of them being disease and patient characteristics, and not technical aspects, except pre-existing complications. These observations challenge the importance frequently given to byzantine considerations related to the numerous technical details of endodontic procedures, as opposed to general concepts of good clinical practice.

Guía clínica para el tratamiento de lesiones endoperiodontales sin compromiso radicular en pacientes periodontales / Clinical practice guide for the treatment of endoperiodontal lesions without root compromise in periodontal patients

La comunicación patológica entre la pulpa y el pe-riodonto se denomina lesión endoperiodontal. Puede presentarse de forma aguda o crónica, y su mani-festación más común es la presencia de un absceso acompañado de dolor. Es importante realizar una detenida evaluación clínica y radiográfica para esta-blecer un correcto diagnóstico y plan de tratamiento. Por este motivo, el objetivo de esta guía es presentar un protocolo consensuado entre las Cátedras de Pe-riodoncia y Endodoncia de la Facultad de Odontología de la Universidad de Buenos Aires (FOUBA), para su tratamiento (AU)

The pathological communication between the pulp and the periodontium is called Endoperiodontal Lesion. It can be presented in an acutely or chronically form and its most common manifestation is the presence of an abscess accompanied by pain. It is important to carry out a careful clinical and radiographic evaluation to establish a correct diagnosis, prognosis, and treatment plan. For this reason, the objective of this guide is to present a consensus protocol between Periodontics and Endodontics Departments of the Faculty of Dentistry of the University of Buenos Aires (FOUBA) for their treatment (AU)

[Progress in the diagnosis and treatment strategies of caries-derived dental pulp diseases].

Caries-derived dental pulp diseases are characterized with high incidence and serious endangerment. Considering the complexity of the pulpal infection and the limitation of the pulp self-repairing capability, it is still an urgent problem that how to eradicate infection and to promote tissue regeneration subsequently for dental clinicians. This review discusses and prospects on the pathogenesis, diagnosis and treatment strategies of caries-derived dental pulp diseases, so as to provid a reference on diagnosis and treatment of such diseases for the clinicians.

Endosoft: herramienta para el aprendizaje de las patologías pulpares y periapicales / Endosoft: a tool for learning from pulp and periapical diseases

Introducción: el empleo de software educativo es una alternativa motivadora en los diferentes escenarios docentes. Objetivo: mostrar la validación del software educativo sobre diagnóstico y tratamiento de enfermedades pulpares y periapicales para su generalización en estudiantes de Estomatología. Material y Métodos: se realizó un estudio de innovación tecnológica o producto terminado digital en la etapa comprendida desde marzo de 2018 a marzo de 2019. Se utilizó la herramienta Mediator v9.0. Se utilizaron métodos teóricos: histórico-lógico, analítico-sintético y el sistémico-estructural; y empíricos: la revisión documental y una encuesta a estudiantes y expertos en función de evaluadores externos del producto. Para evaluar la factibilidad del software se utilizó el método de Criterio de Experto y el Criterio de usuario. Las principales variables evaluadas fueron el diseño de las secciones del software, su funcionalidad, cientificidad del contenido, relación de las imágenes con el objetivo del software, así como su uso en la docencia. Resultados: el producto obtenido consta de un texto básico con hipervínculos para acceder a los demás componentes, así como galerías de imágenes y ejercicios de autoevaluación. Según Criterio de Experto la calidad técnica del producto y la calidad del contenido quedaron evaluadas en la categoría Muy Adecuado. Según Criterio de Usuario, la funcionalidad, la motivación individual y los aspectos de diseño fueron evaluados de Bien. Conclusiones: se desarrolló un software educativo que cuenta con recursos variados para el aprendizaje sobre el tema abordado(AU)

Introduction: The use of the educational software is a motivating alternative in different teaching scenarios. Objective: To validate the educational software related to the diagnosis and treatment of pulp and periapical diseases for its generalization in dental students. Material and Methods: A study linked with technological innovation or digital finished product was conducted during the period between March 2018 and March 2019. The tool used was Mediator v9.0. Theoretical methods such as historical-logical, analytical-synthetic, inductive-deductive, and systemic-structural were used; empirical methods, which included the documentary review and a survey, were applied to students and experts as external evaluators of the product. The methods of Expert Judgment and Customer Judgment were used to evaluate the feasibility of the software. The main variables evaluated were the design of software sections, its functionality, scientific content, relationship between the images and the objective of the software and its use in the teaching-learning process. Results: The product obtained is a basic text with hyperlinks to access the rest of the components, image galleries and self-evaluation exercises. According to Expert Judgment, the technical quality of the software and the quality of its content were evaluated as good. According to Customer Judgment, the functionality, self-motivation and design aspects were evaluated as optimal. Conclusions: An educational software with various resources for learning about the topic approached was developed(AU)

Efeito de análogos de curcumina, irradiados ou não por LED, como agentes antimicrobianos e indutores de proliferação e migração celular / Effect of curcumin analogues, irradiated or not by LED, as antimicrobial agents and inducers of cell proliferation and migration

O tratamento endodôntico de dentes permanentes jovens com infecções pulpares/periapicais antes de completar a rizogênese ainda é um desafio para a Endodontia e a Odontopediatria. Relatos científicos têm mostrado que a curcumina (CUR), um fitoquímico polifenólico, apresenta diversas propriedades terapêuticas, entre as quais, amplo espectro de ação antimicrobiana e a capacidade de induzir a proliferação e migração celular. Além disso, devido à sua capacidade excitatória na presença de luz, a CUR também tem sido utilizada como fotossensibilizante em terapia fotodinâmica associada ao LED (light emitting diode), promovendo aumento dos seus efeitos biológicos. Uma forma de aumentar seu potencial terapêutico e reduzir algumas limitações do uso da CUR é a síntese de análogos a partir de pequenas modificações químicas na estrutura original, entretanto, mantendo sua capacidade fotossensibilizante. O objetivo desse estudo foi avaliar a ação antimicrobiana e antibiofilme de análogos de curcumina sob a influência ou não do LED sobre microrganismos de interesse endodôntico e sua influência sobre a viabilidade, proliferação e migração de fibroblastos da linhagem L-929. Uma série de compostos análogos de CUR (PCR-4 H, PCR-3 OH, PCR-4 OH, PCR-3 OCH3, PCR-4 OCH3, PCR-3 acetil, PCR-4 acetil) foram sintetizados pela metodologia de Pabon. A atividade antimicrobiana da CUR e seus análogos foi determinada pelo ensaio de Concentração Inibitória Mínima (CIM) e Concentração Bactericida Mínima (CBM) sobre Streptococcus mutans, Lactobacillus casei, Actinomyces israelii, Enterococcus faecalis e Fusobacterium nucleatum, sob a ação ou não do LED InGaN (nitreto de gálio e índio, com potência de saída de 100 mW/cm², ponta do LED com área de 0,78 cm², 60 s). A curcumina e seu análogo com melhor efeito antimicrobiano (PCR-3 OH) foi avaliado sobre o biofilme inicial (72h) e maduro (1 semana) dessas espécies em microplacas e sobre biofilmes multiespécies formados em túbulos dentinários por contagem das UFC/mL e por microscopia confocal, respectivamente, sob ação ou não do LED. Também foram avaliados quanto à citotoxicidade e a capacidade de induzir proliferação e migração em fibroblastos, por meio de ensaios de metiltetrazólio, azul de tripan e azul de Coomassie, respectivamente. Os dados foram avaliados estatisticamente (p<0,05). Dos 7 análogos de curcumina sintetizados, PCR-3 OH foi o único composto que apresentou atividade bactericida quando testado sobre as bactérias de interesse endodôntico selecionadas. Seu efeito foi potencializado na presença do LED, variando entre as espécies bacterianas. A curcumina teve efeito bactericida para as espécies S. mutans, A. israelii, L. casei e F. nucleatum, e em algumas delas, foi independente do LED. Ambos os compostos reduziram o crescimento dos biofilmes iniciais ou maduros, independente do LED. Entretanto, quando irradiados, o efeito dos compostos variou de acordo com a espécie bacteriana, sendo que A. israelii e S. mutans foram os mais afetados. Ambos os compostos reduziram significativamente os biofilmes multiespécies quando comparados ao controle sem tratamento, sendo que melhor efeito foi observado para PCR-3 OH. A curcumina foi considerada citocompatível a partir de 0,039µg/mL e PCR-3 OH a partir de 0,019 µg/mL. Houve redução significativa na viabilidade celular quando os compostos foram irradiados com LED nas concentrações 0,039 e 0,019 µg/mL. O LED, dentro dos parâmetros testados, reduziu significativamente a viabilidade, a proliferação e a migração celular, independente do composto ou tempo de exposição. Conclui-se que PCR-3 OH apresentou atividade bactericida e sobre biofilmes simples e multiespécies de bactérias de interesse endodôntico superior à CUR, principalmente sob ação do LED. Entretanto, sua citocompatiblidade foi inferior à da CUR. A presença do LED afetou a viabilidade, proliferação e migração dos fibroblastos, mostrando que os parâmetros utilizados para fins antimicrobianos não foram adequados para aplicação em células eucarióticas(AU)

Endodontic treatment of young permanent teeth with pulp / periapical infections before completing rhizogenesis is still a challenge for Endodontics and Pediatric Dentistry. Scientific reports have shown that curcumin (CUR), a polyphenolic phytochemical, has several therapeutic properties, including a broad spectrum of antimicrobial action and the ability to induce cell proliferation and migration. In addition, due to its excitatory capacity in the presence of light, CUR has also been used as a photosensitizer in photodynamic therapy associated with LED (light emitting diode), promoting an increase in its biological effects. One way to increase its therapeutic potential and reduce some limitations of the use of CUR is the synthesis of analogues from small chemical modifications in the original structure, however, maintaining its photosensitizing capacity. The aim of this study was to evaluate the antimicrobial and antibiofilm action of curcumin analogues under the influence or not of LED on microorganisms of endodontic interest and their influence on the viability, proliferation and migration of L-929 fibroblasts. A series of CUR analog compounds (PCR-4 H, PCR-3 OH, PCR-4 OH, PCR-3 OCH3, PCR-4 OCH3, PCR-3 acetyl, PCR-4 acetyl) were synthesized by Pabon's methodology. The antimicrobial activity of CUR and its analogs was determined by the Minimum Concentration Inhibitory (CIM) and Minimum Bactericidal Concentration (CBM) assay on Streptococcus mutans, Lactobacillus casei, Actinomyces israelii, Enterococcus faecalis and Fusobacterium nucleatum, with or without the InGaN LED (gallium and indium nitride, with output power of 100 mW / cm², LED tip with an area of 0.78 cm², 60 sec). Curcumin and its analog with the best antimicrobial effect (PCR-3 OH) were evaluated on the initial (72h) and mature (1 week) biofilm of these species in microplates and on multispecies biofilms formed in dentinal tubules by counting CFU / mL and by confocal microscopy, respectively, under the action or not of the LED. They were also evaluated for cytotoxicity and the ability to induce proliferation and migration in fibroblasts, using methyltetrazolium, trypan blue and Coomassie blue assays, respectively. The data were evaluated statistically (p <0.05). Of the 7 curcumin analogues synthesized, PCR-3 OH was the only compound that showed bactericidal activity when tested on selected bacteria of endodontic interest. Its effect was enhanced in the presence of LED, varying between bacterial species. Curcumin had a bactericidal effect for the species S. mutans, A. israelii, L. casei and F. nucleatum, and in some of them, it was independent of the LED. Both compounds reduced the growth of the initial or mature biofilms, regardless of the LED. However, when irradiated, the effect of the compounds varied according to the bacterial species, with A. israelii and S. mutans being the most affected. Both compounds significantly reduced multispecies biofilms when compared to the untreated control, with the best effect being observed for PCR-3 OH. Curcumin was considered cytocompatible from 0.039 µg / mL and PCR-3 OH from 0.019 µg / mL. There was a significant reduction in cell viability when the compounds were irradiated with LED at concentrations of 0.039 and 0.019 µg / mL. The LED, within the parameters tested, significantly reduced cell viability, proliferation and migration, regardless of the compound or time of exposure. It is concluded that PCR-3 OH showed bactericidal activity and on simple and multispecies biofilms of bacteria of endodontic interest superior to CUR, mainly under the action of LED. However, its cytocompatibility was lower than that of the CUR. The presence of the LED affected the viability, proliferation and migration of fibroblasts, showing that the parameters used for antimicrobial purposes were not suitable for application in eukariotic cells(AU)

Fotoativação mobiliza pericitos e células de origem neural no reparo da polpa dentária / Photoactivation mobilizes pericytes and cells of neural origin in the repair of dental pulp

Introdução: O laser tem se mostrado capaz de fotoativar células-tronco endógenas induzindo sua diferenciação em múltiplos tecidos, além de modular processos inflamatórios e imunes em microambientes injuriados. Essa terapia é hoje chamada de terapia por fotobiomodulação (PBM) ou simplesmente fotoativação. Células da glia e pericitos - células perivasculares -, por sua vez, têm sido sugeridas como as principais células de reparo da polpa dentária. No entanto, os efeitos da PBM sobre essas células nunca foram explorados utilizando técnicas elegantes (state-of-art) de rastreamento, as quais poderiam prover informações relevantes sobre as interações do laser com os componentes celulares marcados. Objetivos: Este estudo visou verificar a capacidade estimuladora da PBM na mobilização de pericitos e células de origem neural no reparo da polpa dentária após injúria tecidual in vivo. Para isso, foi utilizado um modelo murino(NG2-DsRed/Nestin-GFP) com transgene para pericitos (NG2) e células neurais indiferenciadas (Nestina). Métodos: As polpas dentárias dos primeiros molares superiores dos camundongos (n =12) foram expostas utilizando broca #1190F e lima K #20. O grupo PBM (n = 6) foi tratado imediatamente, 24h, 48h e 72h após a injúria com laser de diodo (InGaAlP; 660nm; 20mW; 5J/cm2; 0,71 W/cm2; 7s; modo contínuo e em contato) e o outro grupo foi mantido como controle(n = 6) sem qualquer tratamento. No 4º dia, os animais foram eutanasiados e os efeitos da aplicação da PBM sobre a mobilização dos pericitos e no reparo da polpa dentária foram verificados por microscopia confocal e por análises histológicas (H&E e azul de toluidina). Polpas dentárias saudáveis foram utilizadas como parâmetro de normalidade (n = 6). Os dados foram analisados pelo teste de ANOVA seguido pelo post-hoc de Tukey (¿ = 0,05). Resultados: A terapia promoveu a mobilização significativa de pericitos e células indiferenciadas nos cornos pulpares coronários contíguos à região injuriada em relação ao controle (p<0,05). Além disso a PBM mostrou intensa proliferação de capilares terminais nos dentes fotoativados (p<0,05), enquanto manteve sinais de vitalidade pulpar nos terços coronários adjacentes à injúria. Embora não identificados na polpa dentária em nenhum grupo estudado, mastócitos puderam ser observados intactos ou degranulados nos tecidos orais moles adjacentes ao dente fotoativado (p<0,05). Conclusão: A PBM estimulou a a neoformação da microvasculatura tecidual local e contribuiu para o influxo de células potentes para a região injuriada. A PBM pode ser considerada uma terapia adjuvante promissora em tratamentos endodônticos regenerativos da polpa dentária.

Introduction: Laser light has proven to be capable of photoactivate endogenous stem cells inducing their differentiation into multiple tissues, in addition to modulating inflammatoryand immune processes in injured microenvironments. This therapy is now called photobiomodulation therapy (PBM). Glial cells and pericytes ­ the perivascular cells ­ have been identified as the true stem cells of our body. However, the effects of PBM on these cells have never been explored using elegant (state-of-art) tracking techniques, which could providerelevant information about the laser's interactions with these labeled cellular components. Objectives: The goal of this study is to verify the stimulating capacity of PBM in the mobilization of pericytes and other endogenous cells in the repair of the dental pulp upon tissueinjury in vivo using a murine model (NG2-DsRed/Nestin-GFP) with transgenes for pericytes (NG2) and undifferentiated cells (Nestin). Methods: The dental pulps of the animals' first upper molars (n = 12) were exposed using drill 3195 and K#20 file. The PBM group (n = 6) was treated for 3 consecutive days with a diode laser (InGalP; 660nm; 20mW; 5J/cm2 ; 0.71 W/cm2 ;7s; continuous and in contact) and the other group was maintained as control (n = 6) without any treatment. On the 4 th day, the animals were euthanized and the effects of the application ofPBM on the mobilization of pericytes and on the dental pulp repair were verified by confocal microscopy and histological analysis (H&E and toluidine blue), respectively. Healthy dental pulps were used as a normality parameter (n = 6). The data were analyzed by the ANOVA testfollowed by the Tukey's poshoc (α = 0.05). Results: PBM showed an intense proliferation of terminal capillaries in the photoactivated teeth (p<0.05), while signs of pup vitality were observed in the coronal thirds adjacent to the injury site. In addition, the therapy promoted significant mobilization of pericytes and undifferentiated cells in the coronary pulp horns contiguous to the injury concerning the control group (p<0.05). Mast cells could not be identified in the dental pulp of any of the studied groups but could be seen mostly degranulated in the smooth tissues adjacent to the mesial root of the teeth of the photoactivated group (p<0.05). Conclusion: PBM stimulates the pulp tissue microvasculature neoformation and contributes to the influx of potent cells into the injured site. PBM may be a promise adjunct tool in regenerative endodontic procedures of the pulp tissue

[Clinical management and prognosis evaluation of pulp regeneration therapy].

Pulp regeneration in a tooth with pulp necrosis is the research hotspot in current clinical treatment of endodontic diseases. Up to now, the revascularization therapy, which is one of the regenerative endodontic treatment, and the most extensive and effective method in clinical practice, can partially achieve the goal of pulp regeneration and root development in young permanent immature teeth. In order to standardize the technique and improve the curative effect, this atticle discusses the indications, pre-treatment preparation, treatment procedure and the rapeutic evaluation of pulp revascularization therapy.

Phages in a thermoreversible sustained-release formulation targeting E. faecalis in vitro and in vivo.

INTRODUCTION: Enterococcus faecalis is a key pathogen recovered from root canals when conventional treatment fails. Phage therapy has generated new interest in combating pathogens. A sustained-release formulation using specific phages against E. faecalis may offer an alternative approach. OBJECTIVES: To evaluate the efficacy of anti-E. faecalis phages formulated in a thermo- sustained-release system against E. faecalis in vitro and in vivo. METHODS: EFDG1 and EFLK1 phages were formulated with poloxamer P407. Gelation time, phage survival, activity and toxicity were evaluated. Lytic activity was evaluated in vitro against E. faecalis at various growth phases, including anti-biofilm activity. Methods included viable bacterial count (CFU/mL), biofilm biomass determination and electron microscopy (live/dead staining). Further evaluation included infected incisors in an in vivo rat model. Anti-E. faecalis phage-cocktail suspension and sustained-release phage formulation were evaluated by viable bacterial count (CFU/mL), histology, scanning electron microscopy (SEM) and 16S genome sequencing of the microbiota of the root canal. RESULTS: Gelation time for clinical use was established. Low toxicity and a high phage survival rate were recorded. Sustained-release phages reduced E. faecalis in logarithmic (4 logs), stationary (3 logs) and biofilm (4 logs) growth phases. Prolonged anti-biofilm activity of 88% and 95% reduction in biomass and viable counts, respectively, was recorded. Reduction of intracanal viable bacterial counts was observed (99% of enterococci) also seen in SEM. Phage treatment increased Proteobacteria and decreased Firmicutes. Histology showed reduced periapical inflammation and improved healing following phage treatment. CONCLUSION: Poloxamer P407 formulated with phages has an effective and long-lasting effect in vitro and in vivo targeting E. faecalis.

Dentist-related factors influencing the use of vital pulp therapy: a survey among dental practitioners in China.

OBJECTIVE: To evaluate dentist-related factors associated with the use of vital pulp therapy (VPT) for the treatment of pulp exposures in permanent teeth. METHODS: This survey-based study sent an online questionnaire to collect data on the demographics of the respondents, the use of VPT and the choice of materials for VPT, to all members of the Society of Endodontology of Guangdong, China. RESULTS: A total 183 of 380 members responded (48.2%). The majority (89.6%; 164 of 183) had performed direct pulp capping (DPC) while 55.2% (101 of 183) had performed partial pulpotomy (PP) at least once. The most-cited reason for not performing VPT was unfamiliarity with the technique. Mineral trioxide aggregate was the most commonly used material for both DPC (67.1%; 110 of 164) and PP (73.3%; 74 of 101). Endodontists, compared with general practitioners, preferred to perform DPC and chose calcium silicate materials (CSMs) for VPT (odds ratios 5.81 and 8.07, respectively). DPC and CSMs for VPT were also favoured more by respondents who had practised for > 5 years. Senior respondents were more likely to use PP. CONCLUSIONS: Speciality, years of practise and age of dentists influenced the decision making and the choice of materials for VPT. Continuing education is essential to promote the clinical use of VPT.

In-office and walking bleach dental treatments on endodontically-treated teeth: 25 years follow-up.

BACKGROUND: Many techniques have been evolved for the purpose of managing discoloured non-vital tooth such as dental bleaching, restorative and prosthetic treatment. In order to achieve better control on the patients, in-office and intra-coronal bleaching procedures were introduced in clinical practice. Such techniques usually use higher whitening agent concentrations activated by means of heat or light sources, resulting in improved color stability in the long term. The aim of this study was to evaluate the color stability, after 25 years, of endodontically-treated teeth subjected to in-office and walking bleach dental treatments with carbamide peroxide. METHODS: A population of patients with a single endodontic treatment on an incisor teeth was recruited. All the teeth selected for the study were subjected to both in-office intra-coronal dental bleaching and walking bleach technique with 10% carbamide peroxide gel. The patients were recalled at follow-up every 12 months for a total observational period of 25 years. RESULTS: After 25 years of clinical service on 40 patients, an optimal tooth color stability in relation to adjacent teeth was evidenced in 34 patients, while 6 patients were classified as failures, since a color mismatch of two or more shades were noticed. Consequently, a success rate of 85% was reported after 25 years. CONCLUSIONS: Ten percent carbamide peroxide proved to be an effective dental whitening agent in the long-term for endodontically-treated.

O impacto da patência apical para o sucesso do tratamento endodôntico: uma revisão de literatura / The impact of apical patency for the success of endodontical treatment: a review of the literature

Objetivo: analisar a importância da realização da patência apical durante o preparo químico-mecânico do sistema de canais radiculares, enfatizando os prós e contras do procedimento. Materiais e método: foi realizada uma busca na base de dados PubMed e na Biblioteca Virtual em Saúde sobre o tema patência apical no contexto da terapia endodôntica. Foram incluídos nesta revisão 30 artigos, publicados no período de 1974 a 2018. Revisão de literatura: a patência apical consiste na limpeza passiva do canal cementário sem ampliação da constrição apical, realizada com instrumentos finos e flexíveis, a fim de manter o forame apical livre de raspas de dentina, remanescentes pulpares e microrganismos. Tal manobra é indicada para dentes com necrose pulpar. Contudo, em dentes com polpa necrótica sem lesão perirradicular, em que há possibilidade de vitalidade do coto pulpar, ou em casos de biopulpectomia, esse procedimento não tem sido bem aceito, devido à preservação da vitalidade do coto pulpar ser muito importante para o reparo periapical. Considerações finais: a etapa correspondente ao preparo químico-mecânico é de extrema importância para se ter êxito na intervenção endodôntica. Durante o preparo dos canais radiculares, o acúmulo de debris dentinários no terço apical pode gerar perda no comprimento de trabalho. Dessa forma, a patência apical impede que essa dentina seja compactada nesta porção do canal, o que favorece modelagem, desinfecção, irrigação e, posteriormente, obturação adequada dessa importante região do sistema de canais radiculares. (AU)

during the chemical-mechanical preparation of the root canal system, emphasizing the pros and cons of this procedure. Materials and method: a search in the literature for relevant articles on the topic apical patency in the context of endodontic therapy was carried out by consulting the databases of PubMed and the Virtual Health Library. A total of 30 articles, published between 1974 and 2018, were selected for inclusion in this literature review. Literature review: the apical patency consisted of passive cleaning of the cementum canal without enlargement of the apical constriction, performed with thin and flexible instruments, in order to maintain the apical foramen free of dentin scrapings, remaining pulp and microorganisms. This maneuver is indicated for teeth with pulp necrosis. However, in teeth with necrotic pulp without periradicular lesion, in which there is possibility of vitality of the pulp stump, or cases of biopulpectomy, this procedure has not been well accepted, due to the preservation of the vitality of the pulp stump being very important for the periapical repair. Final considerations: the stage corresponding to the chemical-mechanical preparation is extremely important to succeed in endodontic intervention. During the preparation of the root canals, the accumulation of dentinal debris in the apical third can cause loss of working length. Thus, the apical patency prevents this dentin from being compacted in this portion of the canal, which favors the modeling, disinfection, irrigation and subsequent filling of this important region of the root canal system. (AU)

Pulp therapy for primary and immature permanent teeth: an overview.

Pulp therapy for pediatric patients aims to alleviate pulpal infection, relieve associated symptoms, and, ultimately, preserve the tooth. Primary teeth adequately retain space for their successors and have been described as "the best space maintainers." Therefore, the decision to extract a primary tooth should take into consideration occlusal growth and development as well as the potential outcome of pulp therapy. Maintaining pulpal vitality in young permanent teeth is essential for continued root formation; if vitality is lost, the root will cease growth and remain at an unfavorable length. A systematic approach to diagnosis and treatment planning is imperative, and a good history of signs and symptoms and a detailed evaluation of radiographs are prerequisites to accurate diagnosis. The purpose of this review is to aid dental professionals in correctly establishing a pulpal diagnosis and selecting the appropriate method of pulp therapy to achieve a successful outcome. The article discusses contemporary views on indications and pulp medicaments and presents step-by-step descriptions of pulp treatments for both primary and immature permanent teeth.

Root perforations: a review of diagnosis, prognosis and materials.

Root perforation results in the communication between root canal walls and periodontal space (external tooth surface). It is commonly caused by an operative procedural accident or pathological alteration (such as extensive dental caries, and external or internal inflammatory root resorption). Different factors may predispose to this communication, such as the presence of pulp stones, calcification, resorptions, tooth malposition (unusual inclination in the arch, tipping or rotation), an extra-coronal restoration or intracanal posts. The diagnosis of dental pulp and/or periapical tissue previous to root perforation is an important predictor of prognosis (including such issues as clinically healthy pulp, inflamed or infected pulp, primary or secondary infection, and presence or absence of intracanal post). Clinical and imaging exams are necessary to identify root perforation. Cone-beam computed tomography constitutes an important resource for the diagnosis and prognosis of this clinical condition. Clinical factors influencing the prognosis and healing of root perforations include its treatment timeline, extent and location. A small root perforation, sealed immediately and apical to the crest bone and epithelial attachment, presents with a better prognosis. The three most widely recommended materials to seal root perforations have been calcium hydroxide, mineral trioxide aggregate and calcium silicate cements. This review aimed to discuss contemporary therapeutic alternatives to treat root canal perforations. Accordingly, the essential aspects for repairing this deleterious tissue injury will be addressed, including its diagnosis, prognosis, and a discussion about the materials actually suggested to seal root canal perforation.

Crown Reduction and Vital Pulp Therapy in a Dog With Malocclusion.

Crown reduction and vital pulp therapy is an accepted treatment for abnormal occlusion resulting in palatal trauma caused by malpositioned mandibular canine teeth in dogs and cats. This article describes use of mineral trioxide aggregate for vital pulp therapy after crown reduction. A list of materials and commonly used equipment is provided.

[Role of the operating microscope in diagnosis and treatment of endodontic diseases].

The excellent magnification and illumination of the operating microscope not only helps to improve the quality of conventional root canal therapy, but also plays an important role in the diagnosis and treatment of the difficult cases of endodontic diseases. It has an irreplaceable position over other equipment especially for the treatment of root canal therapy complications and the apical surgery. The structure and operation of the operating microscope are relatively complicated. The proficiency of the dentist may influence the evaluation of its clinical application effect. Based on the review of literature and author's clinical experience, this paper evaluates the role of operating microscope in the diagnosis and treatment of endodontic diseases.

[Clinical management of the intentional tooth replantation].

Intentional tooth replantation is the last resort for saving natural teeth in treatment of the endodontic diseases. In order to promote the utilization, standardize the operation and improve the success rate of this treatment, this review suggests the indication, discusses the key points of the surgical procedure, proposes the path of the diagnosis and the treatment protocol of the intentional replantation.

Impact of Case Difficulty on Endodontic Mishaps in an Undergraduate Student Clinic.

INTRODUCTION: The aim of this study was to identify the effect of case difficulty on the number of endodontic mishaps and the number of treatment visits using 2 different instrumentation methods, hand files, and reciprocating engine-driven WaveOne files (Dentsply Maillefer, Ballaigues, Switzerland) in an undergraduate student clinic. METHODS: Endodontic treatment performed by fourth-year dental students using 2 different instrumentation methods was evaluated: hand files and reciprocating engine-driven WaveOne files. All cases were categorized according to the American Association of Endodontists case difficulty assessment form. Endodontic mishaps related to instrumentation and treatment visits needed to complete the treatment were recorded. RESULTS: Of the 257 teeth included in the study, 141 were instrumented with hand files and 116 with WaveOne files. Eighty-two teeth (31.9%) were registered with at least 1 endodontic mishap. The most frequent endodontic mishap was overinstrumentation (17.5%). This was followed by loss of working length (8.56%), obturation more than 2 mm from the radiographic apex (8.56%), overfill with gutta-percha (6.61%), canal transportation (4.28%), instrument separation (2.33%), and lateral or strip perforation (1.56%). Several endodontic mishaps were significantly correlated. Cases in the high difficulty category had significantly more endodontic mishaps (P < .001) and required more treatment visits (P < .01). There were no significant differences in endodontic mishaps or the number of treatment visits between the hand and engine-driven groups. Several endodontic mishaps were associated with significantly more treatment visits (P < .05). CONCLUSIONS: Case difficulty rather than the instrumentation method was the main determinant of endodontic mishaps in the undergraduate clinic. The American Association of Endodontists case difficulty assessment form is an important and valuable tool in undergraduate dental education to predict potential endodontic mishaps and the number of treatment visits.

A clinicoradiographic comparison of the effects of platelet-rich fibrin gel and platelet-rich fibrin membrane as scaffolds in the apexification treatment of young permanent teeth.

AIMS: This triple blinded clinical trial was undertaken to check whether Platelet rich firin in its membrane form is as reliable as when it is in the gel form. SETTINGS AND DESIGN: Triple blinded randomized clinical trial. METHODS AND MATERIAL: 20 patients in PRF gel group and 20 patients in PRF membrane group selected after randomization and considering inclusion and exclusion criteria were taken up for this study. The samples were clinically and radiographically evaluated for success. RESULTS AND CONCLUSIONS: Regenerative endodontics with PRF membrane is easier and less time consuming. They have similar clinical success.PRF gel gave a better radiographic success in 12 months period.