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1.
BMC Oral Health ; 20(1): 111, 2020 04 16.
Artigo em Inglês | MEDLINE | ID: mdl-32299409

RESUMO

BACKGROUND: Evaluate the fracture resistance of endodontically treated teeth after cervical preflaring and root canal preparation and to assess the volume of the root canal and the amount of remaining root dentin before and after cervical preflaring. METHODS: Forty-four mandibular incisors were selected using micro-CT scanning and distributed into 4 groups (n = 11) according to the instrument used for cervical preflaring: control group - no cervical preflaring; Gates Glidden - burs size #2 and #3; WXN - 25.07 Navigator instrument; and Easy - 25.08 ProDesign S instrument. Coronal opening was performed, and the canals were prepared with Wave One Gold Primary and filled with an epoxy-resin based sealer and gutta-percha cones. Micro-CT scans were performed before and after root canal instrumentation. All images were reconstructed and assessed for the thickness of mesial and distal root dentin at 3 mm and 5 mm from the cement -enamel junction and for the volume of cervical portion of the canal after preparation. Fracture resistance test was performed applying compressive loads at a crosshead speed of 0.5 mm/min, applied on the palatal aspect of specimens at 135° along the long axis of the tooth. The data were analyzed using ANOVA and Tukey's test (P = .05). RESULTS: Cervical preflaring and canal preparation reduced the dentin thickness (P < .05) and increased the canal volume (P < .05) in all groups at 3 mm an 5 mm. Cervical preflaring with Gates Gliden burs reduced the fracture resistance of endodontically treated teeth (P < .05). CONCLUSIONS: All instruments reduced the dentin thickness and increased the canal volume in the cervical at 3 mm and 5 mm. Gates Glidden reduced fracture resistance of mandibular incisors submitted to cervical preflaring, whereas NiTi instruments did not. CLINICAL RELEVANCE: Cervical preflaring assumes particular importance previously to the root canal preparation because it minimizes the occurrence of operative accidents, and permits more accurate determination of working length and the apical diameter.


Assuntos
Cavidade Pulpar/patologia , Guta-Percha/uso terapêutico , Materiais Restauradores do Canal Radicular/uso terapêutico , Preparo de Canal Radicular/instrumentação , Dente não Vital/fisiopatologia , Resinas Epóxi/uso terapêutico , Humanos , Preparo de Canal Radicular/métodos , Fraturas dos Dentes , Dente não Vital/diagnóstico por imagem
2.
J Appl Oral Sci ; 28: e20190544, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32348440

RESUMO

Objective To evaluate the influence of three levels of dental structure loss on stress distribution and bite load in root canal-treated young molar teeth that were filled with bulk-fill resin composite, using finite element analysis (FEA) to predict clinical failure. Methodology Three first mandibular molars with extensive caries lesions were selected in teenager patients. The habitual occlusion bite force was measured using gnathodynamometer before and after endodontic/restoration procedures. The recorded bite forces were used as input for patient-specific FEA models, generated from cone-beam computed tomographic (CT) scans of the teeth before and after treatment. Loads were simulated using the contact loading of the antagonist molars selected based on the CT scans and clinical evaluation. Pre and post treatment bite forces (N) in the 3 patients were 30.1/136.6, 34.3/133.4, and 47.9/124.1. Results Bite force increased 260% (from 36.7±11.6 to 131.9±17.8 N) after endodontic and direct restoration. Before endodontic intervention, the stress concentration was located in coronal tooth structure; after rehabilitation, the stresses were located in root dentin, regardless of the level of tooth structure loss. The bite force used on molar teeth after pulp removal during endodontic treatment resulted in high stress concentrations in weakened tooth areas and at the furcation. Conclusion Extensive caries negatively affected the bite force. After pulp removal and endodontic treatment, stress and strain concentrations were higher in the weakened dental structure. Root canal treatment associated with direct resin composite restorative procedure could restore the stress-strain conditions in permanent young molar teeth.


Assuntos
Força de Mordida , Resinas Compostas/química , Resinas Compostas/uso terapêutico , Restauração Dentária Permanente/métodos , Dente Molar , Dente não Vital/terapia , Criança , Força Compressiva , Tomografia Computadorizada de Feixe Cônico , Análise do Estresse Dentário , Módulo de Elasticidade , Análise de Elementos Finitos , Humanos , Modelagem Computacional Específica para o Paciente , Valores de Referência , Reprodutibilidade dos Testes , Resistência à Tração , Dente não Vital/diagnóstico por imagem , Resultado do Tratamento
3.
J Endod ; 46(1): 34-39.e1, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31733814

RESUMO

INTRODUCTION: Untreated root canals may have a direct impact on the prognosis of root canal treatment. The objective of this cross-sectional study was to evaluate the association of missed canals with periapical lesions in endodontically treated teeth. METHODS: One thousand one hundred sixty preexisting cone-beam computed tomographic scans from 8 different health centers were assessed between January 2018 and December 2018 by 5 independently calibrated observers. Two thousand three hundred five endodontically treated teeth were identified in a sample of 20,836 teeth (27,046 roots). All endodontically treated teeth were evaluated for the presence or absence of missed root canals and periapical lesions. The z test for proportions was used to analyze differences between groups, and an odds ratio was calculated in order to analyze the association between missed canals and lesions. P < .05 was considered statistically significant. RESULTS: The prevalence of missed canals was 12.0%, and teeth with untreated canals were associated with periapical pathology in 82.6% of the cases. The root presenting with the highest percentage of missed canals (62.8%) was the mesiobuccal root of the maxillary first molar, being associated with periapical lesions in 75.2% of cases. Maxillary molar mesiobuccal roots presenting with a missed canal were 3.1 times more likely to be associated with periapical pathology than maxillary molars with all canals identified and treated. CONCLUSIONS: The association between untreated root canals and the presence of periapical lesions noted in the present study shows that missed canals have a significant impact on treatment prognosis.


Assuntos
Cavidade Pulpar , Periodontite Periapical , Dente não Vital , Tomografia Computadorizada de Feixe Cônico , Estudos Transversais , Humanos , Prevalência , Raiz Dentária , Dente não Vital/diagnóstico por imagem
4.
J Endod ; 46(2): 264-270, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31812360

RESUMO

INTRODUCTION: The aim of this study was to assess 2 cone-beam computed tomographic systems on the detection of artificially induced vertical root fractures (VRFs) and artifact intensity using birooted teeth restored with different intracanal materials. METHODS: The sample consisted of 20 extracted birooted premolars. Root fracture was induced in half of the sample. Seven intracanal material combinations were used in each tooth, 1 at a time: unrestored, gutta-percha, a buccal root with gutta-percha and a lingual root with a fiberglass post, a buccal root with gutta-percha and a lingual root with a metal core fiberglass post, fiberglass posts, metal core fiberglass posts, and NiCr posts. Cone-beam computed tomographic scans were acquired using CS 9000 3D (Carestream Dental Rochester, NY) and OP300 (Instrumentarium Dental Inc, Tuusula, Finland) units. Exposure parameters were fixed at 90 kV and 8 mA. The voxel size and field of view were set at 0.085 mm and 5 × 5 cm for OP300 and 0.076 mm and 5 × 3.75 cm for CS 9000, respectively. Two observers assessed all images using a 5-point confidence scale for VRF detection and a 4-point score for artifact interference. The sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve were compared using 2-way analysis of variance and the Tukey test (α = 0.05). Artifact interference was evaluated by descriptive statistics and the chi-square test. RESULTS: There were significant differences between scanners (P > .05) and among the different intracanal material groups (OP300) (P < .05) for specificity. When a metal post was present in both roots, severe artifact interference was observed in all images. CONCLUSIONS: CS 9000 3D presented better performance than OP300 on VRF detection of endodontically treated teeth. Unrestored teeth and teeth filled with fiberglass posts were considered the groups with the lowest artifact interference and the highest VRF detection results.


Assuntos
Tomografia Computadorizada de Feixe Cônico , Fraturas dos Dentes , Dente não Vital , Finlândia , Guta-Percha , Humanos , Fraturas dos Dentes/diagnóstico por imagem , Raiz Dentária/diagnóstico por imagem , Dente não Vital/diagnóstico por imagem
5.
Clin Oral Investig ; 24(4): 1551-1560, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31414272

RESUMO

OBJECTIVE: To assess the impact of various local pathologies on facial alveolar bone dimensions at tooth sites. MATERIALS AND METHODS: Cone-beam computed tomography images of 60 patients were analyzed. Healthy teeth and teeth with local pathologies (i.e., endodontically treated, periodontally diseased teeth, and teeth with periapical lesions) were included. The thickness of the facial alveolar bone was measured at five locations: (1) the bone crest (W0), (2) 25% (W25), (3) 50% (W50), (4) 75% (W75) of the distance from the bone crest to the root apex (A), and (5) in the A region (W100). The results were considered statistically significant at p < 0.0008 (adjustment according to the statistical correction for multiple testing). RESULTS: A total of 1174 teeth (707 healthy and 467 with the local pathologies) were assessed. Periodontally diseased maxillary premolars and anterior teeth in the mandible in the W0 position, as well as maxillary molars in the W25 position, tended to have a lower facial bone thickness when compared to the healthy teeth (0.68 mm vs. 0.84 mm, p = 0.008; 0.47 mm vs. 0.55 mm, p = 0.004; and 1.27 mm vs. 1.72 mm; p = 0.009, respectively). In contrast, the observed tendency pointed towards thicker facial bone wall for the periodontally diseased mandibular anterior teeth in the W50 position (0.74 vs. 0.52, p = 0.001). Healthy maxillary molars tended to display a thicker facial alveolar bone compared to the teeth with local pathologies in the W25, W50, and W75 positions (p = 0.001, p = 0.005, and p = 0.004, respectively). CONCLUSIONS: The present analysis has indicated that local pathologies are commonly associated with a compromised socket morphology. CLINICAL RELEVANCE: The facial bone thickness was particularly reduced at periodontally diseased teeth, which may challenge implant therapy.


Assuntos
Processo Alveolar/diagnóstico por imagem , Tomografia Computadorizada de Feixe Cônico , Dente não Vital/diagnóstico por imagem , Dente/diagnóstico por imagem , Humanos , Maxila , Doenças Periapicais , Doenças Periodontais , Estudos Retrospectivos
6.
Acta Odontol Scand ; 78(2): 81-86, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31322454

RESUMO

Objective: The tooth weakens due to removal of hard tissue during an endodontic procedure. Many dentists find it difficult to choose between different coronal restorations after root canal treatment (RCT). Studies show that the coronal restoration may affect the endodontic prognosis. This student-based study had three aims. (1) Examine the choice of coronal restoration of endodontically treated teeth at a Scandinavian dental school, (2) examine the survival of these restorations and (3) evaluate the influence of the coronal restoration on the outcome of the RCT. Material and methods: Radiographic and clinical examination was performed on 127 posterior teeth. The quality of the root canal treatment and the periapical status (PAI-index) were evaluated. Results: 43.8% of the teeth were restored with an indirect coronal restoration and 47.2% with a direct coronal restoration. The period from finished root canal treatment until placement of a permanent coronal restoration was significantly longer for an indirect restoration than a direct restoration. The teeth treated with a PAI score of 1 and 2 following pulpectomy, necrotic pulp treatment and endodontic retreatment was 93.8%, 82.6% and 69.4%, respectively.Conclusion: There was no significant association between choice of coronal restoration and PAI-score.


Assuntos
Restauração Dentária Permanente , Doenças Periapicais/etiologia , Tratamento do Canal Radicular , Dente não Vital/terapia , Distribuição de Qui-Quadrado , Humanos , Estudos Retrospectivos , Dente , Dente não Vital/diagnóstico por imagem , Resultado do Tratamento
7.
J. appl. oral sci ; 28: e20190544, 2020. tab, graf
Artigo em Inglês | LILACS, BBO - Odontologia | ID: biblio-1101250

RESUMO

Abstract Objective To evaluate the influence of three levels of dental structure loss on stress distribution and bite load in root canal-treated young molar teeth that were filled with bulk-fill resin composite, using finite element analysis (FEA) to predict clinical failure. Methodology Three first mandibular molars with extensive caries lesions were selected in teenager patients. The habitual occlusion bite force was measured using gnathodynamometer before and after endodontic/restoration procedures. The recorded bite forces were used as input for patient-specific FEA models, generated from cone-beam computed tomographic (CT) scans of the teeth before and after treatment. Loads were simulated using the contact loading of the antagonist molars selected based on the CT scans and clinical evaluation. Pre and post treatment bite forces (N) in the 3 patients were 30.1/136.6, 34.3/133.4, and 47.9/124.1. Results Bite force increased 260% (from 36.7±11.6 to 131.9±17.8 N) after endodontic and direct restoration. Before endodontic intervention, the stress concentration was located in coronal tooth structure; after rehabilitation, the stresses were located in root dentin, regardless of the level of tooth structure loss. The bite force used on molar teeth after pulp removal during endodontic treatment resulted in high stress concentrations in weakened tooth areas and at the furcation. Conclusion Extensive caries negatively affected the bite force. After pulp removal and endodontic treatment, stress and strain concentrations were higher in the weakened dental structure. Root canal treatment associated with direct resin composite restorative procedure could restore the stress-strain conditions in permanent young molar teeth.


Assuntos
Humanos , Criança , Força de Mordida , Resinas Compostas/química , Dente não Vital/terapia , Restauração Dentária Permanente/métodos , Dente Molar , Valores de Referência , Resistência à Tração , Reprodutibilidade dos Testes , Resultado do Tratamento , Resinas Compostas/uso terapêutico , Dente não Vital/diagnóstico por imagem , Força Compressiva , Análise de Elementos Finitos , Análise do Estresse Dentário , Tomografia Computadorizada de Feixe Cônico , Módulo de Elasticidade , Modelagem Computacional Específica para o Paciente
8.
J Endod ; 45(12): 1479-1488, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31630784

RESUMO

INTRODUCTION: This retrospective cross-sectional study investigated the applicability of the periapical and endodontic status scale (PESS) to determine the association of endodontically treated teeth with maxillary sinus (MS) abnormalities through cone-beam computed tomographic imaging. METHODS: A total of 631 endodontically treated teeth were analyzed. MS abnormalities were classified as mucosal thickening, sinus polyp, antral pseudocyst, nonspecific opacification, periostitis, and antral calcification. The PESS was used to evaluate the quality of endodontic treatment as well as periapical tissue conditions. The data were analyzed by chi-square tests (P < .05). RESULTS: MS abnormalities were detected in 70.52% of the sample, with a greater prevalence of mucosal thickening (38.19%), whereas periapical lesions were observed in 55.94% of the cases. Treated root canals with unsatisfactory filling, homogeneity, and coronal sealing had an odds Ratio (OR) of 2.21, 2.88, and 2.99, respectively (P < .001). Periapical lesions larger than 5 mm (OR = 314.95), in more than 1 root (OR = 3.72), involving the furcation region (OR = 5.21), in contact with important structures (OR = 7.37), and with cortical bone destruction (OR = 4.09) were significantly related to the presence of MS abnormalities (P < .001). An OR of 99,668 was observed in periostitis lesions greater than 5 mm (P < .001). CONCLUSIONS: The PESS proved to be an important tool for the analysis of endodontic and periapical conditions and was applicable to determine potential associations with MS abnormalities.


Assuntos
Tomografia Computadorizada de Feixe Cônico , Periodontite Periapical , Dente não Vital , Estudos Transversais , Implantes Dentários , Humanos , Seio Maxilar , Periodontite Periapical/diagnóstico , Periodontite Periapical/terapia , Estudos Retrospectivos , Dente não Vital/diagnóstico por imagem
9.
Rev. Asoc. Odontol. Argent ; 107(2): 42-48, abr.-jun. 2019. ilus, tab
Artigo em Espanhol | LILACS | ID: biblio-1015526

RESUMO

Objetivo: Evaluar radiográficamente, en dientes extraídos, el grado de homogeneidad y adaptación de las obturaciones endodónticas realizadas por alumnos de grado, comparando las técnicas de condensación lateral e híbrida. Materiales y métodos: Entre 2003 y 2017, los alumnos de tercer año de la Escuela de Odontología de la Universidad del Salvador / Asociación Odontológica Argentina realizaron 5.384 tratamientos endodónticos ex vivo empleando, para la obturación, las técnicas de condensación lateral e híbrida. En las radiografías posoperatorias, un docente especialista en endodoncia evaluó la homogeneidad y la adaptación de cada obturación para categorizarla como correcta o incorrecta. Para la comparación entre técnicas, dentro de cada año lectivo, se utilizó la prueba exacta de Fisher, y para el análisis porcentual de las observaciones, la prueba de Chi cuadrado. El nivel de significancia fue establecido en P<0,05. Resultados: Del total de 5.384 tratamientos, 4.970 (92,3%) mostraron obturaciones correctas. Con la técnica de condensación lateral, de los 1.741 tratamientos, 1.560 (89,6%) mostraron obturaciones correctas con la técnica híbrida, de los 3.643 tratamientos, 3.410 (93,6%) tuvieron obturaciones correctas. En función del tamaño total de las muestras, sumando todos los años, puede estimarse con 95% de confianza que la diferencia de obturaciones incorrectas entre ambas técnicas está entre el 2,3% y el 5,7%. Con la prueba del Chi cuadrado, se observa una diferencia significativa de obturaciones correctas a favor de la técnica híbrida (P<0,01) Conclusiones: La evaluación radiográfica de los tratamientos endodónticos realizados ex vivo por alumnos de pregrado mostró un alto porcentaje de obturaciones correctas. Así mismo, el empleo de la técnica híbrida dio, en general, mejores resultados de compactación de la masa del material obturador que la técnica de condensación lateral (AU)


Aim: To evaluate radiographically the degree of homogeneity and adaptation of endodontic obturations completed by undergraduate students in extracted teeth using lateral and hybrid condensation techniques. Materials and methods: Between 2003 and 2017, third year students of a the School of Dentistry of the Universidad del Salvador / Asociación Odontológica Argentina performed 5384 ex vivo endodontic treatments using lateral condensation and hybrid technique. In the postoperative radiographs, a specialist in endodontics assessed the homogeneity and adaptation of each obturation and categorize it as correct or incorrect. The data were submitted to statistical analysis to compare results obtained with the two techniques. Fisher and Chi-square tests were used and significance level was set at P<0.05. Results: Out of 5384 treatments, 4970 (92.3%) showed correct obturation. Within the 1741 treatments completed with the lateral condensation technique, 1560 (89.6%) were correct while within the 3634 where a hybrid technique was used, 3410 (93.6%) were correct. When the whole sample was considered (sum of treatment carried out during each of the academic years) a statistically significant difference (P<0.01) favoring the hybrid technique was found. The difference in incorrect cases can be estimated to be between 2.3% and 5.7% with 95% confidence. Conclusions: The radiographic evaluation completed by undergraduate students in extracted teeth showed a high percentage of correct fillings. The use of the hybrid technique showed, in general, better compaction of the obturation material than the lateral condensation technique (AU)


Assuntos
Humanos , Obturação do Canal Radicular/métodos , Tratamento do Canal Radicular/métodos , Tratamento do Canal Radicular/estatística & dados numéricos , Dente não Vital/diagnóstico por imagem , Educação Pré-Odontológica , Argentina , Análise Estatística , Adaptação Marginal Dentária
10.
J Endod ; 45(2): 136-143, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30711168

RESUMO

INTRODUCTION: Histologic examination of teeth after regenerative endodontic treatment (RET) shows that the type, quality, and quantity of tissues formed in the root canal space are not predictable. The aim of this study was to examine clinically, radiographically, and histologically the outcome of RET in immature noninfected human teeth using SynOss Putty (Collagen Matrix Inc, Oakland, NJ) as a scaffold. METHODS: Three pairs of maxillary/mandibular first premolars in 3 patients scheduled for extraction were included. Sensibility tests confirmed the presence of vital pulps. After informed consent, anesthesia, and rubber dam isolation, the pulps were removed. RET was performed using the following scaffolds: SynOss Putty + blood in both teeth in patient #1, SynOss Putty with or without blood in patient #2, and SynOss Putty + blood or blood only in patient #3. After a follow-up period of 2.5-7.5 months, the teeth were clinically and radiographically evaluated, extracted, and examined histologically. RESULTS: Patients remained asymptomatic after treatment. Radiographic examination of the teeth showed signs of root development after treatment. In teeth treated with SynOss Putty + blood, histologic examination showed formation of intracanal mineralized tissue around the scaffold particles solidifying with newly formed cementumlike tissue on the dentinal walls. The tooth treated with SynOss Putty without blood showed the formation of a periapical lesion. The tooth treated with a blood clot only showed tissues of periodontal origin growing into the root canal space. CONCLUSIONS: SynOss Putty + blood showed a predictable pattern of tissue formation and mineralization when used as a scaffold for RET in human immature noninfected teeth. The newly formed mineralized tissue solidifies with newly formed cementum on the dentinal walls.


Assuntos
Colágeno , Cavidade Pulpar/fisiologia , Dentina/fisiologia , Durapatita , Regeneração Tecidual Guiada Periodontal/métodos , Radiografia Dentária , Regeneração , Endodontia Regenerativa/métodos , Tecidos Suporte , Raiz Dentária/fisiologia , Dente não Vital/diagnóstico por imagem , Dente não Vital/patologia , Criança , Cavidade Pulpar/diagnóstico por imagem , Dentina/diagnóstico por imagem , Feminino , Humanos , Masculino , Raiz Dentária/diagnóstico por imagem , Dente não Vital/fisiopatologia , Resultado do Tratamento
11.
J Endod ; 45(2): 209-213.e2, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30711180

RESUMO

INTRODUCTION: This study quantitatively evaluated the type and amount of image artifacts generated by different intracanal materials in birooted teeth scanned at different exposure parameters. METHODS: The sample consisted of 15 birooted premolars. Seven different intracanal material combinations were used in each tooth one at a time: (1) roots without intracanal materials, (2) roots with gutta-percha, (3) a buccal root with gutta-percha and a lingual root with a fiberglass post, (4) a buccal root with gutta-percha and a lingual root with a metal core fiberglass post, (5) buccal and lingual roots with fiberglass posts, (6) buccal and lingual roots with metal core fiberglass posts, and (7) buccal and lingual roots with NiCr metal posts. Cone-beam computed tomographic scans were acquired using a CS 9000 unit (Carestream Dental, Atlanta, GA). An image of each tooth was captured under 5 exposure parameters: 2.5, 4, 6.3, 8, and 12 mA. The voxel size, field of view, and tube voltage were fixed at 0.076 mm, 5 × 3.75 cm, and 75 kV. We assessed each artifact quantitatively using ImageJ's threshold tool (National Institutes of Health, Bethesda, MD) to determine the hypodense and hyperdense artifact areas within 8-bit images extracted from the scans. All analyses were conducted with a 95% confidence level (α <0.05). RESULTS: The inferential analysis showed that roots filled with metal posts presented the highest amount of hypodense and hyperdense artifacts, whereas fiberglass post in both roots presented fewer artifacts. All materials presented more hypodense than hyperdense artifact formation. Overall, the low-exposure settings presented fewer artifacts and higher values of preserved dental images. CONCLUSIONS: Low-exposure protocols and fiberglass posts presented fewer image artifacts in CBCT scans.


Assuntos
Artefatos , Dente Pré-Molar/diagnóstico por imagem , Tomografia Computadorizada de Feixe Cônico , Vidro , Materiais Restauradores do Canal Radicular , Raiz Dentária/diagnóstico por imagem , Dente não Vital/diagnóstico por imagem , Guta-Percha , Humanos
12.
Clin Oral Investig ; 23(5): 2371-2381, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30302609

RESUMO

OBJECTIVE: To evaluate the feasibility of synchrotron-based phase-contrast (PC) µCT for visualization of the gaps and differentiation between the gaps, restorative, and endodontic materials at the tooth-restoration interface. MATERIALS AND METHODS: Standardized access cavities were prepared in human maxillary molars and subjected to materials, simulating endodontic treatment: (1) saline irrigation; (2) NaOCl and 17% EDTA irrigation; (3) same as group 2, followed by application of Ca(OH)2; and (4) same as group 2, followed by application of root canal sealer. The access cavities were cleaned and restored using an etch-and-rinse adhesive and a composite material in multilayering technique. The samples were thermocycled (1000 cycles, 5-55 °C). Synchrotron-based µCT imaging was performed obtaining absorption and PC µCT images before and after the immersion of the samples into 50% AgNO3. PC µCT images were compared to absorption µCT and conventional optical microscopy images. RESULTS: PC µCT of unstained samples enabled the best visualization of gaps and differentiation of restorative and endodontic materials, contaminating the cavity surface. PC µCT revealed that AgNO3 staining leads to an overestimation of gap size due to anterograde and retrograde AgNO3 infiltration into dentinal tubules and underestimation of large gaps due to lack of AgNO3 penetration. CONCLUSION: Synchrotron PC µCT imaging enables better visualization of gap and differentiation of materials at the tooth-restoration interface. µCT imaging with AgNO3 staining has shown certain over- and underestimations. Future research should be aimed at incorporating PC µCT imaging of unstained samples for the validation of results obtained with other methods. CLINICAL SIGNIFICANCE: Contamination of cavity walls with an endodontic sealer or Ca(OH)2 leads to increased gap formation at the tooth-restoration interface.


Assuntos
Cárie Dentária/terapia , Reparação de Restauração Dentária , Materiais Restauradores do Canal Radicular , Dente não Vital/diagnóstico por imagem , Microtomografia por Raio-X , Resinas Compostas , Corrosão Dentária , Dentina , Adesivos Dentinários , Humanos , Técnicas In Vitro , Dente Molar/diagnóstico por imagem , Síncrotrons
13.
Endodoncia (Madr.) ; 36(3): 8-21, dic. 2018. ilus
Artigo em Espanhol | IBECS | ID: ibc-178382

RESUMO

La Tomografía Computarizada de Haz Cónico (TCHC) (Cone Beam Computed Tomography - CBCT) es un método de imagen que nos ofrece en Endodoncia unas ventajas relevantes sobre la radiografía periapical y otras técnicas radiográficas a la hora de establecer un diagnóstico y plan de tratamiento adecuados. Debemos tener en cuenta, no obstante, que no se debe hacer de manera rutinaria y que no todos los aparatos ni todas las modalidades (campo de adquisición y resolución espacial) están indicadas para su uso en el campo de la endodoncia. Debemos tener un conocimiento técnico mínimo de las cualidades físicas de esta tecnología, para poder realizar una adquisición de datos que sea correcta en cuanto a la radiación del paciente (la menor posible), y en cuanto a la resolución espacial (la mayor posible) para la tarea diagnóstica que vamos a realizar. Repasaremos las indicaciones de uso de el CBCT en endodoncia, el porqué de sus indicaciones y casos clínicos que demuestran la relevancia de la utilización de esta tecnología en Endodoncia


No disponible


Assuntos
Humanos , Dente não Vital/diagnóstico por imagem , Tomografia Computadorizada de Feixe Cônico/métodos , Endodontia/métodos , Doenças Periapicais/diagnóstico por imagem , Tecido Periapical/diagnóstico por imagem
14.
Endodoncia (Madr.) ; 36(3): 32-42, dic. 2018. ilus
Artigo em Espanhol | IBECS | ID: ibc-178384

RESUMO

La evaluación radiográfica y las pruebas diagnósticas son de vital importancia para realizar un adecuado plan de tratamiento en endodoncia. En el campo de la endodoncia, tradicionalmente se han utilizado diferentes pruebas como la palpación, la percusión, las pruebas de sensibilidad pulpar y las radiografías periapicales (RP). Hasta la actualidad las RP (convencionales o digitales) han sido un complemento indispensable para realizar el tratamiento endodóntico, así como para determinar el éxito de dicho tratamiento. Sin embargo, está demostrado que las RP presentan ciertas limitaciones como superposiciones de estructuras anatómicas, la visión en dos dimensiones (2D) y la distorsión geométrica. Las imágenes obtenidas mediante RP ofrecen solamente datos de la dimensión mesio-distal, lo que dificulta la detección de cierta información como: la anatomía radicular, la presencia de alteraciones alrededor de las raíces, la pérdida ósea, los diferentes tipos de reabsorciones radiculares, las fracturas radiculares y otros aspectos importantes en la planificación de una cirugía apical. A través de la imágenes obtenidas a partir de la tomografía computarizada de haz cónico (TCHC), en inglés llamada cone-beam computed tomography (CBCT), se puede obtener una mayor información diagnóstica en comparación a las RP preoperatorias; información que influye directamente en el plan de tratamiento del clínico, especialmente en los casos de dificultad alta. Por todo a ello, en este artículo se presentan diferentes situaciones clínicas en las que la CBCT juega un papel fundamental en relación al plan de tratamiento endodóncico


No disponible


Assuntos
Humanos , Dente não Vital/diagnóstico por imagem , Dente não Vital/terapia , Tomografia Computadorizada de Feixe Cônico/métodos , Abscesso Periapical/diagnóstico por imagem , Reabsorção Óssea/diagnóstico por imagem , Reabsorção de Dente/diagnóstico por imagem , Traumatismos Dentários/diagnóstico por imagem , Doenças Periapicais/diagnóstico por imagem , Tecido Periapical/diagnóstico por imagem
15.
J Endod ; 44(11): 1665-1670, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30409447

RESUMO

INTRODUCTION: The outcomes of an immature tooth with necrotic pulp treated with regenerative endodontic procedures (REPs) were assessed clinically and radiographically. Root maturation is an important outcome of REPs, and several radiographic measurement methods have been used to measure this. The aim of this study was to compare radiographic measurement methods, measuring root maturation in immature teeth with necrotic pulp treated with REPs. METHODS: Seventy-one radiographic images of REP cases were measured and compared using 3 radiographic measurement methods described by Bose et al (2009), Alobaid et al (2014), and Flake et al (2014). The intraclass correlation coefficient values were evaluated using the intra- and interobserver reliability test and the effect of the stage of root development. RESULTS: The intra- and interobserver reliability for Alobaid et al's method and Flake et al's method were slightly higher than Bose et al's method as quantified by the intraclass correlation coefficient without a significant difference (P > .05). The stage of root development did not affect the reliability of the measurement methods. A high level of agreement was found among the 3 stages of root development for all 3 quantitative radiographic measurement methods. CONCLUSIONS: All 3 quantitative radiographic measurement methods exhibited high agreement regarding reliability. The stage of root development did not have an impact on the reliability of the measurement methods.


Assuntos
Radiografia Dentária/métodos , Endodontia Regenerativa/métodos , Raiz Dentária/diagnóstico por imagem , Raiz Dentária/crescimento & desenvolvimento , Dente não Vital/diagnóstico por imagem , Necrose da Polpa Dentária/terapia , Humanos , Reprodutibilidade dos Testes
16.
Clin Implant Dent Relat Res ; 20(5): 763-769, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30086197

RESUMO

BACKGROUND: Elevation of the schneiderian membrane, during maxillary sinus floor augmentation (MSFA) may theoretically result in devitalization of adjacent teeth, which are in a close spatial relationship to the sinus floor. PURPOSE: To assess retrospectively the probability of devitalization of teeth adjacent to the osteotomy site after MSFA in a relatively large number of patients. MATERIALS AND METHODS: All MSFA procedures, performed at a university oral surgery clinic within a time period of 10 years, were assessed on the following eligibility criteria: (1) presence of vital teeth (ie, not root canal treated and no periapical radiolucency on a panoramic radiograph taken just after MSFA), (2) presence of a 3 to 12 months postoperative radiograph of the teeth adjacent to the osteotomy site displaying the root apices, and (3) complete medical records up to at least 12 months postoperatively. The radiographs of the different time points were compared and any changes in the radiographic status of the adjacent teeth (eg, development of a periapical lesion, root canal treatment, etc.) were recorded and the spatial relationship of the adjacent teeth to the maxillary sinus classified. RESULTS: Out of 684 MSFAs, 257 fulfilled the inclusion criteria and involved 357 adjacent teeth, of which 221 presented close to and/or intimate relationship to the sinus. In only a single case, tooth vitality might have been lost due to the procedure. Thus, the probability for tooth devitalization for teeth with close to and/or intimate spatial relationship to the sinus floor ranged from 0.45% to 0.7%. CONCLUSIONS: Even for teeth with apices very close to and/or intimately related to the sinus tooth devitalization after MSFA is an extremely rare complication; that is, the probability of tooth devitalization after MSFA is ≤0.7%.


Assuntos
Levantamento do Assoalho do Seio Maxilar/efeitos adversos , Dente não Vital/etiologia , Feminino , Humanos , Masculino , Maxila/cirurgia , Pessoa de Meia-Idade , Radiografia Dentária , Radiografia Panorâmica , Estudos Retrospectivos , Dente não Vital/diagnóstico por imagem
17.
J Endod ; 44(10): 1500-1508, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30154006

RESUMO

INTRODUCTION: This study aimed to evaluate the diagnostic accuracy of panoramic radiography (PAN) for the detection of clinically/surgically confirmed apical periodontitis (AP) in root canal-treated teeth using cone-beam computed tomographic (CBCT) imaging as the reference standard. METHODS: Two hundred forty patients with endodontically treated AP (diseased group) were detected via CBCT imaging using the periapical index system. They were divided into groups of 20 each according to lesion size (2-4.5 mm and 4.6-7 mm) and anatomic area (incisor, canine/premolar, and molar) in both the upper and lower arches. Another 240 patients with root filling and a healthy periapex (healthy group) were selected. All diseased and healthy patients underwent PAN first and a CBCT scan within 40 days. The periapical index system was also used to assess AP using PAN. Sensitivity, specificity, diagnostic accuracy, positive predictive value, and negative predictive value for PAN images with respect to CBCT imaging were analyzed. The k value was calculated to assess both the interobserver reliability for PAN and the agreement between PAN and CBCT. RESULTS: PAN showed low sensitivity (48.8), mediocre negative predictive value (64.7), good diagnostic accuracy (71.3), and high positive predictive value (88.6) and specificity (93.8). Both interobserver reliability for PAN and agreement between PAN and CBCT were moderate (k = 0.58 and 0.42, respectively). The best identified AP was located in the lower canine/premolar and molar areas, whereas the worst identified AP was located in the upper/lower incisor area and upper molar area. CONCLUSIONS: PAN showed good diagnostic accuracy, high specificity, and low sensitivity for the detection of endodontically treated AP.


Assuntos
Tomografia Computadorizada de Feixe Cônico/métodos , Periodontite Periapical/diagnóstico por imagem , Periodontite Periapical/cirurgia , Radiografia Dentária/métodos , Radiografia Panorâmica/métodos , Tratamento do Canal Radicular , Dente não Vital/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Adulto Jovem
18.
J Endod ; 44(10): 1517-1525, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30144988

RESUMO

INTRODUCTION: A regenerative endodontic procedure (REP) is a biologically based treatment to functionally replace the pulp of infected immature permanent teeth. The purpose of this retrospective case series was to assess the outcome of REPs of infected immature permanent teeth in terms of periapical bone healing (PBH), root development (RD), and pulp vitality. METHODS: Five patients (1 tooth/patient) who had undergone a REP based on the cell homing concept were recalled 3, 6, 12, 24, and 36 months postoperatively. At each recall session, clinical and periapical radiographic (PR) investigations were performed. Cone-beam computed tomographic (CBCT) imaging was taken before and 36 months after REPs. Qualitative and quantitative PR assessments were performed on the teeth that underwent REPs. Quantitative CBCT analyses were performed on the teeth that underwent REP and contralateral teeth. RESULTS: At each recall session, all teeth were asymptomatic but reacted negatively on carbon dioxide snow and electrical pulp testing. All teeth that underwent a REP showed complete PBH and further RD on PR and CBCT assessments when comparing the baseline with the final recall radiographs. CBCT analyses indicated increases in root hard tissue volume and RL for all teeth that underwent a REP, but they were 5 and 3 times less, respectively, than the contralateral teeth. The postoperative CBCT images presented bone ingrowth inside the root canal, calcification, or nonuniform RD. CONCLUSIONS: Thirty-six months after the REPs (based on the cell homing concept), this RCS resulted radiographically and clinically in functional and asymptomatic teeth with complete PBH and continued reparative RD. CBCT quantitative measurements and qualitative root development observations are more reliable and accurate than PR analysis.


Assuntos
Tomografia Computadorizada de Feixe Cônico , Imageamento Tridimensional , Radiografia Dentária , Endodontia Regenerativa/métodos , Dente não Vital/diagnóstico por imagem , Dente não Vital/fisiopatologia , Criança , Polpa Dentária/fisiologia , Feminino , Humanos , Masculino , Estudos Retrospectivos , Ápice Dentário/fisiologia , Raiz Dentária/crescimento & desenvolvimento , Resultado do Tratamento
19.
BMC Oral Health ; 18(1): 121, 2018 07 06.
Artigo em Inglês | MEDLINE | ID: mdl-29980211

RESUMO

BACKGROUND: The aim of this study was to evaluate the relationship between Endodontic Access Cavity (EAC) types with MB2 canal detection ratio in the upper first molars. METHODS: A total of 60 roots of extracted human maxillary first molars were selected. All teeth were prepared with Point EAC (PEAC), Conservative EAC (CEAC) and Traditional EAC (TEAC) respectively. After each group were completed, extra canal was searched. Preoperative and postoperative tooth weigh was calculated using precise scale. McNemar's chi-square test and a paired test significant difference were used for statistical analyses. RESULTS: The EAC types statistically were changed of tooth tissue loss quantity (p = 0.000). MB2 detection rate of CEAC (%53,3) and TEAC (%60) are higher than statistically that of PEAC (%31.6) (p < 0.05). 8 teeth MB2 canal was detected only with the CBCT images. CONCLUSIONS: In upper molars, CEAC seems reasonable in terms of detected the MB2 canal and removed hard tissue.


Assuntos
Cavidade Pulpar/cirurgia , Tratamento do Canal Radicular/métodos , Dente não Vital/cirurgia , Tomografia Computadorizada de Feixe Cônico , Cavidade Pulpar/diagnóstico por imagem , Humanos , Dente Molar/diagnóstico por imagem , Dente Molar/cirurgia , Radiografia Dentária , Preparo de Canal Radicular/métodos , Dente não Vital/diagnóstico por imagem
20.
J Endod ; 44(7): 1179-1185, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29866407

RESUMO

INTRODUCTION: Endodontically treated teeth have an increased risk of biomechanical failure because of significant loss of tooth structure. The biomechanical behavior of endodontically treated teeth restored was evaluated using different extensions of endocrowns inside the pulp chamber by in vitro and 3-dimensional finite element analysis (FEA). METHODS: Thirty mandibular human molars were endodontically treated. Standardized endocrown preparations were performed, and the teeth were randomly divided into 3 groups (n = 10) according to different endocrown extensions inside the pulp chamber: G-5 mm, a 5-mm extension; G-3 mm, a 3-mm extension; and G-1 mm, a 1-mm extension. After adhesive cementation, all specimens were subjected to thermocycling and dynamic loading. The survival specimens were subjected to fracture resistance testing at a crosshead speed of 1 mm/min in a universal testing machine. All fractured specimens were subjected to fractography. Data were analyzed by 1-way analysis of variance and the Tukey post hoc test (P < .05). Stress distribution patterns in each group were analyzed using FEA. Qualitative analyses were performed according to the von Mises criterion. RESULTS: After dynamic loading, a survival rate of 100% was observed in all groups. For static loading, statistically significant differences among the groups were observed (P < .05) (G-5 mm = 2008.61 N, G-3 mm = 1795.41 N, and G-1 mm = 1268.12 N). Fractography showed a higher frequency of compression curls for G-5 mm and G-3 mm than for G-1 mm. FEA explained the results of fracture strength testing and fractography. CONCLUSIONS: Greater extension of endocrowns inside the pulp chamber provided better mechanical performance.


Assuntos
Coroas , Cimentação/métodos , Coroas/efeitos adversos , Planejamento de Prótese Dentária , Falha de Restauração Dentária , Restauração Dentária Permanente/efeitos adversos , Restauração Dentária Permanente/métodos , Análise do Estresse Dentário , Análise de Elementos Finitos , Humanos , Técnicas In Vitro , Dente Molar/cirurgia , Dente não Vital/diagnóstico por imagem , Microtomografia por Raio-X
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