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1.
J Med Life ; 14(1): 81-85, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33767790

RESUMO

This study aims to determine whether the design of resin posts reinforced with glass fiber (FRC) and Reporfost (Angelus, Londrina, PR, Brazil) significantly improves the fracture resistance of endodontically treated teeth restored through this method.A batch of 30 maxillary monoradicular teeth (15 central incisors, 15 canines) were treated endodontically by step-back technique (apical enlargement 40-K file) sealed with Sealapex (Kerr Corporation, Orange, US) and gutta-percha by lateral condensation, cold. They were divided into two equal groups, prepared for cementing the FRC posts. The Exacto posts (Angelus, Londrina, PR, Brazil) in group 1 and the Reforpost posts (Angelus; Londrina; PR, Brazil) were cemented with dual cure resin cement Breeze Self-Adhesive Resin Cement (Pentron Clinical, Orange, US). Fracture resistance testing was performed on the crown-apical axial direction, using the Hounsfield / Tinius Olsen H1-KS, PA, USA mechanical testing apparatus. The behavior of each tooth-post assembly was recorded as a graph. The statistical analysis was done using one way ANOVA (α=0.05). The differences between the Exacto post group and the Reforpost post group are not statistically significant (p = 0.466). The maximum force recorded was 970 N and the minimum 186N. The mean force at which the fracture occurred was approximately 500N for both groups. The strain test showed that modifying the Reforpost post design did not improve the fracture resistance parameters of the tooth-post assembly through increasing the surface friction or maintaining adhesion to the walls of the root dentin.


Assuntos
Resinas Compostas/uso terapêutico , Vidro/química , Técnica para Retentor Intrarradicular , Fraturas dos Dentes/terapia , Dente não Vital/terapia , Humanos , Teste de Materiais , Estresse Mecânico
2.
Ned Tijdschr Tandheelkd ; 128(1): 29-40, 2021 Jan.
Artigo em Holandês | MEDLINE | ID: mdl-33449054

RESUMO

There aren't any generally accepted guidelines for the restoration of an endodontically treated tooth. With a questionnaire among dental general practitioners and endodontists, several restorative treatment options for endodontically treated molars and premolars were identified. The questionnaire inventoried the influence of various parameters on treatment preferences. For each case, additional questions were put about material choice, cuspal coverage and the use of root canal posts. Both groups identified the vertical root fracture as the most common reason for extraction. The dentist general practitioner waited longer than the endodontist to make a permanent restoration in the case of apical periodontitis. Treatment preferences were found to be the same for premolars and molars. In the case of premolars, a root canal post was indicated more often and the location of the wall (bearing/non-bearing) influenced the choice of cuspal coverage. Of the dentist general practitioners and endodontists, 51-53% and 75-94%, respectively, preferred a partial over a full crown preparation in the case of single-walled teeth.


Assuntos
Restauração Dentária Permanente , Dente não Vital , Dente Pré-Molar , Resinas Compostas , Humanos , Dente Molar , Dente não Vital/terapia
3.
J Prosthet Dent ; 124(4): 485.e1-485.e10, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32522363

RESUMO

STATEMENT OF PROBLEM: Crown-lengthening procedures (CLPs) and orthodontic eruption procedures (OEPs) improve the biomechanical properties of residual root restoration. However, their use is limited by clinic time, cost, and crown-root ratio. An inner shoulder retention form (ISRF) overcomes these limits; however, whether ISRF meets the biomechanical requirements is unclear. PURPOSE: The purpose of this in vitro and finite element analysis (FEA) study was to evaluate the effects of 3 residual root treatments (ISRF, CLP, and OEP) on premolar fracture resistance and stress distribution after post-and-core restoration. MATERIAL AND METHODS: Thirty-two extracted mandibular second premolars were screened and randomly divided into 4 groups (n=8): a 2-mm ferrule restoration group (NPR2; control group) and 3 experimental groups (0.5×0.5-mm ISRF [ISRF0.5], 2-mm CLP [CLP2], and 2-mm OEP [OEP2]). After removal of the crown, endodontic treatment, and embedding and restoration, the specimens were loaded on a universal tester (crosshead speed of 0.1 mm per minute) at 30 degrees to the long axis of the tooth until fracture. Fracture resistance and pattern were analyzed. Four groups were added in FEA: 1-mm ferrule restoration group (NPR1), 1.0×1.0-mm ISRF (ISRF1), 1-mm CLP (CLP1), and 1-mm OEP (OEP1). The maximum principal stress peak (σmax), maximum displacement, and stress distribution were evaluated. RESULTS: Mean fracture load ±standard deviation was 796.23 ±155.61 N (NPR2), 650.32 ±150.43 N (ISRF0.5), 385.38 ±149.92 N (CLP2), and 542.93 ±79.34 N (OEP2); these differences were statistically significant (F=12.724; P<.001). The main fracture patterns were decementation from the lingual crown margin and oblique root fracture in ferrule restoration groups and post-and-core decementation and oblique fracture starting from the middle proximal surface in the ISRF groups without ferrules. In FEA, the results of NPR2, ISRF0.5, CLP2, and OEP2 were consistent with the in vitro experiments and provided stress distribution and displacement information. CONCLUSIONS: Teeth with crown dentin ferrules showed higher fracture resistance and lower stress concentration. For residual roots, ISRF and OEP showed no differences, but CLP had lower fracture resistance and higher stress concentration.


Assuntos
Técnica para Retentor Intrarradicular , Fraturas dos Dentes/terapia , Dente não Vital/terapia , Coroas , Falha de Restauração Dentária , Análise do Estresse Dentário , Análise de Elementos Finitos , Humanos
4.
Int. j. odontostomatol. (Print) ; 14(2): 144-149, June 2020. graf
Artigo em Inglês | LILACS | ID: biblio-1090666

RESUMO

Loss of teeth vitality when root formation is incomplete, results in weaker structures leaving them prone to fractures and unfavourable long-term prognosis. Apexogenesis is currently the treatment of choice in immature teeth and is indicated in vital teeth without pulpal pathologies. The treatment aims to eliminate the causal agent of the damage, and provide the necessary conditions to preserve vitality in the tooth and induce apical root closure. A 6-year-old male patient was treated at the Endodontics Clinic, Universidad de La Frontera upon complaining of acute pain in tooth 30. The tooth presented incomplete root development due to dental caries with pulp exposure and a diagnosis of irreversible symptomatic pulpitis. Total pulpotomy was performed with the application of Mineral Trioxide Aggregate and controlled at 1, 4, 6, 7 and 12 months, achieving root development and apical closure in the permanent molar. The result was comparable with studies that support this therapy in teeth with irreversible pulpitis. This work seeks to contribute to the existing evidence on the management of immature permanent teeth with irreversible pulpitis to induce root development and apical closure, and maintain pulp vitality.


La pérdida de vitalidad en dientes con formación radicular incompleta trae como resultado el debilitamiento de estos, dejándolos propensos a fracturas con un desfavorable pronóstico a largo plazo. Las terapéuticas actuales de regeneración pulpar en dientes inmaduros estan principalmente indicadas en cuadros de pulpitis irreversible y buscan eliminar el agente causal de daño y brindarle al diente las condiciones y estímulos necesarios para preservar vitalidad e inducir el cierre apical radicular. Un paciente de 6 años de edad y de sexo masculino, acude a la Clínica de Especialidad de Endodoncia de la Universidad de la Frontera, consultando por un dolor agudo en diente 4.6 el cual presentaba un desarrollo radicular incompleto producto de una caries con exposición pulpar con diagnóstico de Pulpitis Irreversible Sintomática. Se realiza una pulpotomia total con aplicación de Mineral Trioxide Aggregate y se controla a los 1, 4, 6 y 7 meses obteniendo un interesante resultado comparable con estudios que avalan dicha terapeutica en dientes con pulpitis irreversible. Este trabajo busca contribuir a la evidencia existente sobre el manejo de dientes permanentes inmaduros con cuadros de pulpitis irreversible para inducir el desarrollo radicular, cierre apical y mantener vitalidad pulpar.


Assuntos
Humanos , Masculino , Criança , Óxidos/administração & dosagem , Pulpite/terapia , Pulpotomia/métodos , Silicatos/administração & dosagem , Compostos de Cálcio/administração & dosagem , Compostos de Alumínio/administração & dosagem , Regeneração , Materiais Restauradores do Canal Radicular , Dentição Permanente , Dente não Vital/terapia , Cárie Dentária , Combinação de Medicamentos , Apexificação
5.
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
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.
Clin Exp Dent Res ; 5(4): 326-335, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31452943

RESUMO

Objectives: Deciding when cuspal coverage is needed for posterior teeth is considered a challenge for dentists. The aims were to assess dentists' decision making regarding the need for cuspal coverage for vital teeth (VT) and endodontically treated teeth (ETT) with varying amounts of tooth structure loss and to identify clinical situations of dissimilarity and uncertainty in decision making. Materials and Methods: A random sample of 182 dentists were invited to participate in the survey. The survey included photos of 13 posterior teeth: six VT and seven ETT. The clinical situations selected were based on a hypothetical scale of typodont teeth with ascending amounts of tooth structure loss. A brief description of each situation was provided. Each dentist was asked to decide whether cuspal coverage is needed, not needed, or unsure. Descriptive analyses using SPSS were conducted. Seventy-five percent was chosen as a cutoff point for assessing similarity in decision making. The unsure answer reflected uncertainty. Associations were assessed using chi-square test. Results: One hundred twenty dentists participated (65.9% response rate, 70 females). Median for years of experience was 3.5 (interquartile range 1.1-10.8). Analyses revealed a similarity percentage of <75% in decision making among dentists for six clinical situations: four VT and two ETT. More similarity was observed for situations at both ends of the scale with minimal and severe amounts of tooth structure loss and more for ETT than for VT. The highest percentages of uncertainty were more for VT than for ETT. Clinical conditions of VT were more likely to receive the "not sure" decision compared with those of ETT (χ 2, P < .001). No association was detected with gender (χ 2, P = .509) or years of experience (χ 2, P = .223). Conclusions: Dissimilarity and uncertainty in deciding when cuspal coverage is needed were observed especially for VT and teeth with a moderate amount of structure loss.


Assuntos
Tomada de Decisão Clínica , Resinas Compostas/administração & dosagem , Restauração Dentária Permanente/métodos , Dente não Vital/terapia , Feminino , Humanos , Masculino , Inquéritos e Questionários/estatística & dados numéricos , Coroa do Dente
9.
Niger J Clin Pract ; 22(6): 782-789, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31187762

RESUMO

Objective: The aim of this in vitro study was to investigate the fracture strength and cuspal deflection of endodontically treated premolars restored using different composite resins along with or without fiber post application. Materials and Method: Eighty intact premolars were randomly divided into eight groups (n = 10); CO group: intact teeth (control), OPR group: mesio-occlusal-distal-palatal (MODP) preparation (OPR) + endodontic treatment (ET), TC group: MODP preparation + ET + Tetric N-Ceram, TB group: MODP preparation + ET + Tetric EvoCeram Bulk Fill, SO group: MODP preparation + ET + SonicFill 2, TC-P group: MODP preparation + ET + Hahnenkratt glass fiber post + Tetric N-Ceram, TB-P group: MODP preparation + ET + Hahnenkratt glass fiber + Tetric EvoCeram Bulk Fill, and SO-P Group: MODP preparation + ET + Hahnenkratt glass fiber post + SonicFill 2. After thermocycling, specimens were subjected to a compressive load until fracture. Data were analyzed using analysis of variance and Tukey tests (P < 0.05). Results: The mean fracture strength of groups which received post treatment showed similar fracture strength values [TC-P (931.6 ± 97.9), TB-P (882.0 ± 59.7), SO-P (862.0 ± 143.0) (P > 0.05)] and was significantly higher than OPR (530.6 ± 41.7), TC (841.2 ± 93.1), TB (774.5 ± 101.8), and SO (735.0 ± 178.01) groups (P < 0.05). No significant difference was detected among groups considering cuspal deflection (P > 0.05). The fiber post insertion resulted in more unfavorable fractures. Conclusion: Endodontically treated teeth restored with fiber post and bulk-fill or conventional composite resins demonstrated fracture strength values similar to intact teeth.


Assuntos
Resinas Compostas/uso terapêutico , Restauração Dentária Permanente/instrumentação , Vidro , Dente não Vital/terapia , Dente Pré-Molar/lesões , Força Compressiva , Análise do Estresse Dentário , Resistência à Flexão , Humanos , Teste de Materiais , Distribuição Aleatória , Fraturas dos Dentes/etiologia , Preparo do Dente/métodos
10.
Niger J Clin Pract ; 22(3): 328-334, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30837419

RESUMO

Aims: The aim of this study was to compare the effect of different restoration techniques on fracture resistance of endodontically treated teeth with different wall thicknesses. Materials and Methods: Extracted and endodontically treated 210 premolars were randomly divided into three thickness groups [2 mm (A), 1.5 mm (B), and 1 mm (C)] and, each group was further divided into seven restoration subgroups (n = 10): direct composite (control) (K), composite with fiber on cavity floor (KT), composite with fiber on occlusal level (KO), fiber post and composite (FP), inlay (L), fiber on cavity floor and inlay (LT), and inlay and fiber on occlusal level (LO). Fracture test was performed, and data were compared with Kruskal-Wallis and Mann-Whitney U tests (P < 0.05). Results: There were no differences between the subgroups in A and C statistically (P > 0.05). However, in B, KO subgroup showed statistically higher values (P = 0.039). Conclusion: Wall support of 2 mm was adequate, and support of 1 mm was completely insufficient. When the wall thickness was 1.5 mm, direct restoration with fiber at the occlusal level significantly improved resistance.


Assuntos
Resinas Compostas/uso terapêutico , Cárie Dentária , Preparo da Cavidade Dentária , Materiais Dentários/química , Restauração Dentária Permanente/métodos , Fraturas dos Dentes/prevenção & controle , Dente não Vital/terapia , Dente Pré-Molar , Resinas Compostas/química , Materiais Dentários/uso terapêutico , Análise do Estresse Dentário , Humanos , Fraturas dos Dentes/etiologia , Dente não Vital/complicações
11.
Biomed Res Int ; 2019: 3126931, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30805363

RESUMO

Objective: The aim of this study is to evaluate the effects of different fiber insertion techniques and thermomechanical aging on the fracture resistance of endodontically treated mandibular premolar teeth restored using bulk-fill composites. Materials and Methods: Eighty human mandibular premolar teeth were randomly divided into eight groups: Group IN, Group BF, Group PRF1, Group PRF2, Group IN-TMA, Group BF-TMA, Group PRF1-TMA ,and Group PRF2-TMA. Group IN (intact) and Group IN-TMA (intact but subjected to thermomechanical aging) served as control groups. In the other six groups, endodontic treatment was performed and standardized mesio-occluso-distal (MOD) cavities were prepared. In BF, PRF1, and PRF2, the cavities were restored with bulk-fill composite only, bulk-fill/Ribbond, and bulk-fill/additional Ribbond, respectively. In BF-TMA, PRF1-TMA, and PRF2-TMA, the teeth were subjected to thermomechanical aging after the restorations. All of the teeth were fractured on the universal testing machine. Fracture surfaces were analyzed with a stereomicroscope. Results: Control groups showed significantly higher fracture strengths than tested groups (P<0.05). No statistically significant difference was observed among the tested groups (P>0.05). Most of the favorable fractures were seen in PRF1, PRF2, and PRF2-TMA. Most of the unfavorable fractures were seen in BF-TMA. Conclusions: Although fiber insertion with different techniques did not increase the fracture strength of teeth restored with bulk-fill composites, it increased the favorable fracture modes. Thermomechanical aging did not change the fracture strength of the groups.


Assuntos
Resinas Compostas/uso terapêutico , Materiais Dentários/uso terapêutico , Resistência à Flexão/efeitos dos fármacos , Fraturas dos Dentes/terapia , Viscosidade/efeitos dos fármacos , Preparo da Cavidade Dentária/métodos , Restauração Dentária Permanente/métodos , Análise do Estresse Dentário/métodos , Humanos , Teste de Materiais/métodos , Polietilenos/uso terapêutico , Dente não Vital/terapia
12.
Oper Dent ; 44(1): E1-E11, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30715998

RESUMO

PURPOSE:: The purpose of this in vitro study was to evaluate the resistance and patterns of fracture of endodontically treated maxillary premolars (ETPs) restored with different methods. METHODS AND MATERIALS:: Mesio-occluso-distal cavities were prepared in 50 extracted caries-free human maxillary premolars after endodontic treatment. The teeth were divided into five groups (n=10), according to the restorative method. G1: intact teeth (control group); G2: conventional composite resin; G3: conventional composite resin with a horizontal glass fiber post inserted between buccal and palatal walls; G4: bulk-fill flowable and bulk-fill restorative composites; and G5: ceramic inlay. For direct restorations, Filtek Z350 XT, Filtek Bulk Fill Flowable Restorative, and Filtek Bulk Fill Posterior Restorative were used. Indirect restorations were fabricated from a pressable lithium disilicate glass-ceramic (IPS e-max Press) and adhesively cemented (RelyX Ultimate). All specimens were subjected to thermocycling (5°C to 55°C/5000 cycles) and additionally submitted to cyclic loading 50,000 times in an Electro-Mechanical Fatigue Machine. Next, the specimens were subjected to a compressive load at a crosshead speed of 1 mm/min until fracture. The fractured specimens were analyzed to determine the fracture pattern using a stereomicroscope, and then representative specimens were carbon coated to allow for the studying of the fracture surface under scanning electron microscopy. One-way analysis of variance (ANOVA) was used to compare fracture resistance of the groups. The results of fracture patterns were submitted to the Fisher exact test (α=0.05). RESULTS:: All specimens survived fatigue. Mean (standard deviation) failure loads (N) for groups were as follows: G1: 949.6 (331.5); G2: 999.6 (352.5); G3: 934.5 (233.6); G4: 771.0 (147.4); and G5: 856.7 (237.5). The lowest fracture resistance was recorded for G4, and the highest ones were recorded for G2, followed by that of G1 and G3. One-way ANOVA did not reveal significant differences between groups ( p>0.05). The highest repairable fracture rates were observed in G1 (100%) and G3 (80%). CONCLUSIONS:: ETPs restored with conventional composite resin with or without horizontal fiber post, bulk-fill composite, and ceramic inlay showed fracture resistance similar to that of sound teeth. Conventional composite resin restorations exhibited the highest prevalence of unrepairable fractures, and the insertion of a horizontal fiber post decreased this prevalence. Intact teeth showed 100% of repairable fractures. It is difficult to extrapolate the results directly to a clinical situation due to the limitations of this study.


Assuntos
Restauração Dentária Permanente/métodos , Fraturas dos Dentes/prevenção & controle , Dente não Vital/terapia , Dente Pré-Molar , Resinas Compostas/química , Porcelana Dentária , Falha de Restauração Dentária , Análise do Estresse Dentário , Vidro , Humanos , Técnicas In Vitro , Restaurações Intracoronárias , Maxila , Técnica para Retentor Intrarradicular , Cimentos de Resina
13.
Clin Oral Investig ; 23(3): 1373-1382, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30022270

RESUMO

OBJECTIVES: The study aimed at assessing, as primary objective, the periapical status and quality of root fillings, and, as secondary objective, the endodontic treatment need of a German urban population in a cross-sectional study 20 years after the first one. MATERIALS AND METHODS: Clinical and radiographic data of 353 patients were evaluated. Descriptive and regression analyses were performed and the endodontic treatment need was calculated. Results were compared with data from the year 1993. RESULTS: A total of 9269 teeth were examined (26.2 teeth per patient; 1993, 24.4), of which 337 teeth were root filled (3.6%; 1993, 2.7%). Prevalence of apical periodontitis in root-filled teeth was 34% (1993, 61%). Quality of root fillings was adequate in 117 cases (35%; 1993, 14%). Minimum endodontic treatment need was estimated with 1.6% (1993, 2.3%), including teeth with clinical symptoms. Considering symptomless teeth with apical periodontitis and poor quality of root filling, the treatment need was 2.9% (1993, 3.7%). Regression analysis identified quality of root filling as a significant factor for periapical health (p = 0.01, odds ratio 3.4×, 95% CI 1.9-6.3×), likewise the type of instrumentation. Teeth treated with rotary files had a significantly better outcome (p = 0.02, odds ratio 2.0×, 95% CI 1.1-3.7×). CONCLUSIONS: Quality of root fillings and the periapical status have improved over the last 20 years in Germany. However, there is still a need for an increase in quality of root canal treatment.


Assuntos
Periodontite Periapical/epidemiologia , Tratamento do Canal Radicular , Dente não Vital/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Estudos Transversais , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , População Urbana , Adulto Jovem
14.
Clin Oral Investig ; 23(1): 381-389, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29713887

RESUMO

OBJECTIVES: The aim of this ex-vivo study was to evaluate the impact of cavity size and glass-fiber post (GFP) placement on the load capability of endodontically treated maxillary incisors directly restored with resin composite. MATERIALS AND METHODS: Ninety-six extracted human maxillary central incisors were endodontically treated and distributed to four groups (n = 24): access cavity (A), access cavity and uni-proximal class III cavity (U), access cavity and bi-proximal class III cavity (B), and decoronated tooth (D). Specimens were restored with resin composite, and 12 specimen of each group received an adhesively placed glass-fiber post (P). Prior to linear loading, specimens were exposed to thermo-mechanical loading (TCML). Statistical analysis was performed using log-rank test after TCML, Kruskall-Wallis and Mann-Whitney U test to compare load capabilities (Fmax). RESULTS: Significantly more failures occurred in group D for specimens without GFP during TCML (p = 0.001). Fmax (mean (SD) in N was (A) 513 (124), (AP) 554 (201), (U) 438 (171), (UP) 537 (232) (B) 483 (219), (BP) 536 (281), D 143 (181), and DP 500 (331), and differed significantly among groups (p = 0.003). Pair-wise comparison revealed lower Fmax values for group D compared to all other groups (p < 0.034) except group DP. CONCLUSIONS: Endodontically treated maxillary central incisors with cavity sizes up to bi-proximal class III may be successfully directly restored with resin composite. Post placement shows no additional effect except for decoronated endodontically treated incisors. CLINICAL RELEVANCE: Endodontically treated incisors with access cavities to class III cavities can be successfully restored with resin composite. Post placement for decoronated ETT is recommended.


Assuntos
Resinas Compostas/química , Restauração Dentária Permanente , Incisivo , Técnica para Retentor Intrarradicular , Dente não Vital/terapia , Falha de Restauração Dentária , Análise do Estresse Dentário , Humanos , Técnicas In Vitro , Maxila
15.
Acta Odontol Scand ; 77(1): 33-38, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30156134

RESUMO

Objective: Assessment of long-term clinical data regarding post-endodontic restorations is essential for the evaluation of different post-and-core concepts. The aim of the present study was to assess the diagnostic accuracy of patient self-reporting on post-endodontic restorations after 11 years of clinical service.Materials and methods: Twenty-nine patients (61 ± 15 years old) with endodontic glass-fibre and titanium post-endodontic restorations were examined within the 11-year follow-up of a randomized controlled trial. Restorations were assessed by self-reports during a telephone interview (one item), the completion of a four-item questionnaire and clinical and radiographic examination. A gold standard for restoration in situ or 'failure' was defined by clinical and radiographic examination. Diagnostic accuracy of patients' self-reports was evaluated by calculating the sensitivity, specificity, and positive (PPV) and negative predictive values (NPV).Results: After a mean observation time of 137 months (min/max: 125/154 months), 25 (86.2%) restorations were in situ and 4 (13.8%) failures were detected. Self-report during a telephone interview and the four-item questionnaire correctly identified all in situ restorations (specificity = both 100%, NPV = 92.6%/96.2%). Self-report during a telephone interview identified two out of four failures (sensitivity = 50%, PPV = 100%), and self-report on the four-item questionnaire identified three out of four failures (sensitivity = 75%, PPV = 100%).Conclusions: When the clinical examination is not feasible, patients' self-report shows valuable diagnostic potential in the identification of the post-endodontic failure.


Assuntos
Técnica para Retentor Intrarradicular , Dente não Vital/terapia , Idoso , Resinas Compostas/química , Falha de Restauração Dentária , Seguimentos , Humanos , Pessoa de Meia-Idade , Avaliação de Resultados da Assistência ao Paciente , Ensaios Clínicos Controlados Aleatórios como Assunto , Autorrelato
16.
Clin Oral Investig ; 23(3): 1435-1442, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30046906

RESUMO

AIM: The aim of this prospective, non-interventional, multi-center, practice-based study was, firstly, to evaluate the longevity of composite build-ups in endodontically treated teeth (ETT) without post placement and, secondly, to analyze factors influencing the success of these composite build-ups. METHODOLOGY: Each of seven general dental practitioners placed up to 50 composite build-ups without additional posts in ETT. Teeth were restricted to incisors, canines, and premolars. Several clinical data were recorded for 192 coronal restorations on ETT in 192 patients. Cox proportional hazard models were applied to analyze associations between clinical factors and time until failure. RESULTS: Within a follow-up period of 10 years, 167 restorations were judged as successful [mean success time, 110 (105-115) months] and 180 teeth survived [mean survival time, 114 (110-119) months]. The main failure type was fracture of the restoration (n = 15). The annual failure rate was 2.4%. In bivariate Cox regression, both factors such as number of restored tooth surfaces and adhesive were significantly associated with the failure rate. In multivariate Cox proportional hazards regression, none of the investigated factors were significantly associated with the failure rate. CONCLUSION: For composite build-ups in ETT without post placement, high success rates could be found after up to 10 years of observation time. Within the limitations of the present study, none of the analyzed factors such as "tooth type" or "number of restored tooth surfaces" was a significant predictor for the failure rate. CLINICAL RELEVANCE: Endodontically treated teeth can be successfully directly restored with composite build-ups even when no additional post is inserted. TRIAL REGISTRATION: The study was registered in the German Clinical Trials Register (DRKS-ID: DRKS00012882).


Assuntos
Resinas Compostas , Coroas , Falha de Restauração Dentária , Técnica para Retentor Intrarradicular , Dente não Vital/terapia , Humanos , Estudos Prospectivos
17.
J Adhes Dent ; 20(6): 519-526, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30564798

RESUMO

PURPOSE: The aim of this ex-vivo study was to evaluate the load capacity of direct or indirect endodontically restored maxillary central incisors with Class III defects, with or without glass-fiber posts. MATERIALS AND METHODS: Seventy-two extracted human maxillary central incisors were endodontically treated and bi-proximal Class III cavities were prepared. Specimens were randomly allocated to six groups (n = 12): direct restoration with composite (C); direct restoration with composite and additional glass-fiber post (CP); ceramic veneer restoration (V), ceramic veneer restoration and additional glass-fiber post (VP), ceramic crown restoration (Cr), ceramic crown restoration and additional glass-fiber post (CrP). Specimens were exposed to thermomechanical loading (TML: 1.2 million cycles, 1 to 50 N; 6000 thermal cycles between 5°C and 55°C for 1 min each), and subsequently linearly loaded until failure (Fmax [N]) at an angle of 135 degrees 3 mm below the incisal edge on the palatal side. Statistical tests were performed using the Kruskall-Wallis and Mann-Whitney U-Test. RESULTS: During dynamic loading by TML, one early failure occurred in group C, CP, and CrP. Subsequent linear loading resulted in mean fracture load values [N] of C = 483 ± 219, CP = 536 ± 281, V = 908 ± 293, VP = 775 ± 333, Cr = 549 ± 258, CrP = 593 ± 259. The Kruskal-Wallis test showed significant differences of load capacity between groups (p < 0.05). Mann-Whitney U-test revealed significantly lower maximum fracture load values of group C compared to group V (p = 0.014), after Bonferroni-Holm correction. Non-restorable root fracture was the most frequent type of failure. CONCLUSION: Endodontically treated maxillary central incisors with Class III defects directly restored with composite are as loadable as indirect crown restorations. Compared to full-coverage restorations, less invasive veneers appear to be more beneficial. Additional placement of glass-fiber posts shows no positive effect.


Assuntos
Resinas Compostas , Coroas , Restauração Dentária Permanente/métodos , Facetas Dentárias , Análise do Estresse Dentário , Humanos , Incisivo , Técnica para Retentor Intrarradicular , Distribuição Aleatória , Dente não Vital/terapia
18.
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
19.
Endodoncia (Madr.) ; 36(3): 44-50, dic. 2018. ilus
Artigo em Espanhol | IBECS | ID: ibc-178385

RESUMO

Introducción: La metamorfosis cálcica se presenta comúnmente tras lesiones traumáticas y se caracteriza por presentar depósitos de tejido duro dentro del espacio pulpar, obliterando parcial o totalmente la cámara pulpar y/o el conducto radicular. Este proceso suele provocar un cambio de coloración de la corona clínica haciéndola más oscura y opaca. Caso clínico: Paciente mujer de 40 años acude a la consulta motivada por una preocupación estética debido al oscurecimiento del diente 21. Se proponen varias opciones de tratamiento, hasta que finalmente se opta por el tratamiento de conductos de forma ortógrada, así como blanqueamiento interno del diente. Conclusión: El plan de tratamiento en dientes con metamorfosis cálcica sin patología periapical y con compromiso estético partirá siempre desde el más conservador. Es esencial en el tratamiento de estos dientes la experiencia del operador, así como el buen manejo del microscopio y los ultrasonidos, herramientas fundamentales para su abordaje


Introduction: Calcium metamorphosis commonly occurs after traumatic injuries and is characterized by hard tissue deposits within the pulp space, partially or totally obliterating the pulp chamber and/or the root canal. This process usually causes a change in the color of the clinical crown, making it darker and more opaque. Clinical case: A 40-year-old female patient came to the clinic motivated by an aesthetic concern due to the darkening of the tooth 21. Various treatment options are proposed, until finally the endodontic treatment is chosen, as well as internal bleaching of the tooth. Conclusion: The treatment in teeth with calcium metamorphosis, without periapical pathology and with aesthetic compromise, should always be the most conservative. It is essential in the treatment of these teeth the experience of the operator, as well as the correct use of the microscope and ultrasounds, which are fundamental tools for its approach


Assuntos
Humanos , Feminino , Adulto , Clareamento Dental/métodos , Dente não Vital/terapia , Depósitos Dentários/terapia , Traumatismos Dentários/diagnóstico por imagem , Traumatismos Dentários/terapia , Espectrometria de Fluorescência/métodos , Cavidade Pulpar/diagnóstico por imagem , Tecido Periapical/diagnóstico por imagem
20.
Braz Oral Res ; 32(suppl 1): e74, 2018 Oct 18.
Artigo em Inglês | MEDLINE | ID: mdl-30365615

RESUMO

Adhesive procedures have changed the way to restore endodontically treated teeth (ETT). It started with the shift from cast post-and-core to fiber post. The original focus on strength also shifted towards failure modes, revealing that catastrophic failures are still a concern when restoring endodontically-treated teeth even with fiber posts. As an alternative, postless approaches have been proposed in order to improve the chances of repair. The goal of this critical review is to present a survey of the current knowledge on adhesive approaches to restore endodontically treated teeth with and without extensive coronal tissue loss. The preservation of tooth structure of endodontically treated teeth is paramount. Partial versus full coverage of ETT, the role of the ferrule, the post type effect on catastrophic failures and postless alternatives as endocrowns and postless build-ups are reviewed. There is a consensus that the remaining tooth structure plays an important role in ETT survival, although the current literature still is contradictory on the influence of post type on root fractures as well as the benefits of avoiding a post or partially restoring a tooth. More clinical studies should be carried out with the modern postless adhesive alternatives to conventional approaches.


Assuntos
Colagem Dentária/métodos , Restauração Dentária Permanente/métodos , Técnica para Retentor Intrarradicular , Tratamento do Canal Radicular/métodos , Dente não Vital/terapia , Resinas Compostas/uso terapêutico , Falha de Restauração Dentária , Vidro , Humanos , Fraturas dos Dentes , Raiz Dentária/lesões
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