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1.
Dent Med Probl ; 57(2): 171-175, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32104993

RESUMO

BACKGROUND: There are no studies evaluating the possible association between ankylosing spondylitis (AS) and apical periodontitis (AP). OBJECTIVES: The aim of the present cross-sectional study was to investigate the possible association between AS and AP. MATERIAL AND METHODS: Fifty patients diagnosed with AS, receiving treatment at the Rheumatology Clinic in Erzurum, Turkey, were included in the experimental group. Another 50 ageand gender-matched individuals without any history of systemic disease were included in the study as the control group. All patients were examined radiographically and clinically to diagnose the presence of AP. The following data was recorded for all patients: the smoking habit, the number of teeth present, the number of teeth with AP, the number of root canal-treated (RCT) teeth, and the number of RCT teeth with AP. RESULTS: There were 1,283 teeth in the AS group and 1,305 in the control group. There was a significant association between teeth with AP and AS, as the prevalence of teeth with AP was significantly lower in the control group (1.3%) than in the AS group (2.9%) (OR (odds ratio) = 2.250; p = 0.005). There was no statistically significant difference between the groups in terms of the number of RCT teeth and RCT teeth with AP (p > 0.05). CONCLUSIONS: Ankylosing spondylitis is significantly associated with an increased prevalence of AP. It can be concluded that patients with AS can be more prone to develop AP. However, AS does not reduce the success rate of endodontic treatment, because there was no significant difference between the AS and control groups in terms of RCT teeth with AP.


Assuntos
Periodontite Periapical , Espondilite Anquilosante , Estudos Transversais , Humanos , Periodontite Periapical/diagnóstico por imagem , Periodontite Periapical/epidemiologia , Tratamento do Canal Radicular , Espondilite Anquilosante/complicações , Espondilite Anquilosante/diagnóstico por imagem , Espondilite Anquilosante/epidemiologia , Turquia
2.
J Endod ; 46(3): 397-403, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31983459

RESUMO

INTRODUCTION: This retrospective study aimed to assess the radiologic characteristics of the possible associations between mucosal thickening of the maxillary sinuses (MSs) and periodontal and anatomic conditions of healthy and diseased maxillary teeth. METHODS: The periapical health of the maxillary molars in cone-beam computed tomographic (CBCT) images from 50 patients (mean age = 40.60±14.59 years) was evaluated using the CBCT-periapical index. Anatomic associations between maxillary molars and the inferior wall of the MSs and periodontal bone loss and its relation to MS pathology were assessed. The possible effects of these conditions on mucosal thickening of MSs were analyzed. Kruskal-Wallis, Mann-Whitney U, chi-square, and logistic regression (for relative risk) tests were used for statistical analysis. RESULTS: CBCT-periapical index 4 was the most frequently encountered apical periodontitis (AP) lesion. The risk for pathologic changes in the MSs was significantly higher in the presence of AP (P < .001). This risk was 62.364 times greater than that in areas of MSs adjacent to healthy teeth of the same patient (95% confidence interval, 7.968-488.14). Thicker MS mucosae were detected when the molar roots with AP were closer to the MSs (P < .004). No statistically significant difference was found between periodontal status and MS pathology. CONCLUSIONS: The findings of this study showed that MSs were affected by the endodontic health of adjacent molar teeth. Dental and medical practitioners should take into consideration the possible odontogenic causes while examining pathologic changes in the MS.


Assuntos
Seio Maxilar , Dente Molar , Periodontite Periapical , Adulto , Tomografia Computadorizada de Feixe Cônico , Humanos , Seio Maxilar/diagnóstico por imagem , Pessoa de Meia-Idade , Periodontite Periapical/diagnóstico por imagem , Estudos Retrospectivos
3.
Radiol Med ; 125(2): 145-154, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31701292

RESUMO

INTRODUCTION: This study aimed to evaluate the accuracy of both digital complete and small portion of panoramic radiography (PAN) in the detection of clinically/surgically confirmed asymptomatic apical periodontitis (AP) lesions with and without endodontic treatment. METHODS: A total of 480 patients/teeth including 120 AP with and without endodontic treatment, and 120 healthy periapex with and without endodontic treatment were detected via CBCT using the periapical index system. Each diseased and healthy patient underwent PAN first and a CBCT scan within 40 days. All 480 cases were assessed by four different methods, as follows: complete PAN with clinical examination of each tooth available and not available, respectively, and small portion of PAN in which a root with crown and root without crown were displayed, respectively. Periapical index system was also used to assess AP by PAN. Accuracy for both complete and small portion of PAN with respect to CBCT was analyzed. RESULTS: The overall accuracy of the four methods for teeth with endodontic treatment (73.4) was higher than teeth without endodontic treatment (66.6). Accuracy of complete PAN and portion of PAN was 71.3 and 68.7, respectively. As regards teeth without endodontic treatment, accuracy was higher for complete PAN in the upper/lower incisive area and for small portion of PAN in the upper molar area. No difference was found in teeth with endodontic treatment. CONCLUSION: Complete and small portion of PAN showed greater accuracy in the upper/lower incisive area and upper molar area of untreated teeth, respectively, whereas no difference was found in treated teeth.


Assuntos
Tomografia Computadorizada de Feixe Cônico , Periodontite Periapical/diagnóstico por imagem , Intensificação de Imagem Radiográfica , Interpretação de Imagem Radiográfica Assistida por Computador , Radiografia Panorâmica , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Periodontite Periapical/terapia
4.
Int J Occup Med Environ Health ; 33(1): 45-57, 2020 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-31729491

RESUMO

OBJECTIVES: Epidemiological studies show that apical periodontitis (AP), alongside tooth decay, is the most common oral disease. The aim of the study was to evaluate the influence of smoking on the prevalence of AP in the population of the Lódz region, Poland. MATERIAL AND METHODS: The study involved 815 first-time, randomly selected patients reporting to the Central Teaching Hospital of the Medical University of Lodz. The studied group was a systematic sample of the population admitted for treatment in 2016. The study consisted of a questionnaire and a radiological part. Each patient filled out a questionnaire containing demographic data, and an interview regarding smoking and diabetes. The radiological part of the study included the analysis of panoramic radiographs which showed the periapical status, and the presence and quality of root canal treatment. RESULTS: Teeth with AP were observed more frequently in patients addicted to tobacco either at the time of the study or in the past (group 1) - 7.2% than in people who had never smoked (group 2) - 5.2% (p < 0.0005). In the teeth without root canal treatment, AP was observed more frequently in group 1 - 3.5% than in group 2 - 1.9% (p < 0.0005). A statistically significant difference was found in the percentage of endodontically treated teeth between group 1 and group 2 (10.7% vs. 9.6%) (p = 0.017). However, no difference was observed in the frequency of AP in the endodontically treated teeth in both groups (37.6% vs. 35.8%) (p = 0.451). CONCLUSIONS: Smokers are a group facing an increased risk of AP and, therefore, there is a need for an early detection and treatment of caries and its complications in this group of patients. The multifactorial etiology of AP indicates the necessity to undertake further studies on the effect of smoking on the periapical status. Int J Occup Med Environ Health. 2020;33(1):45-57.


Assuntos
Periodontite Periapical/diagnóstico por imagem , Periodontite Periapical/epidemiologia , Tratamento do Canal Radicular/estatística & dados numéricos , Fumar/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polônia/epidemiologia , Prevalência , Radiografia Panorâmica , Inquéritos e Questionários
5.
J Endod ; 45(12): 1535-1542, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31606146

RESUMO

Endodontic microsurgery is a predictable alternative to nonsurgical treatment of persistent and recurrent apical periodontitis. The modern endodontic microsurgical procedure has been evolving in pace with technological advances. The introduction of modern innovations such as cone-beam computed tomographic (CBCT) imaging, 3-dimensional (3D) printing technology, and a 3D surgical guide designed with computer-aided software has allowed for a novel approach to the surgical site. The aim of these case reports was to describe root-end surgery with the use of the implant DDS-Pro planning software (Natrodent Polska, Poland), a 3D-printed surgical guide precisely positioned according to the preoperative CBCT scan measurements (CS 8100; Carestream Dental, Atlanta, GA), and a modified soft tissue access. A hollow trephine bur was used to perform the osteotomy, resection of the root, and enucleation of the lesion. The intact cortical plate was salvaged and used as a graft along with plasma-rich fibrin acquired preoperatively from the patient's blood. The positioning guide allowed the clinicians to precisely achieve targeted tissues and shorten the procedure time. Modified soft tissue management helped achieve a small surgical wound for uneventful healing. A less than 12-month CBCT follow-up of both cases showed complete 3D healing of the surgical site.


Assuntos
Microcirurgia , Periodontite Periapical , Fibrina Rica em Plaquetas , Stents , Tomografia Computadorizada de Feixe Cônico , Humanos , Periodontite Periapical/diagnóstico por imagem , Periodontite Periapical/cirurgia
6.
J Endod ; 45(10): 1184-1191, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31451288

RESUMO

INTRODUCTION: The detection of a tooth with a sinus tract (ST) of endodontic origin and its pathway are conventionally assessed with a periapical radiograph and a gutta-percha cone introduced into its stoma. The aim of this study was to evaluate the possibility to detect STs and trace their route using ultrasound real-time examination. METHODS: Two calibrated examiners performed echography on 10 patients who had a lesion of apical periodontitis (AP) and ST and 10 patients in the control group with AP without an ST recruited in 2 endodontic practices. They also traced the pattern of the STs with a computer program. The images were then submitted to 2 calibrated and blinded observers who were asked to describe the presence of AP and ST and to trace it with the same program. The data obtained were compared with the clinical and radiographic diagnosis of ST. For sensitivity, specificity, accuracy, and positive and negative predictive values, the receiver operating characteristic curve and Fisher exact test were used (P < .05). RESULTS: Interobserver agreement was high as was the diagnostic accuracy of the ultrasound examination of STs (mean value = 97.5%), and the Fisher exact test showed statistical significance (P < .05). High sensitivity and a negative predictive value and 100% specificity and a positive predictive value were also obtained. The application of the 3-dimensional mode further enabled the reconstructions of the more complex paths, and the implementation with color power Doppler disclosed the vascularity surrounding the STs. CONCLUSIONS: The ultrasound examination is a technique feasible to describe and trace the STs of endodontic origin.


Assuntos
Periodontite Periapical , Dente , Guta-Percha , Humanos , Periodontite Periapical/diagnóstico por imagem , Sensibilidade e Especificidade , Ultrassonografia
7.
Niger J Clin Pract ; 22(8): 1126-1131, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31417057

RESUMO

Objective: The aim of this cross-sectional study was to assess the prevalence of apical periodontitis in root canal treated teeth in Turkish subpopulation and to evaluate the effects of both coronal restoration quality and root canal treatment (RCT) quality on apical periodontitis. Materials and Methods: Panoramic images of individuals who applied to our department for different diagnostic reasons were randomly and retrospectively scanned. Total RCT number, RCT quality, type of coronal restoration, restoration quality, periapical status, and total number of teeth were recorded. The criteria used for coronal restorations quality and RCT quality were defined by De Moor et al. and slightly modified by Gunduz et al. Periapical status was assessed by the periapical index developed by Orstavik et al. Pearson's Chi-square test was used for statistical analysis, and the intraobserver agreements were assessed by Kappa coefficients. Values of P < 0.05 were accepted to be meaningful. Results: The total examined teeth number was 6064, of which had 541 (8.9%) RCT. The prevelance of apical periodontitis was 40.5%. The number of adequate RCT was 178 (32.9%), and 138 (77.5%) of them were healthy. The number of adequate coronal restoration was 334, and 62.3% of them were healthy. For the cases that have adequate coronal restorations, there was statistically significant relationship between adequate RCT and periapical status (P < 0.001). Conclusion: The prevelance of apical periodontitis was 40.5% and there was statistically significant relationship between adequate RCT and periapical status.


Assuntos
Cavidade Pulpar/diagnóstico por imagem , Restauração Dentária Permanente/efeitos adversos , Periodontite Periapical/diagnóstico por imagem , Radiografia Panorâmica/métodos , Tratamento do Canal Radicular/efeitos adversos , Coroa do Dente/diagnóstico por imagem , Raiz Dentária/diagnóstico por imagem , Adulto , Distribuição de Qui-Quadrado , Estudos Transversais , Restauração Dentária Permanente/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Periodontite Periapical/epidemiologia , Prevalência , Estudos Retrospectivos , Tratamento do Canal Radicular/normas , Turquia/epidemiologia
8.
J Endod ; 45(9): 1114-1118, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31280911

RESUMO

INTRODUCTION: Acute and chronic apical abscesses are 2 dramatic ways that periradicular tissues may react to pulpal infection and necrosis. Although both of these clinical states are the response to pulpal infection, their clinical manifestations are significantly different. It is not clear why the body responds to root canal infection in one way or another. The objective of this study was to evaluate the size and pattern of bone loss in patients with acute apical abscess (AAA) and chronic apical abscess (CAA) using cone-beam computed tomographic images. METHODS: Twenty-three cone-beam computed tomographic images of cases with AAA and 25 cases with CAA were selected and evaluated. The presence and location of fenestration and the volume and pattern of the periradicular lesions were recorded and compared between the 2 groups using the Fisher exact and Mann-Whitney U tests. RESULTS: One hundred percent of cases with CAA had cortical fenestration, but only 47% of cases with AAA had cortical fenestration (P < .05). The median volume of the lesions was 233 mm3 in the CAA group and 109 mm3 in the AAA group (P > .05). CAA cases, in comparison with the AAA group, had a relatively larger cortical disruptions. CONCLUSIONS: Cortical fenestration is fundamental for the development of CAA. However, periradicular lesions without evident cortical fenestration can still cause AAA and fascial space involvement.


Assuntos
Abscesso , Doenças da Polpa Dentária , Doenças Periapicais , Periodontite Periapical , Abscesso/diagnóstico por imagem , Osso e Ossos , Tomografia Computadorizada de Feixe Cônico , Humanos , Periodontite Periapical/diagnóstico por imagem , Tratamento do Canal Radicular
9.
Med Princ Pract ; 28(6): 533-538, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30999319

RESUMO

OBJECTIVE: This study aimed to investigate the prevalence of apical periodontitis (AP) in patients with type II diabetes mellitus (DM) with either optimal glycemic control (OGC) or poor glycemic control (PGC) compared with nondiabetics using cone beam computed tomography (CBCT). SUBJECTS AND METHODS: The periapical status of 75 teeth with adequate root canal treatment performed at least 1 year ago that could be visualized in the field of view of CBCT images of 43 DM patients (29 females, 14 males) was compared with a control group consisting of 162 teeth of 86 nondiabetics (56 females, 30 males). In addition, the DM group was divided into subgroups according to the patients' mean glycated hemoglobin level as either having OGC or PGC. The periapical status of the teeth was evaluated using the CBCT periapical index (CBCTPAI), and AP was diagnosed as a CBCTPAI ≥1. χ2, Fisher's exact test, and independent-samples t tests were used for the statistical analysis, and p < 0.05 was considered significant. RESULTS: Significant differences between the DM group and the control group were observed (p< 0.05) in terms of AP (the frequencies of both CBCTPAI ≥1 and CBCTPAI ≥3) and the frequency of cardiovascular disease, while there were no significant differences between the DM subgroups (p > 0.05). CONCLUSION: The prevalence of AP and severe bone destruction in periapical tissues was significantly higher in the DM patients compared with the nondiabetic patients.


Assuntos
Tomografia Computadorizada de Feixe Cônico/métodos , Diabetes Mellitus Tipo 2/complicações , Periodontite Periapical/diagnóstico por imagem , Periodontite Periapical/etiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Periodontite Periapical/epidemiologia , Periodontite Periapical/cirurgia , Prevalência , Tratamento do Canal Radicular
10.
J Endod ; 45(3): 343-348, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30803544

RESUMO

We describe complete healing of an extensive cystic lesion by using a conservative approach: root canal treatment with concurrent surgical drainage. A silicone Foley catheter drain was modified into a surgical drainage stent, which was then used for 4 weeks. Disinfection of the root canal was achieved by the use of hand files and irrigation with 5.25% NaOCl for a minimum of 30 minutes. The irrigant changes were performed at 5-minute intervals, and no intracanal dressing was used. At subsequent follow-up examinations, cone-beam computed tomography and periapical radiographs confirmed that complete healing had occurred around the periapical and lateral areas of affected teeth. This case report indicates the potential for healing of large cystic lesions by nonsurgical root canal treatment.


Assuntos
Tratamento Conservador/métodos , Necrose da Polpa Dentária/terapia , Desinfecção/métodos , Drenagem/métodos , Periodontite Periapical/terapia , Cisto Radicular/terapia , Irrigantes do Canal Radicular/administração & dosagem , Tratamento do Canal Radicular/métodos , Hipoclorito de Sódio/administração & dosagem , Terapia Combinada , Necrose da Polpa Dentária/complicações , Necrose da Polpa Dentária/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Periodontite Periapical/complicações , Periodontite Periapical/diagnóstico por imagem , Cisto Radicular/complicações , Cisto Radicular/diagnóstico , Fatores de Tempo , Resultado do Tratamento
11.
Braz Oral Res ; 33: e007, 2019 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-30758407

RESUMO

The aim of this study was to assess self-reported history of root canal treatment (SRHRCT) as a method for detecting the presence of root canal treatment (RCT) and apical periodontitis (AP) in a southern Brazilian subpopulation. In this cross-sectional study, 136 military police officers from the city of Porto Alegre, Brazil, were included. The participants were interviewed and full-mouth periapical radiographs were taken. A calibrated examiner determined the presence of RCT and AP by applying standardized criteria. The diagnostic accuracy of SRHRCT was calculated separately for RCT and AP. Accuracy, sensitivity, specificity, positive and negative predictive values (+PV and -PV), efficiency, and positive and negative likelihood ratios (+LR and -LR) were estimated. The mean age of the participants was 34.1 ± 10.4 years and 88.2% were males. Overall, SRHRCT demonstrated high sensitivity and specificity for RCT, but not for AP: sensitivity (RCT = 0.960, AP = 0.757) and specificity (RCT = 0.835, AP = 0.631). The estimated values for PV and LR were: +PV (RCT=0.777, AP=0.396), -PV (RCT = 0.972, AP = 0.890), +LR (RCT = 5.853, AP = 2.057), and -LR (RCT = 0.046, AP = 0.383). SRHRCT proved to be a good predictor of the presence of RCT, but a weak predictor of AP in this subpopulation.


Assuntos
Periodontite Periapical/epidemiologia , Tratamento do Canal Radicular/estatística & dados numéricos , Autorrelato/normas , Adulto , Brasil/epidemiologia , Estudos Transversais , Reações Falso-Negativas , Reações Falso-Positivas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Periodontite Periapical/diagnóstico por imagem , Prevalência , Radiografia Dentária , Valores de Referência , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
12.
Clin Oral Investig ; 23(5): 2055-2060, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30238413

RESUMO

OBJECTIVE: The aim of this study was to evaluate the relationship between length of root canal obturation (RCO) and the presence of apical periodontitis (AP) in different dental groups using cone-beam computed tomography (CBCT) analysis. MATERIALS AND METHODS: A total of 392 roots with canal treatment performed for more than 4 years were evaluated using CBCT. Distances from the apex to the tip of filling material were measured and classified as more than 2 mm short of the apex, approximately 1-2 mm short of the apex, at the apex, and beyond the apex. Odds ratio, confidence interval, and the χ2 test were used for statistical analyses. RESULTS: The frequency of AP was significantly greater in molars than in the other tooth groups (p < 0.05). Moreover, RCO that ended 1-2 mm short of the apex was associated with a lower prevalence of AP in molars and premolars (p < 0.05) and in anterior teeth (p < 0.1) when compared with RCO at the apex, more than 2 mm short of the apex, or beyond the apex. When the RCO reached the apex, there was no difference in the presence of AP among dental groups (p > 0.05). CONCLUSION: The length of RCOs can influence the presence of AP, with molars showing a higher prevalence. RCOs ending 1-2 mm short of the apex are associated with an absence of AP. CLINICAL RELEVANCE: The length of obturation is related to the presence of apical peridontitis and consequently to the success of endodontic treatment.


Assuntos
Tomografia Computadorizada de Feixe Cônico , Periodontite Periapical/diagnóstico por imagem , Obturação do Canal Radicular , Ápice Dentário/patologia , Estudos Transversais , Cavidade Pulpar , Humanos
13.
Acta Odontol Scand ; 77(2): 142-149, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30394169

RESUMO

OBJECTIVE: Endodontic originated chronic apical periodontitis (AP) is an inflammatory disease of periapical tissue. High-sensitivity C-reactive protein (hsCRP) as an inflammatory marker and hemogram indexes provide valuable information to clinicians for diagnosis, screening and follow-up of various diseases. The aim of this study was to investigate AP in terms of its association with hemogram indices and hsCRP levels. MATERIAL AND METHODS: Study includes 104 patients with AP and 40 participants as the control group. 160 teeth were diagnosed as AP through digital radiographic images and scored with respect to Periapical Index (PAI) scoring. Afterwards, patients were categorized into 3 grades in accordance with both the number and the severity of AP. AP grade 0 was considered for the control group with regard to a new scoring system. Patients with only one tooth involved with AP with a PAI score of 3 or 4 were categorized as an AP Grade 1, when a patient had more than one tooth with a PAI score of 3 or 4 he was classified as an AP Grade 2 and a patient with at least one tooth scored as a PAI 5 was rated as an AP Grade 3. Hemograms and hsCRP levels were measured for each individual to establish a correlation with inflammatory markers. RESULTS: The neutrophil/lymphocyte ratio (NLR) levels of patients with AP Grade 3 were significantly higher than all other AP grades (p < .05). hsCRP levels in patients with an AP Grade 2 and 3 were higher than both AP Grade 0 and 1 (p < .05). CONCLUSIONS: hsCRP levels of patients were reliable predictive indicators for AP severity in correlation with the new proposed scoring system for AP.


Assuntos
Proteína C-Reativa/metabolismo , Linfócitos/metabolismo , Neutrófilos/metabolismo , Periodontite Periapical/metabolismo , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Periodontite Periapical/diagnóstico por imagem , Prevalência , Radiografia Dentária Digital , Dente não Vital/metabolismo , Adulto Jovem
14.
J Endod ; 44(12): 1802-1811, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30477666

RESUMO

INTRODUCTION: Regeneration of the pulp-dentin complex is the penultimate goal of regenerative endodontic procedures (REPs). Histological outcomes have demonstrated reparative tissue formation in human teeth extracted post-REPs. However, lack of accurate characterization has precluded identification of the true nature of tissues formed post-REP. METHODS: Here, we present 2 case reports of tooth #29 and #9 treated with REPs and demonstrate their clinical, radiographic, and histological outcomes. RESULTS: Clinical outcomes revealed healing of apical periodontitis in both teeth and re-establishment of vitality responses in tooth #29. Moreover, radiographic assessments using 2D and 3D-volumetric analyses demonstrate considerable increase in root development for both teeth. Further, histological outcomes evaluated using Hematoxylin and Eosin and immunohistochemical staining demonstrates presence of vascular and lymphatic structures as well as immune cell markers indicative of regeneration of an immunocompetent pulp. Lastly, examination of hard tissue deposition shows dentin-like tissue in parts of tooth #29 demonstrating for the first time, regeneration of a pulp-dentin complex post-REP. CONCLUSIONS: Collectively, this is the first study demonstrating recapitulation of several tissues commonly found as part of a pulp-dentin complex in teeth treated with REPs.


Assuntos
Polpa Dentária/fisiologia , Dentina/fisiologia , Periodontite Periapical , Regeneração , Endodontia Regenerativa/métodos , Raiz Dentária/fisiologia , Criança , Polpa Dentária/diagnóstico por imagem , Polpa Dentária/imunologia , Polpa Dentária/inervação , Necrose da Polpa Dentária/terapia , Dentina/diagnóstico por imagem , Dentina/imunologia , Dentina/inervação , Feminino , Humanos , Imageamento Tridimensional , Regeneração Nervosa , Periodontite Periapical/diagnóstico por imagem , Periodontite Periapical/patologia , Periodontite Periapical/fisiopatologia , Periodontite Periapical/terapia , Radiografia Dentária , Raiz Dentária/diagnóstico por imagem , Raiz Dentária/imunologia , Raiz Dentária/inervação , Resultado do Tratamento , Cicatrização
15.
J Endod ; 44(12): 1777-1782, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30390972

RESUMO

INTRODUCTION: We evaluated healing after nonsurgical primary/secondary endodontic treatment of apical periodontitis (AP) in patients with inflammatory bowel diseases (IBDs) treated with anti-tumor necrosis factor alpha biologic medications (BMs). METHODS: Nineteen patients with 22 teeth affected by AP from the gastroenterology unit of the hospital with IBDs under treatment with BMs formed the study group (the IBD group). Fourteen patients with 22 teeth with AP, matched by age and sex, without systemic diseases and not taking medications formed the control group. Teeth underwent primary or secondary root canal treatments and clinical and radiographic follow-up every 3 months for 24 months. The periapical index score was recorded, and 2 trained and calibrated endodontists evaluated and compared radiographs (weighted kappa values, κ = 0.8). The Mann-Whitney, t, chi-square, Fisher, and Bruner-Langer tests and analysis of variance-type statistics were used as appropriate. RESULTS: The recall rate was 100%. All teeth in the IBD patients and 81% in the control patients healed (P = .108). Initial healing was appreciable at 3 months in the IBD group and 6 months in the control group (P = .174). Overall healing was reached at 6 and 10.5 months in the IBD and control groups, respectively (P = .106). At any time of the experiment, teeth in the IBD patients showed a higher probability of healing (P < .05). Both groups exhibited a similar decrement of the periapical index (P = .291), more significant for the IBD at the 3-month follow-up (P < .05). The 2 BMs used showed a similar trend of healing (P = .628). CONCLUSIONS: The treatment of AP in patients taking BMs had no complications; furthermore, it was associated with faster healing than the controls. These results support the possible therapeutic aid of BMs in treating AP.


Assuntos
Anticorpos Monoclonais/uso terapêutico , Doenças Inflamatórias Intestinais/complicações , Doenças Inflamatórias Intestinais/tratamento farmacológico , Periodontite Periapical/fisiopatologia , Periodontite Periapical/terapia , Tratamento do Canal Radicular , Fator de Necrose Tumoral alfa/imunologia , Cicatrização , Anticorpos Monoclonais/farmacologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Periodontite Periapical/complicações , Periodontite Periapical/diagnóstico por imagem , Fatores de Tempo , Resultado do Tratamento , Cicatrização/efeitos dos fármacos
16.
Indian J Dent Res ; 29(5): 683-686, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30409954

RESUMO

The purpose of this article was to highlight the importance of having a thorough knowledge about the root canal morphology. This case report highlights the unusual anatomy of a maxillary first molar with three mesiobuccal (MB) canals, two palatal canals, and one distobuccal canal which is extremely rare. The use of operating microscope was crucial, both for the detection and for the management of the additional canals. The use of surgical operating microscope and digital radiograph showed that MB root had Type 3-1 of Gulabivala classification and palatal canal showed Vertucci's Type II canal morphology This report describes and discusses the identification of variation in canal morphology of maxillary first molar and the use of latest adjuncts in successfully diagnosing and negotiating them.


Assuntos
Variação Anatômica , Cavidade Pulpar/anatomia & histologia , Cavidade Pulpar/diagnóstico por imagem , Maxila , Microscopia , Dente Molar/anatomia & histologia , Dente Molar/diagnóstico por imagem , Preparo de Canal Radicular/métodos , Cirurgia Assistida por Computador/métodos , Adolescente , Doença Crônica , Cárie Dentária/diagnóstico por imagem , Cárie Dentária/terapia , Cavidade Pulpar/cirurgia , Humanos , Masculino , Periodontite Periapical/diagnóstico por imagem , Periodontite Periapical/cirurgia , Intensificação de Imagem Radiográfica , Radiografia Dentária , Obturação do Canal Radicular/métodos
17.
Cell Physiol Biochem ; 49(3): 884-898, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30184545

RESUMO

BACKGROUND/AIMS: Periapical periodontitis is caused by bacterial infection and results in both one destruction and tooth loss. Osteopontin (OPN) is a secreted phosphorylated glycoprotein that participates in bone metabolism. METHODS: Thirty-three patients with chronic periapical periodontitis and 10 patients who had undergone the orthodontic removal of healthy tooth tissue (control) at the periodontal ligament were investigated, and an animal model of mouse periapical periodontitis was established for an in vivo analysis. The relationship between OPN and bone destruction during periapical periodontitis was analyzed. Osteoblasts and osteoclasts were cultured in vitro and treated with lipopolysaccharide. An inhibitor of NF-κB was used to pretreat the transfected cells. RESULTS: OPN increased osteoclast proliferation and differentiation, but reduced osteoblasts proliferation and differentiation. OPN activated the NF-κB pathway during periapical periodontitis and accelerated the transfer and phosphorylation of P65 from the cytoplasm to the nucleus. CONCLUSION: This study demonstrated that OPN played important roles in the progression of periapical periodontitis, and a dual role in bone metabolism during periapical periodontitis, linking osteoclasts and osteoblasts. The underlying mechanism may be related to the NF-κB pathway.


Assuntos
NF-kappa B/metabolismo , Osteopontina/metabolismo , Periodontite Periapical/patologia , Transdução de Sinais , Animais , Catepsina K/genética , Catepsina K/metabolismo , Diferenciação Celular/efeitos dos fármacos , Modelos Animais de Doenças , Humanos , Interleucina-6/genética , Interleucina-6/metabolismo , Lipopolissacarídeos/farmacologia , Masculino , Mandíbula/diagnóstico por imagem , Camundongos , Camundongos Endogâmicos C57BL , Osteopontina/antagonistas & inibidores , Osteopontina/genética , Periodontite Periapical/diagnóstico por imagem , Periodontite Periapical/metabolismo , Tecido Periapical/diagnóstico por imagem , Tecido Periapical/metabolismo , Ligamento Periodontal/metabolismo , Células RAW 264.7 , Interferência de RNA , RNA Interferente Pequeno/metabolismo
18.
J Endod ; 44(10): 1583-1592, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30174105

RESUMO

This article describes 2 unusual cases of mucosal fenestration associated with necrotic infected teeth, resulting in exposure of the root apex to the oral cavity. Both cases consisted of maxillary incisors with pulp necrosis and radiographic/tomographic evidence of apical periodontitis. Clinically, the root apex was exposed to the oral cavity through a fenestration in both bone and mucosa and covered with bacterial plaque and calculus. These teeth were treated by a combination of nonsurgical and surgical endodontic treatment. During surgery, the root apices were resected to within the alveolus and the fenestrated area covered by the flap. Specimens consisting of the root apex and surrounding soft tissues were subjected to histopathological and histobacteriological analyses. Histobacteriological analysis revealed extensive resorptive defects on the root apices filled with thick bacterial biofilm, irregular detachment of the cementum layers with consequent infection of the underlying spaces, and heavy infection in the apical foramina. The soft tissue specimens exhibited no or minimal inflammation. The 2 cases showed satisfactory postsurgical healing of the hard and soft tissues. Both cases of mucosal fenestration showed root apices covered with dense bacterial biofilms and associated with a bone crypt with no significant inflammatory tissue therein. The 2 cases were successfully treated by conservative approaches involving a combination of nonsurgical and surgical endodontic treatment with root-end resection.


Assuntos
Cálculos/microbiologia , Placa Dentária/microbiologia , Necrose da Polpa Dentária/complicações , Incisivo , Doenças da Boca/etiologia , Doenças da Boca/patologia , Mucosa Bucal/patologia , Periodontite Periapical/etiologia , Periodontite Periapical/microbiologia , Ápice Dentário/microbiologia , Ápice Dentário/patologia , Adulto , Biofilmes , Cálculos/patologia , Placa Dentária/patologia , Necrose da Polpa Dentária/diagnóstico por imagem , Necrose da Polpa Dentária/terapia , Endodontia/métodos , Feminino , Humanos , Masculino , Maxila , Pessoa de Meia-Idade , Doenças da Boca/terapia , Periodontite Periapical/diagnóstico por imagem , Periodontite Periapical/terapia , Ápice Dentário/cirurgia , Resultado do Tratamento
19.
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
20.
J Endod ; 44(8): 1308-1316, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30053937

RESUMO

This article describes a case of large persistent posttreatment apical periodontitis associated with 2 maxillary incisors, which was successfully managed by periradicular surgery. Histobacteriologic analysis revealed that the lesion was a granuloma that contained in its body a very large actinomycoticlike colony surrounded by accumulations of polymorphonuclear leukocytes and showing no direct communication with the root canal systems from both teeth. One incisor had no evidence of persistent intraradicular infection, whereas the other exhibited some residual dentinal tubule infection in the apical canal, which may have not significantly contributed to persistent inflammation given the organization and agglomeration of inflammatory cells around the large extraradicular bacterial colony. Findings showed that the main cause of persistent disease was the extraradicular infection in the form of a large bacterial floc, apparently independent of an intraradicular infection and as such only solved by surgery.


Assuntos
Periodontite Periapical/microbiologia , Adolescente , Feminino , Humanos , Incisivo/microbiologia , Periodontite Periapical/diagnóstico por imagem , Periodontite Periapical/cirurgia , Tecido Periapical/microbiologia , Tecido Periapical/patologia , Radiografia Dentária , Tratamento do Canal Radicular/métodos
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