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1.
Int Endod J ; 54(5): 646-654, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33630330

RESUMO

The European Society of Endodontology (ESE) is in the process of developing S3Level Clinical Practice Guidelines for the treatment of pulpal and apical disease for the benefit of clinicians and patients. In order to ensure a homogenous review process in the development of the clinical practice guidelines, it is essential that the core outcomes for all endodontic treatments are standardized and recommendations are made regarding minimum follow-up time specific to each outcome measure. In the absence of a recognized core outcome set in Endodontics, the current project aimed to follow an established consensus process to define the most appropriate clinician and patient-reported outcomes. As part of the project, recommendations will also be agreed regarding an acceptable minimum follow-up period for studies by literature review and group discussion. The selected outcome measures and follow-up periods will be used in subsequent systematic analyses of the literature to investigate the effectiveness of endodontic treatment to alleviate pulpitis and apical periodontitis. In this paper, previous reviews, ESE Guidelines and Position Statements were searched in order to compile a list of potentially important outcome measures for the treatment of pulpitis (working group 1), the nonsurgical treatment of apical periodontitis (working group 2), the surgical treatment of apical periodontitis (working group 3) and the regenerative treatment of apical periodontitis (working group 4). Initially, the two S3 guideline leads selected two independent senior clinical academics with experience of evidence-based dentistry to lead each of the four working groups forming a 10-member steering group. The working group leads in turn selected 32 academics with experience of evidence-based dentistry to lead the individual systematic reviews contained within the respective working groups. These 42 individuals make up the Guideline Development Group (GDG). Prior to the selected systematic reviewers commencing writing and submitting the review protocol, the complete list of outcome variables identified in this document will be ranked by the 42 members of the GDG in their importance to the individual patient using a 9-point Likert scale. A summary of the survey scores will thereafter be shared with the members of the group and the final list of clinician and patient-reported outcome measures rated as critical for decision making (7-9 on Likert scale by majority of survey participants) to guide systematic reviews will be consented and confirmed during an online meeting of the steering group. In this online meeting, another aspect with regard to meaningfulness of clinical trial results to be addressed in systematic reviews will be consented: length of follow-up. In order to develop high quality guidelines, it is suggested that the follow-up period after treatment should be related to the specific outcome measure being addressed; however, a minimum of one year for assessing the effectiveness of treatments for pulpitis and apical periodontitis should be considered. It is accepted, that selected research questions that focus on pain, swelling, medication taken or investigating diagnostic accuracy are likely to have shorter follow-up periods. As a result of the GDG consensus process, the outcome measures and length of follow-up will, alongside the use of standard instruments to assess the methodological quality of clinical trials and other comparative studies, be applied to all the commissioned systematic reviews that will inform the subsequent process when developing the ESE S3 Level Clinical Practice Guidelines.


Assuntos
Endodontia , Periodontite Periapical , Pulpite , Consenso , Humanos , Avaliação de Resultados em Cuidados de Saúde , Periodontite Periapical/terapia , Guias de Prática Clínica como Assunto , Pulpite/terapia , Revisões Sistemáticas como Assunto
2.
J Endod ; 47(5): 711-720, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33548330

RESUMO

INTRODUCTION: Proresolving lipid mediators are specialized molecules (SPMs) involved in the active resolution of the inflammatory process by regulating tissue homeostasis. The aim of this study was to investigate the scientific literature to assess the potential of SPMs as an adjunct in the treatment of endodontic infection. METHODS: Three electronic databases (PubMed, Web of Science, and Scopus) were searched from their inception until February 2020 (PROSPERO CRD42020164743). Supplemental research was performed by screening the references of the relevant studies eligible for inclusion. A quality assessment of animal studies was performed using the Animal Research: Reporting of In Vivo Experiments guidelines, whereas the Systematic Review Centre for Laboratory animal Experimentation Risk of Bias tool was used to assess the risk of bias. RESULTS: A total of 3295 records were screened, and 8 articles meeting the criteria were included for this qualitative review. The eligible studies showed a high to moderate overall quality and a low to moderate risk of bias. SPMs positively affected the development of pulpitis and apical periodontitis in experimental animal models. The early treatment of pulpitis with the topical application of SPMs was beneficial to control inflammation within 24 hours from contamination. In addition, SPMs delivered within the root canals after disinfection were found effective in promoting periapical healing. CONCLUSIONS: Our findings suggest that SPMs may play a role in the inception and treatment of pulpal-periapical diseases, and they should be considered for future research for developing new therapeutics as an adjunct to endodontic treatment.


Assuntos
Endodontia , Periodontite Periapical , Pulpite , Animais , Assistência Odontológica , Humanos , Inflamação , Periodontite Periapical/terapia
3.
Aust Endod J ; 47(1): 105-112, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33523556

RESUMO

Cemento-osseous dysplasia (COD) is a lesion in which periapical bone is replaced by fibrous tissue, including osseous or cementum-like tissue. In the initial stage of COD, radiolucencies are noted at the root apex on periapical radiography, which can be confused with apical periodontitis. Understanding of correct pathological condition and careful assessment of COD is critical to avoid unnecessary endodontic interventions in healthy teeth. This report describes the ability and usefulness of cone-beam computed tomography (CBCT) and multi-slice computed tomography (MSCT) to detect COD. The findings in this case suggest that MSCT is more appropriate than CBCT, especially for patients with early- to middle-stage COD. However, the radiation dose is higher in MSCT than in CBCT; the application of MSCT should be limited to assessment of whether treatment or surgical management is necessary.


Assuntos
Periodontite Periapical , Tomografia Computadorizada de Feixe Cônico , Humanos , Periodontite Periapical/diagnóstico por imagem , Periodontite Periapical/terapia , Tomografia Computadorizada por Raios X
4.
J Appl Oral Sci ; 29: e20210483, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33503222

RESUMO

OBJECTIVE: The aim of this study was to evaluate whether probiotics multi-strain formula affects the development of apical periodontitis (AP) induced in rats. METHODOLOGY: 16 Wistar rats were divided in two groups (n=8): rats with AP fed with regular diet (Control-C (CG)); rats with AP, fed with regular diet and supplemented with multi-strain formula (one billion colony-forming units (CFU)): GNC Probiotic Complex (PCG) ( Lactobacillus acidophilus, Lactobacillus salivaris, Lactobacillus plantarum, Lactobacillus rhamnosus, Bifidobacterium bifidum, Bifidobacterium animalis subs. lactis and Streptococcus thermofilus ). AP was induced in the upper and lower first molars by dental pulp exposure to the oral environment. PCG was administered orally through gavage for 30 days during the AP development. After this period the animals were euthanized and the mandibles were removed and processed for histologic analysis, and immunochemical assays for interleukin (IL)-6, IL-10, IL-1ß, RANKL, OPG, and TRAP. The Mann-Whitney U test and Student's t test were performed (P<.05). RESULTS: The CG showed more intense inflammatory infiltrate than the PCG group (P<.05). IL-1ß, IL 6 and RANKL decreased in the PCG group compared with CG (P<.05). The IL-10 level increased in the PCG group (P<.05). The OPG level was similar in both groups (P>.05). The number of mature osteoclasts (TRAP-positive multinucleated cells) was lower in PCG group when compared to the CG (P<.05). CONCLUSION: Probiotic Complex modulates inflammation and bone resorption in apical periodontitis.


Assuntos
Lactobacillus rhamnosus , Periodontite Periapical , Probióticos , Animais , Suplementos Nutricionais , Periodontite Periapical/terapia , Ratos , Ratos Wistar
5.
J Endod ; 46(10): 1448-1454, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32681848

RESUMO

INTRODUCTION: This study evaluated the bacterial levels after regenerative endodontic procedures and their correlation with the treatment outcome using molecular microbiology methods. METHODS: Root canal samples of 15 necrotic immature teeth were analyzed by quantitative polymerase chain reaction. Bacteria were counted before treatment (S1), after irrigation with 6% sodium hypochlorite (S2), and after intracanal dressing (S3) using either triple antibiotic paste (n = 7) or calcium hydroxide with chlorhexidine (n = 8). The Wilcoxon test for related samples and the Mann-Whitney test were used for statistical analysis (P < .05). After a follow-up period of 12-48 months, clinical and radiographic findings were correlated with microbiological data using a linear regression model (P < .05). RESULTS: All S1 and S2 samples were positive for bacteria, but the number of positive S3 samples decreased to 53.3% (P = .001). Overall, there was a significant reduction of bacterial levels after each treatment step (S1-S2, P = .001; S2-S3, P = .02). In the triple antibiotic paste and chlorhexidine groups, 57.1% and 50% of S3 samples were positive with median numbers of 6.97 × 103 and 3.59 × 104 bacterial cells, respectively. No significant differences were found between the groups. Periapical healing occurred in all cases despite the presence of low levels of residual bacteria. However, the latter had a negative impact on the thickness of dentinal walls (R2 = 0.0043). CONCLUSIONS: Although the bacterial levels were drastically reduced after the regenerative endodontic procedures, the residual bacteria influenced the thickness of the dentinal walls.


Assuntos
Periodontite Periapical/terapia , Endodontia Regenerativa , Hidróxido de Cálcio/uso terapêutico , Cavidade Pulpar , Necrose da Polpa Dentária/terapia , Irrigantes do Canal Radicular/uso terapêutico , Preparo de Canal Radicular , Tratamento do Canal Radicular , Hipoclorito de Sódio/uso terapêutico
6.
J Endod ; 46(10): 1371-1386.e8, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32673634

RESUMO

INTRODUCTION: This study aimed to summarize data on apical periodontitis (AP) and nonsurgical root canal treatment (NSRCT) prevalence and risk factors related to age, gender, and quality of restorative and endodontic treatment in the general population from cross-sectional studies published between 2012 and 2020. METHODS: An electronic search was performed in the following databases: Web of Science, Scopus, and PubMed. The conducted literature search covered studies published between 2012 and 2020, without restrictions on language. The STROBE and NOS tools were used for quality assessment of the included studies. RESULTS: Sixteen articles were included in the review. In total, 200,041 teeth were examined. On average, 6.3% of teeth had AP, and 7.4% had NSRCT. Forty-one percent of RCT teeth had AP, and 3.5% of untreated teeth had AP. Female patients were less prone to AP in endodontically treated teeth only, compared with male patients (P < .001). Variable stratification of age subgroups among included studies prevented us from conducting a meta-analysis. An increase in AP frequency was found in teeth with inadequate restorative and endodontic treatment (P < .001 and P < .001, respectively). Because of high heterogeneity, these results should be taken with caution. CONCLUSIONS: There is an increased AP prevalence in the adult general population compared with data from 2012 (6.3% versus 5.4%) in both endodontically treated (41.3% versus 35.9%) and untreated teeth (3.5% versus 2.1%). In addition, AP developed less frequently in female patients with endodontically treated teeth and in teeth with inadequate compared with adequate restorative and endodontic treatment.


Assuntos
Periodontite Periapical/epidemiologia , Periodontite Periapical/terapia , Dente não Vital/epidemiologia , Adulto , Estudos Transversais , Cavidade Pulpar , Feminino , Humanos , Masculino , Prevalência , Tratamento do Canal Radicular/efeitos adversos
7.
J Endod ; 46(12): 1920-1927.e1, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32532626

RESUMO

INTRODUCTION: Cell therapy in regenerative endodontics introduces an alternative option to classic treatment strategies for complex endodontic cases. The aim of this case report was to describe cell-based therapy using allogeneic umbilical cord mesenchymal stem cells (UC-MSCs) encapsulated in a bioscaffold for a complex case of a mature permanent tooth with apical periodontitis and accidental root perforation. METHODS: A healthy 19-year-old man undergoing orthodontic treatment was referred for endodontic treatment in tooth #7; he was diagnosed with apical periodontitis during a previously initiated treatment associated with accidental perforation of the radicular cervical third. The root perforation was sealed with glass ionomer and composite resin, and the root canal was instrumented, disinfected, and dressed with calcium hydroxide. After 3 weeks, allogeneic UC-MSCs were encapsulated in platelet-poor plasma and then implanted into the root canal, and Biodentine (Septodont, Saint-Maur-des-Fosses, France) was placed below the cementoenamel junction. Finally, the tooth was restored with composite resin. RESULTS: Follow-up examinations were performed 6 months and 1 year later. The examinations included periapical radiography, cone-beam computed tomographic imaging, and sensitivity and vitality tests. Radiographic and cone-beam computed tomographic images indicated remission of the apical lesion. Clinical evaluations revealed normal responses to percussion and palpation tests; the tooth was responsive to the electric pulp test, and the vitality test indicated low blood perfusion units. CONCLUSIONS: This case report reveals the potential use of allogeneic cellular therapy using encapsulated UC-MSCS in a platelet-poor plasma scaffold for a complex case of a permanent tooth with apical periodontitis and root perforation.


Assuntos
Transplante de Células-Tronco Hematopoéticas , Periodontite Periapical , Adulto , Terapia Baseada em Transplante de Células e Tecidos , Necrose da Polpa Dentária , França , Humanos , Masculino , Periodontite Periapical/terapia , Tratamento do Canal Radicular/efeitos adversos , Raiz Dentária , Adulto Jovem
8.
Int J Oral Sci ; 12(1): 18, 2020 06 18.
Artigo em Inglês | MEDLINE | ID: mdl-32555173

RESUMO

Once pulp necrosis or apical periodontitis occurs on immature teeth, the weak root and open root apex are challenging to clinicians. Berberine (BBR) is a potential medicine for bone disorders, therefore, we proposed to apply BBR in root canals to enhance root repair in immature teeth. An in vivo model of immature teeth with apical periodontitis was established in rats, and root canals were filled with BBR, calcium hydroxide or sterilized saline for 3 weeks. The shape of the roots was analyzed by micro-computed tomography and histological staining. In vitro, BBR was introduced into stem cells from apical papilla (SCAPs). Osteogenic differentiation of stem cells from apical papilla was investigated by alkaline phosphatase activity, mineralization ability, and gene expression of osteogenic makers. The signaling pathway, which regulated the osteogenesis of SCAPs was evaluated by quantitative real time PCR, Western blot analysis, and immunofluorescence. In rats treated with BBR, more tissue was formed, with longer roots, thicker root walls, and smaller apex diameters. In addition, we found that BBR promoted SCAPs osteogenesis in a time-dependent and concentration-dependent manner. BBR induced the expression of ß-catenin and enhanced ß-catenin entering into the nucleus, to up-regulate more runt-related nuclear factor 2 downstream. BBR enhanced root repair in immature teeth with apical periodontitis by activating the canonical Wnt/ß-catenin pathway in SCAPs.


Assuntos
Berberina/farmacologia , Osteogênese/efeitos dos fármacos , Periodontite Periapical/terapia , Células-Tronco/efeitos dos fármacos , Via de Sinalização Wnt/efeitos dos fármacos , Animais , Diferenciação Celular/efeitos dos fármacos , Papila Dentária , Masculino , Ratos , Células-Tronco/citologia , Células-Tronco/metabolismo , Proteína Wnt3A/genética , Proteína Wnt3A/metabolismo , Microtomografia por Raio-X
9.
Endodoncia (Madr.) ; 38(1): 44-48, jun. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-199208

RESUMO

Desde la introducción del término revascularización en 1971, muchos han sido los protocolos descritos para el tratamiento de un diente inmaduro con necrosis pulpar y periodontitis apical. La complejidad que supone la realización de técnicas de apicoformación en dientes con raíces cortas, paredes frágiles, ápices no formados y divergentes, permiten que el tratamiento de endodoncia regenerativa esté indicado. El caso que presentamos a continuación se trata de un paciente de corta edad que acude a la consulta por presentar dolor en el cuarto cuadrante. Tras la anamnesis y pruebas complementarias, llegamos al diagnóstico de necrosis pulpar con periodontitis apical sintomática del diente 44. En la radiografía podemos apreciar la presencia de una raíz corta, con paredes frágiles y ápice no formado. Tras hablar con los padres del paciente decidimos optar por el tratamiento de endodoncia regenerativa. Discutiremos a lo largo del caso la técnica empleada durante la realización de este caso clínico, centrándonos en la desinfección del interior del sistema de conductos, y la posterior creación de una matriz de andamiaje necesaria para poder colocar nuestro material biocerámico. En el apartado de discusión acercaremos al clínico las distintas opciones presentes en la literatura para afrontar la desinfección, medicación intraconducto y material de sellado, pilares fundamentales para el éxito del tratamiento de endodoncia regenerativa. En el seguimiento del caso, el paciente se presenta totalmente asintomático, con un desarrollo radicular completo y una formación de las paredes que devuelven la integridad al diente inmaduro


Since the introduction of the term revascularization in 1971, there have been many specific protocols for the treatment of an immature tooth with pulp necrosis and apical periodontitis. The complexity of performing apexification techniques on teeth with short roots, fragile walls, and non-formed and divergent apices, allows regenerative endodontic treatment to be indicated. The case presented below is about a young patient who comes to the office for presenting pain in the fourth quadrant. After the anamnesis and complementary tests, we arrived at the diagnosis of pulp necrosis with symptomatic apical periodontitis of tooth 44. On radiography, we can detect the presence of a short root, with fragile walls and an unformed apex. After talking with the patient's parents, we decided to opt for regenerative endodontic treatment. We will discuss throughout the case the technique used during the realization of this clinical case, focusing on the disinfection of the interior of the duct system, and the subsequent creation of a scaffolding matrix necessary to be able to place our bioceramic material. In the discussion section we will approach the clinician the different options present in the literature to deal with disinfection, intra-conduction medication and sealing material, fundamental pillars for the success of regenerative endodontic treatment. In the follow-up of the case, the patient appears totally asymptomatic, with a complete root development and a formation of the walls that restore integrity to the immature tooth


Assuntos
Humanos , Criança , Endodontia Regenerativa/métodos , Necrose da Polpa Dentária/terapia , Periodontite Periapical/terapia , Periodontite Periapical/diagnóstico por imagem , Necrose da Polpa Dentária/diagnóstico por imagem , Radiografia Dentária , Tratamento do Canal Radicular/métodos
10.
BMC Oral Health ; 20(1): 29, 2020 01 30.
Artigo em Inglês | MEDLINE | ID: mdl-32000767

RESUMO

BACKGROUND: To report a case of type III dens invaginatus associated with peri-invagination periodontitis in an immature permanent mandibular central incisor with open apex, in which only the invagination area was treated and vitality was preserved. CASE PRESENTATION: A 9-year-old boy was referred complaining of pain in the mandibular left central incisor. After radiographic examination, an invagination into the pulp chamber of the tooth associated with periapical radiolucency was detected. Endodontic access was performed and the orifice was identified under a dental operating microscope. The invagination area was chemo-mechanically cleaned. After 1 week, the invagination was obturated with mineral trioxide aggregate. During the 2-year follow up period, the tooth was asymptomatic. Radiographic examination revealed significant progression of periapical healing and root development in the main root canal of the tooth. CONCLUSION: Non-surgical root canal treatment of the invagination may preserve pulp vitality, and continuous root development of the tooth.


Assuntos
Dens in Dente/terapia , Incisivo/anormalidades , Periodontite Periapical/terapia , Criança , Cavidade Pulpar/patologia , Necrose da Polpa Dentária/terapia , Humanos , Incisivo/diagnóstico por imagem , Masculino , Radiografia Interproximal , Reprodutibilidade dos Testes , Tratamento do Canal Radicular , Coroa do Dente/anormalidades , Coroa do Dente/diagnóstico por imagem , Raiz Dentária/anormalidades , Raiz Dentária/diagnóstico por imagem
11.
BMC Oral Health ; 20(1): 23, 2020 01 29.
Artigo em Inglês | MEDLINE | ID: mdl-31996198

RESUMO

BACKGROUND: This study, by using a variable-controlled survey model, sought to compare clinical decisions made by dentists with different clinical backgrounds in South Korea regarding teeth with apical periodontitis and to identify factors that influenced decision-making. METHODS: A questionnaire with 36 questions about identical patient information, clinical signs, and symptoms was filled out by participants. Each question referred to a radiograph that had been manipulated using computer software in order to control tooth-related factors. Participants were instructed to record their demographic information and choose the ideal treatment option related to each radiograph. Simple and multivariable logistic regression analyses (p < .05) were used to investigate factors related to the decision to extract the tooth. We divided factors into dentist-related factors (gender, years of experience, and professional registration) and tooth-related factors (tooth position, coronal status, root canal filling status, and size of the periapical radiolucency). Dentists were categorized into three groups, based on professional registration: general dental practitioners (GDPs), endodontists, and other specialists. Simple logistic regression analysis (p < .05) was used to evaluate the tooth-related factors influencing extraction, depending on the dentists' specialty. RESULTS: Participants mostly preferred saving the teeth over extraction. This preference was highest among the endodontists, followed by other specialists and GDPs. Extractions were significantly preferred for molars, teeth with previous root canal fillings, and those with apical lesions greater than 5 mm. CONCLUSIONS: This study suggests that dentists' decision-making regarding teeth with apical periodontitis was associated with their work experience and specialty and influenced by tooth position, root canal filling status, and size of the apical lesion. CLINICAL RELEVANCE: This survey revealed that clinical decision-making related to teeth with apical periodontitis was affected by dentists' specialty and work experience and by tooth-related factors, such as tooth position, root canal filling status, and size of the apical lesion.


Assuntos
Tomada de Decisão Clínica/métodos , Odontólogos/psicologia , Periodontite Periapical , Padrões de Prática Odontológica/estatística & dados numéricos , Tratamento do Canal Radicular , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Periodontite Periapical/diagnóstico , Periodontite Periapical/terapia , República da Coreia , Inquéritos e Questionários
12.
J Microbiol ; 58(4): 314-319, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31989544

RESUMO

Apical periodontitis is caused by biofilm-mediated root canal infection. Early phase oral bacterial biofilms are inhibited by Lactobacillus plantarum lipoteichoic acid (Lp.LTA). However, mature biofilms that develop over 3 weeks are more resistant to traditional endodontic medicaments. Therefore, this study examined the effectiveness of Lp.LTA on disrupting mature Enterococcus faecalis biofilms, and on enhancing the effects of endodontic medicaments. LTA was purified from L. plantarum through butanol extraction followed by hydrophobic and ion-exchange chromatography. E. faecalis biofilms were formed over 3 weeks on glass bottom dishes and in dentin blocks obtained from human single-rooted premolars. These mature biofilms were treated with or without Lp.LTA for 1 h, followed by additional treatment with either chlorhexidine digluconate (CHX), calcium hydroxide (CH), or triple antibiotics for 24 h. Biofilms on glass were live/dead stained and quantified by ZEN through confocal laser microscopy. Bio-films in dentin were fixed, sputter coated and analyzed by ImageJ with scanning electron microscopy. Preformed E. faecalis mature biofilms on the culture dishes were dose-dependently disrupted by Lp.LTA. Lp.LTA potentiated the effects of CHX or CH on the disruption of mature biofilm. Interestingly, CHX-induced disruption of preformed E. faecalis mature biofilms was synergistically enhanced only when pre-treated with Lp.LTA. Furthermore, in the dentin block model, Lp.LTA alone reduced E. faecalis mature biofilm and pre-treatment with Lp.LTA promoted the anti-biofilm activity of CHX. Lp.LTA could be an anti-biofilm or supplementary agent that can be effective for E. faecalis-biofilm-induced diseases.


Assuntos
Antibacterianos/farmacologia , Biofilmes/efeitos dos fármacos , Dentina/microbiologia , Enterococcus faecalis/efeitos dos fármacos , Lipopolissacarídeos/farmacologia , Ácidos Teicoicos/farmacologia , Dente Pré-Molar/microbiologia , Hidróxido de Cálcio/uso terapêutico , Clorexidina/análogos & derivados , Clorexidina/uso terapêutico , Infecções por Bactérias Gram-Positivas/terapia , Humanos , Lactobacillus plantarum/metabolismo , Periodontite Periapical/terapia
13.
J Appl Oral Sci ; 28: e20190100, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31800872

RESUMO

OBJECTIVE: This clinical study sought to evaluate the effectiveness of passive ultrasonic activation (PUA) in eliminating microorganisms in primary endodontic infection (PEI) after instrumentation of root canals using microbiological culture and checkerboard DNA-DNA hybridization. METHODOLOGY: Twenty root canals with PEI and apical periodontitis were selected. The root canals were instrumented and then randomly divided into 2 groups, according to the irrigation method: PUA and conventional needle irrigation (CNI). Microbiological samples were collected before instrumentation (S1), after instrumentation (S2) and after irrigation with 17% EDTA (S3). The samples were subjected to anaerobic culture technique and checkerboard DNA-DNA hybridization analysis. RESULTS: A statistically significant difference was found between CNI (23.56%) and PUA (98.37%) regarding the median percentage values for culturable bacteria reduction (p<0.05). In the initial samples, the most frequently detected species was S. constellatus (50%), and after root canal treatment was E. faecalis (50%). CONCLUSION: Both treatments significantly decreased the number of bacterial species compared with the initial sample. However, no statistical difference in the total microbial load between PUA and CNI groups was detected. The number of cultivable anaerobic bacteria reduced significantly using PUA, and the bacterial composition and number of bacterial species after using either CNI or PUA was similar.


Assuntos
Cavidade Pulpar/microbiologia , Periodontite Periapical/terapia , Tratamento do Canal Radicular/instrumentação , Terapia por Ultrassom/instrumentação , Adolescente , Adulto , Análise de Variância , Bactérias/isolamento & purificação , Carga Bacteriana , Contagem de Colônia Microbiana , Tomografia Computadorizada de Feixe Cônico , Sondas de DNA , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Irrigantes do Canal Radicular/uso terapêutico , Tratamento do Canal Radicular/métodos , Hipoclorito de Sódio/uso terapêutico , Irrigação Terapêutica/instrumentação , Irrigação Terapêutica/métodos , Resultado do Tratamento , Terapia por Ultrassom/métodos , Adulto Jovem
14.
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
15.
Clin Oral Investig ; 24(7): 2247-2257, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31650315

RESUMO

OBJECTIVES: To compare the root filling quality, the sealer extrusion, and the healing rates of apical lesions addressed via two endodontic treatment approaches. The hypothesis tested was that both techniques present similar apical periodontitis healing results. MATERIALS AND METHODS: This study was a parallel-design, pragmatic, and randomized clinical trial. One hundred twenty anterior teeth with necrotic pulps and apical periodontitis were randomly allocated to be either instrumented with hand files and obturated with the lateral compaction technique or instrumented with a single file in a reciprocating movement and obturated with a single-cone technique. The root canal filling quality, the occurrence of sealer extrusion, and apical periodontitis healing were the outcomes of interest. Data were analyzed through chi-square analysis, and the odds ratio for healing was adjusted using a logistic regression model (α = 0.05). RESULTS: No significant differences were observed between the endodontic techniques regarding the root filling quality or sealer extrusion. Six months after treatment, both endodontic techniques presented equivalent results regarding apical periodontitis healing. The healing rate was affected only by the periapical status at baseline. CONCLUSIONS: The obturation of the root canal of the anterior teeth using reciprocating file-matched single cones presented a similar quality to that obtained with manual instrumentation followed by the lateral condensation technique. Similar healing rates of apical lesions were also observed. CLINICAL RELEVANCE: For treating anterior teeth with apical periodontitis, a reciprocating single-file, single-treatment protocol was as effective as a traditional protocol combining hand instrumentation and the lateral compaction obturation technique.


Assuntos
Periodontite Periapical , Materiais Restauradores do Canal Radicular , Preparo de Canal Radicular , Humanos , Periodontite Periapical/terapia , Obturação do Canal Radicular , Tratamento do Canal Radicular
16.
J Endod ; 46(1): 116-123, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31761331

RESUMO

The current American Association of Endodontists clinical considerations for a regenerative endodontic procedure state that a regenerative procedure is suitable for immature permanent teeth with necrotic pulp when the pulp space is not needed for a post/core in the final restoration. Therefore, many immature permanent teeth with necrotic pulp that have sustained a substantial loss of coronal tooth structure either from caries or trauma are treated by apexification or mineral trioxide aggregate/Biodentine (Septodent, Lancaster, PA) apical barrier techniques in which no further root maturation would occur. This case series presents 10 immature permanent teeth with necrotic pulp in which a post/core was likely required in the future for adequate coronal restoration because of loss of substantial coronal tooth structure and a modified apexification procedure was used. All 10 cases after the modified apexification procedure showed no clinical symptoms/signs and showed radiographic evidence of healed/healing of periapical lesion after a 2-year review. Eight cases showed increased thickness of the apical root canal walls, increased apical root length, and apical closure. The overall percentage change in root length was 7.52%, in root width at the apical one third it was 18.89%, and in radiographic root area it was 15.04% at the 24- to 72-month follow-up period. This modified apexification procedure allows for the tooth to be restored with a post/core if required for the final restoration in the future as well as continued root development.


Assuntos
Apexificação , Necrose da Polpa Dentária , Periodontite Periapical , Materiais Restauradores do Canal Radicular , Necrose da Polpa Dentária/terapia , Combinação de Medicamentos , Humanos , Óxidos , Periodontite Periapical/terapia , Tratamento do Canal Radicular , Silicatos , Ápice Dentário
17.
Inflamm Bowel Dis ; 26(2): 273-279, 2020 01 06.
Artigo em Inglês | MEDLINE | ID: mdl-31247107

RESUMO

BACKGROUND: Deep carious lesions cause pulpitis, pulpal necrosis and, finally, apical periodontitis (AP). Root canal treatment (RCT) is the treatment of choice for AP, changing the tooth into a root-filled tooth (RFT). Several studies have linked AP and RFT to systemic diseases. Likewise, previous studies have also found an association among inflammatory bowel disease (IBD) and periodontal disease. This study aims to analyze the frequency of AP and RCT in IBD patients and healthy control subjects. METHODS: An age- and gender-matched case-control study design was used. The study group (SG) included 54 IBD patients (28 with Crohn´s disease, 26 with ulcerative colitis). Another 54 healthy subjects without IBD and age- and gender-matched were included in the control group (CG). The radiographic records were analyzed, and periapical radiolucencies were diagnosed as AP, using the periapical index (PAI). The statistical analysis was carried out using the Student t test, χ 2 test, and multivariate logistic regression. RESULTS: The presence of 1 or more teeth with radiolucent periapical lesions (RPLs) was found in 19 patients (35.2%) in the study group and in 9 subjects (16.7%) in the control group (P = 0.03). No differences were found among the 2 groups neither in the amount of teeth with AP nor in the number of RFTs (P > 0.05). However, multivariate logistic regression analysis adjusting for number of teeth and number of RFTs showed that patients with IBD have RPLs with higher likelihood than control patients (odds ratio, 5.7; confidence interval 95%, 1.7-19.1; P = 0.0048). CONCLUSIONS: Subjects with inflammatory bowel disease have higher prevalence of apical periodontitis. An oral health protocol should be established to address the higher prevalence of inflammatory oral processes.


Assuntos
Doenças Inflamatórias Intestinais/complicações , Saúde Bucal , Periodontite Periapical/epidemiologia , Adolescente , Adulto , Fatores Etários , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Doenças Inflamatórias Intestinais/patologia , Masculino , Periodontite Periapical/terapia , Prevalência , Prognóstico , Tratamento do Canal Radicular/métodos , Fatores Sexuais , Espanha/epidemiologia , Adulto Jovem
18.
J. appl. oral sci ; 28: e20190100, 2020. tab, graf
Artigo em Inglês | LILACS, BBO - Odontologia | ID: biblio-1056594

RESUMO

Abstract Objective: This clinical study sought to evaluate the effectiveness of passive ultrasonic activation (PUA) in eliminating microorganisms in primary endodontic infection (PEI) after instrumentation of root canals using microbiological culture and checkerboard DNA-DNA hybridization. Methodology: Twenty root canals with PEI and apical periodontitis were selected. The root canals were instrumented and then randomly divided into 2 groups, according to the irrigation method: PUA and conventional needle irrigation (CNI). Microbiological samples were collected before instrumentation (S1), after instrumentation (S2) and after irrigation with 17% EDTA (S3). The samples were subjected to anaerobic culture technique and checkerboard DNA-DNA hybridization analysis. Results: A statistically significant difference was found between CNI (23.56%) and PUA (98.37%) regarding the median percentage values for culturable bacteria reduction (p<0.05). In the initial samples, the most frequently detected species was S. constellatus (50%), and after root canal treatment was E. faecalis (50%). Conclusion: Both treatments significantly decreased the number of bacterial species compared with the initial sample. However, no statistical difference in the total microbial load between PUA and CNI groups was detected. The number of cultivable anaerobic bacteria reduced significantly using PUA, and the bacterial composition and number of bacterial species after using either CNI or PUA was similar.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Periodontite Periapical/terapia , Tratamento do Canal Radicular/instrumentação , Terapia por Ultrassom/instrumentação , Cavidade Pulpar/microbiologia , Irrigantes do Canal Radicular/uso terapêutico , Tratamento do Canal Radicular/métodos , Hipoclorito de Sódio/uso terapêutico , Bactérias/isolamento & purificação , Terapia por Ultrassom/métodos , Contagem de Colônia Microbiana , Sondas de DNA , Modelos Lineares , Análise de Variância , Resultado do Tratamento , Tomografia Computadorizada de Feixe Cônico , Carga Bacteriana , Irrigação Terapêutica/instrumentação , Irrigação Terapêutica/métodos
19.
J. appl. oral sci ; 28: e20190100, 2020. tab, graf
Artigo em Inglês | LILACS, BBO - Odontologia | ID: biblio-1090785

RESUMO

Abstract Objective: This clinical study sought to evaluate the effectiveness of passive ultrasonic activation (PUA) in eliminating microorganisms in primary endodontic infection (PEI) after instrumentation of root canals using microbiological culture and checkerboard DNA-DNA hybridization. Methodology: Twenty root canals with PEI and apical periodontitis were selected. The root canals were instrumented and then randomly divided into 2 groups, according to the irrigation method: PUA and conventional needle irrigation (CNI). Microbiological samples were collected before instrumentation (S1), after instrumentation (S2) and after irrigation with 17% EDTA (S3). The samples were subjected to anaerobic culture technique and checkerboard DNA-DNA hybridization analysis. Results: A statistically significant difference was found between CNI (23.56%) and PUA (98.37%) regarding the median percentage values for culturable bacteria reduction (p<0.05). In the initial samples, the most frequently detected species was S. constellatus (50%), and after root canal treatment was E. faecalis (50%). Conclusion: Both treatments significantly decreased the number of bacterial species compared with the initial sample. However, no statistical difference in the total microbial load between PUA and CNI groups was detected. The number of cultivable anaerobic bacteria reduced significantly using PUA, and the bacterial composition and number of bacterial species after using either CNI or PUA was similar.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Periodontite Periapical/terapia , Tratamento do Canal Radicular/instrumentação , Terapia por Ultrassom/instrumentação , Cavidade Pulpar/microbiologia , Irrigantes do Canal Radicular/uso terapêutico , Tratamento do Canal Radicular/métodos , Hipoclorito de Sódio/uso terapêutico , Bactérias/isolamento & purificação , Terapia por Ultrassom/métodos , Contagem de Colônia Microbiana , Sondas de DNA , Modelos Lineares , Análise de Variância , Resultado do Tratamento , Tomografia Computadorizada de Feixe Cônico , Carga Bacteriana , Irrigação Terapêutica/instrumentação , Irrigação Terapêutica/métodos
20.
Shanghai Kou Qiang Yi Xue ; 29(6): 628-631, 2020 Dec.
Artigo em Chinês | MEDLINE | ID: mdl-33778831

RESUMO

PURPOSE: To investigate the effect of pulp revascularization on the levels of CCL21 and IFN-γ-inducible protein 10(IP-10)in chronic periapical periodontitis. METHODS: One hundred patients with chronic periapical periodontitis treated from September 2018 to May 2019 were selected as the research subjects. They were divided into two groups by using random number table method. The patients in both groups were taken cone-beam CT(CBCT) film for filing before operation. Patients in the experimental group were treated by pulp revascularization, while patients in the control group were treated by apexification. The level of CCL21 and IP-10 was measured within 4 weeks. The results of operation, the ratio of crown to root and the thickness of root canal wall were analyzed. Statistical analysis of the data was conducted with SPSS 25.0 software package. RESULTS: CCL21 and IP-10 levels of the two groups increased in the course of 1-3 weeks, but decreased after 4 weeks. CCL21 levels were significantly different at 2 weeks, 3 weeks and 4 weeks(P<0.05), but there was no significant difference at one week(P<0.05). There was no significant difference in IP-10 level between the two groups at 1, 2 and 3 weeks of treatment(P<0.05), but there was significant difference at 4 weeks of treatment (P<0.05). The success rate of the experimental group was 90% and that of the control group was 50%,there was a significant difference between the two groups(P<0.05). There was no significant difference in the ratio of crown to root and the thickness of root canal wall between the two groups(P<0.05). CONCLUSIONS: For chronic periapical diseases, pulp revascularization, apical induction can promote the secretion of chemokines CCL21 and IP-10 in the early stage of treatment, the level of CCL21 changes greatly in the early stage of treatment, while changes of IP-10 can be seen in the later stage.


Assuntos
Periodontite Periapical , Apexificação , Quimiocina CCL21 , Quimiocina CXCL10 , Cavidade Pulpar , Humanos , Periodontite Periapical/diagnóstico por imagem , Periodontite Periapical/terapia , Tratamento do Canal Radicular , Ápice Dentário
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