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1.
Braz Dent J ; 35: e245775, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39320000

RESUMO

This study aimed to assess the relationship between Schneiderian membrane thickening and periapical pathology in a retrospective analysis of Cone Beam Computed Tomography (CBCT) images. For this, 147 CBCT scans containing 258 sinuses and 1,181 teeth were assessed. Discontinuation of the lamina dura, widening of the periodontal ligament space, apical periodontitis (AP), and partly demineralized maxillary sinus floor associated with AP were considered periapical pathology. Maxillary sinus mucosal thickening (MSMT) was classified as odontogenic or non-odontogenic. An irregular band with a focal tooth associated thickening and local thickening related to a root were considered odontogenic types of MSMT. The relation between the imaging features of periapical pathology and the type and thickness of MSMT was determined by logistic regression and linear mixed model, respectively. In addition, linear regression and Mann Whitney test evaluated the relation and demineralization of the AP lesion towards the sinus floor (p≤0.05). The odds of having an odontogenic type of MSMT were significantly higher when a periapical pathology was present in the maxillary sinus. Eighty-two percent of AP partly demineralized towards the sinus floor were associated with an odontogenic MSMT. Both AP lesions partly demineralized towards the sinus floor and, with increased diameter, led to increased MSMT. In conclusion, there is an 82% risk of having an odontogenic type of MSMT with the presence of AP partly demineralized towards the sinus floor. More thickening of the maxillary sinus mucosa is seen with larger AP lesions and partial demineralization of the sinus floor.


Assuntos
Tomografia Computadorizada de Feixe Cônico , Mucosa Nasal , Humanos , Tomografia Computadorizada de Feixe Cônico/métodos , Estudos Retrospectivos , Mucosa Nasal/diagnóstico por imagem , Mucosa Nasal/patologia , Feminino , Masculino , Pessoa de Meia-Idade , Doenças Periapicais/diagnóstico por imagem , Doenças Periapicais/patologia , Adulto , Seio Maxilar/diagnóstico por imagem , Seio Maxilar/patologia , Periodontite Periapical/diagnóstico por imagem , Periodontite Periapical/patologia , Idoso
2.
Gerodontology ; 41(3): 436-440, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-39190677

RESUMO

OBJECTIVES: To document the case of a patient who underwent several endodontic treatments due to a glandular odontogenic cyst misdiagnosed as an inflammatory periapical lesion. BACKGROUND: Glandular odontogenic cysts behave more aggressively, while others have an indolent course. There is limited information on this cyst in the gerodontologic literature. MATERIALS AND METHODS: A 76-year-old male patient presented with an asymptomatic expansive lesion in the anterior mandible resistant to several endodontic treatments. Cone-beam computed tomography revealed a multilocular osteolytic lesion measuring 6.0 × 4.0 cm, with cortical bone perforation. RESULTS: Histopathological analysis of a biopsy specimen was consistent with glandular odontogenic cyst. The patient underwent marginal mandibulectomy with preservation of the base of the mandible. CONCLUSION: A strict diagnostic process is important to avoid unwanted consequences, particularly in the geriatric population.


Assuntos
Tomografia Computadorizada de Feixe Cônico , Erros de Diagnóstico , Cistos Odontogênicos , Humanos , Idoso , Masculino , Cistos Odontogênicos/diagnóstico , Cistos Odontogênicos/patologia , Cistos Odontogênicos/cirurgia , Doenças Mandibulares/diagnóstico , Doenças Mandibulares/cirurgia , Doenças Mandibulares/diagnóstico por imagem , Doenças Mandibulares/patologia , Doenças Periapicais/diagnóstico , Doenças Periapicais/diagnóstico por imagem , Doenças Periapicais/patologia
3.
Rev. Ateneo Argent. Odontol ; 70(1): 13-20, jul. 2024. ilus
Artigo em Espanhol | LILACS | ID: biblio-1571500

RESUMO

La terapéutica endodóntica se apoya básicamente en dos modelos teóricos o paradigmas: el concepto de "tubo hueco" técnico y quirúrgico esencialmente mecanicista, y el modelo terapéutico para conductos radiculares, que busca la restitución ad integrum de los tejidos apicales y el hueso alveolar que los rodea. La instrumentación debe complementarse con la limpieza por irrigación abundante y la obturación con un biomaterial bioactivo, con características reológicas que permitan su adaptación plástica a las paredes del conducto radicular y module la respuesta de los tejidos hacia la regeneración con aposición de tejido calcificado en el foramen apical (AU)


Endodontic therapy is basically based on two theoretical models or paradigms, which are the concept of the technical and surgical "hollow tube", essentially mechanistic, and the therapeutic model of root canals, which seeks the ad integrum restitution of the apical tissues and bone. alveolar that surrounds them. The instrumentation must be complemented with cleaning by abundant irrigation, and with a bioactive biomaterial, with rheological characteristics that allows its plastic adaptation to the walls of the root canal and modulates the response of the tissues towards regeneration with apposition of calcified tissue in the apical foramen (AU)


Assuntos
Humanos , Feminino , Adulto , Materiais Biocompatíveis , Preparo de Canal Radicular/instrumentação , Retratamento , Doenças Periapicais/complicações , Irrigantes do Canal Radicular/uso terapêutico , Ápice Dentário , Dente Molar
4.
Acta Odontol Latinoam ; 37(1): 79-87, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38920129

RESUMO

Differentiating orofacial odontogenic pain/disorders from pain/disorders associated with maxillary sinusitis is important to avoid unnecessary dentalprocedures and to properly refer patients to colleagues/dentists and vice versa. AIM: To analyze the association between apical lesions and sinus changes and to evaluate the agreement between the diagnoses of an endodontist, a radiologist, an oral and maxillofacial surgeon, and an otolaryngologist. MATERIALS AND METHOD: 385 axial, coronal, and sagittal MSCT scans were selected using an image archiving andcommunication system (PACS). The examinations had been performed between 2018 and 2022. RESULTS: Apical lesions were observed in 36.10% of sinusitis cases, 73.8% of unilateralsinusitis cases, 48.7% of sinus floor discontinuity cases, and 67.2% of cases in which endodontic treatment had been performed. Agreement between the diagnoses made by the endodontist and those made by the other investigators was high for most study variables (k > 0.60). The exceptions were mucosal thickening, for which agreement between the endodontist and the other investigators was intermediate (k=0.397), and the presence of periapicallesions (k=0.010), previous endodontic treatment (k=0.013), and mucosal thickness (k=0.024), for which agreement between endodontists and radiologists was low. Conclusions: There was an association between sinus changes and apical lesions.


Diferenciar a dor/desordens odontogénicas orofaciais da dor/desordens as sociadas á sinusite maxilar é importante para evitar procedimentos odontológicos desnecessários e para encaminhar adequadamente os pacientes aos colegas/dentistas e vice-versa. OBJETIVO: Analisar a associagdo entre lesoes apicais e alteragóes sinusais e avaliar a concordáncia entre os diagnósticos de um endodontista, um radiologista, um cirurgido bucomaxilofacial e um otorrinolaringologista. MATERIAL E MÉTODO: foram avaliadas 385 imagens. RESULTADOS: Aslesoes apicais foram observadas em 36,10% dos casos de sinusite, em 73,8% dos casos de sinusite unilateral, em 48,7% dos casos de descontinuidade do assoalho do seio e em 67,2%odos casos em que o tratamento endodontico havia sido realizado. A concordancia entre os diagnósticos feitos pelo endodontista e os feitos pelos outros pesquisadores foi alta para a maioria das variáveis do estudo (k > 0,60). As excegoes foram o espessamento da mucosa, para o qual a concordáncia entre o endodontista e os outros pesquisadores foi intermediária (k=0,397) e a presenga delesoes periapicais (k=0,010), tratamento endodontico prévio (k=0,013) e espessura da mucosa (k=0,024), para os quais a concordáncia entre endodontistas e radiologistas foi baixa. CONCLUSÕES: Houve uma associagdo entre as alteragóes sinusais e aslesoes apicais.


Assuntos
Tomografia Computadorizada Multidetectores , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores/métodos , Adulto , Doenças Periapicais/diagnóstico por imagem , Sinusite Maxilar/diagnóstico por imagem , Idoso , Adulto Jovem , Adolescente , Diagnóstico Diferencial
5.
PLoS One ; 19(2): e0297020, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38358980

RESUMO

Systemic diseases affecting the immune system can influence the body's response time to endodontic treatment, potentially necessitating a longer duration for the complete resolution of existing infections when compared to healthy controls. This systematic review aims to evaluate the association between the presence of chronic diseases and periapical status after endodontic treatment through a systematic and comprehensive assessment of existing literature on this topic. The search strategy covered seven electronic databases and grey literature, encompassing articles published until October 2023. Two reviewers independently assessed potentially eligible studies based on the following criteria: Included were studies involving populations exposed to pre-existing chronic diseases who underwent endodontic treatment in permanent teeth. These studies evaluated periapical health status, making comparisons with healthy individuals. There were no language or publication date restrictions. Additionally, two reviewers independently extracted data regarding the characteristics of the included studies. The risk of bias was assessed using the Joanna Briggs Institute Critical Assessment Checklist. Meta-analysis was conducted using random effects models. The certainty of evidence was assessed using the GRADE tool. Twenty-three studies were included in the synthesis. Patients with diabetes were found to have about half the odds of having periapical health compared to non-diabetic patients (OR = 0.46; 95% CI = 0.30-0.70%; I2 = 58%) in teeth that underwent endodontic treatment. On the other hand, other systemic diseases like HIV, cardiovascular disease, and rheumatoid arthritis did not demonstrate significant differences concerning the outcome. In conclusion, diabetic patients showed a lower likelihood of maintaining periapical health. Conversely, patients with HIV, cardiovascular disease, and rheumatoid arthritis did not exhibit significant differences, although the existing evidence is still considered limited. It is crucial to manage these patients in a multidisciplinary manner to provide appropriate care for this population.


Assuntos
Dente não Vital , Humanos , Doença Crônica , Tratamento do Canal Radicular , Doenças Periapicais/epidemiologia
6.
Rev. Ateneo Argent. Odontol ; 68(1): 8-19, jul. 2023. ilus
Artigo em Espanhol | LILACS | ID: biblio-1567882

RESUMO

La endodoncia es preventiva cuando sacrifica la totalidad o parte del tejido pulpar vital para evitar una posible invasión microbiana a los tejidos de so- porte del diente. Esta endodoncia pasa a ser curativa cuando se instala en ellos la noxa bacteriana, donde la farmacoterapéutica local alcanza una relevancia significativa. Cuando se realiza la obturación del conducto radicu- lar con un biomaterial no reabsorbible y se invade el periodonto, la posterior reparación posendodóntica solo se realiza a expensas del hueso medular y se impide el cierre de la trayectoria final del conducto radicular con tejido mineralizado de origen perio- dontal (cemento secundario). Aplicando una técnica intralesional, ya sea transfo- ramen apical o utilizando como vector un trayecto fistuloso, se viabiliza una terapia intralesional con biomateriales biodegradables y bioactivos. Se obtiene así, mayor calidad y rapidez en la regeneración ad integrum de los tejidos lesionados, por medio de la activación de la fase defensiva-constructiva y el cierre del foramen apical con tejido mineralizado. Los tejidos afectados curan con una cinética significativamente más rápida, sin recurrir a la cirugía complementaria de la endodoncia, procedimiento invasivo asociado con ciertos efectos adversos (AU)


Endodontics is preventive when it sacrifices all or part of the vital pulp tissue to avoid possible microbial invasion of the supporting tissues of the tooth. This endodontics becomes curative when bacterial noxa settles in them, where local pharmacotherapeutics reaches significant relevance. When root canal obturation is performed with a non-resorbable biomaterial and the periodontium is invaded, the subsequent postendodontic repair is only performed at the expense of the medullary bone and the closure of the final trajectory of the root canal with mineralized tissue of periodontal origin is prevented. (Secondary cement). Applying an intralesional technique, be it apical transformation or using a fistulous tract as a vector, intralesional therapy with biodegradable and bioactive biomaterials becomes viable. In this way, greater quality and speed is obtained in the ad integrum regeneration of injured tissues, through the activation of the defensive-constructive phase and the closure of the apical foramen with mineralized tissue. Affected tissues heal with significantly faster kinetics, without resorting to complementary endodontic surgery, an invasive procedure associated with certain adverse effects (AU)


Assuntos
Humanos , Feminino , Adulto , Doenças Periapicais/terapia , Aloenxertos Compostos , Cicatrização/fisiologia , Medronato de Tecnécio Tc 99m
7.
Univ. salud ; 25(1): D1-D5, ene.-abr. 2023. tab
Artigo em Espanhol | LILACS, COLNAL | ID: biblio-1424736

RESUMO

Introducción: La prevalencia de periodontitis apical en dientes con tratamiento endodóntico oscila entre el 35 y el 60%, se ha encontrado una fuerte asociación con respecto al grado de inflamación sistémica generada por la periodontitis apical, como por ejemplo altos niveles de citoquinas proinflamatorias, proteína C reactiva e interleuquina 6; estudios refieren que un tratamiento endodóntico adecuado puede reducir los niveles de proteína C reactiva en individuos sanos y con periodontitis apical. Objetivo: Evaluar la frecuencia de periodontitis apical en una población adulta colombiana seleccionada y su correlación con la calidad del tratamiento endodóntico. Materiales y métodos: Estudio observacional analítico de corte transversal, se determinó la frecuencia de periodontitis apical en 318 CBCT (Tomografía Computarizada de Haz Cónico), de pacientes de una subpoblación de Bucaramanga y Medellín y evaluó la asociación de la calidad del tratamiento endodóntico con el estado periapical. Resultados: Sólo el 37,66% de los dientes evaluados fueron considerados sanos; el 44,81% se clasificaron como tratamiento endodóntico adecuado. La calidad del tratamiento endodóntico influyó significativamente en la condición del periodonto apical. Conclusiones: Los tratamientos evaluados presentaron alta frecuencia de periodontitis apical, la cual se asoció en buena parte a la alta frecuencia de tratamientos endodónticos inadecuados.


Introduction: The prevalence of apical periodontitis in teeth with endodontic treatment ranges between 35% and 60%, and a strong association has been found with respect to high levels of systemic inflammation markers (pro-inflammatory cytokines, protein C-reactive and interleukin 6) caused by apical periodontitis. Studies have shown that an adequate endodontic treatment can reduce C-reactive protein levels in healthy individuals and those with apical periodontitis. Objective: To evaluate the frequency of apical periodontitis in a selected Colombian adult population and its correlation with the quality of endodontic treatment. Materials and methods: Observational, analytical, cross-sectional study. The frequency of apical periodontitis was determined in 318 CBCTs of patients from Bucaramanga and Medellin, and the association between quality of endodontic treatment and periapical status was analyzed. Results: Only 37.66% of the observed teeth were considered healthy, whereas 44.81% were classified as teeth with appropriate endodontic treatment. Quality of endodontic treatment significantly affected the condition of the apical periodontium. Conclusions: The analyzed treatments had a high apical periodontitis frequency, which was associated with a high frequency of inadequate endodontic treatments.


Introdução: A prevalência de periodontite apical em dentes com tratamento endodôntico varia entre 35 e 60 %, uma forte associação foi encontrada com relação ao grau de inflamação sistêmica gerada pela periodontite apical, como altos níveis de citocinas pró-inflamatórias, proteína C reativa e interleucina 6; estudos relatam que o tratamento endodôntico adequado pode reduzir os níveis de proteína C-reativa em indivíduos saudáveis ​​e naqueles com periodontite apical. Objetivo: Avaliar a frequência da periodontite apical em uma população adulta colombiana selecionada e sua correlação com a qualidade do tratamento endodôntico. Materiais e métodos: Estudo transversal analítico observacional; a frequência de periodontite apical foi determinada em 318 CBCT de pacientes de uma subpopulação de Bucaramanga e Medellín, foi avaliada a associação da qualidade do tratamento endodôntico com o estado periapical. Resultados: Apenas 37,66% dos dentes avaliados foram considerados saudáveis, 44,81% dos dentes foram classificados como tratamento endodôntico adequado. A qualidade do tratamento endodôntico influenciou significativamente a condição do periodonto apical. Conclusões: Os tratamentos avaliados apresentaram alta frequência de periodontite apical, que foi amplamente associada à alta frequência de tratamentos endodônticos inadequados.


Assuntos
Humanos , Odontologia , Doenças Periapicais , Periodontite Periapical , Tomografia Computadorizada por Raios X , Endodontia
8.
Aust Endod J ; 49 Suppl 1: 323-329, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36735354

RESUMO

This study aimed to perform an analysis of obtaining apical patency indexes during endodontic treatments considering gender, age, pulpoperiradicular diagnosis and canal/tooth (n. 639/383). Following previous clinical procedures, a thin K-File (No. 20, 15, 10 or 08) was used to achieve apical patency. These specific data and some demographic and clinical information were submitted to the statistical analysis (p < 0.05). Significant statistical differences were not identified considering gender (p = 0.156) and age (p = 0.793). However, in 14.6% of the canals of vital teeth and 14.1% of the canals of necrotic teeth without periapical lesions, apical patency could not be achieved, which occurred in only 7% of the canals of necrotic teeth with periradicular disease (p = 0.009). Considering canal/tooth, apical patency was more challenging to obtain in canals of posterior teeth (p = 0.000). The pulpoperiapical diagnosis and canal/tooth significantly influenced the obtaining of apical patency.


Assuntos
Doenças Periapicais , Periodontite Periapical , Humanos , Tratamento do Canal Radicular/métodos , Cavidade Pulpar , Necrose , Periodontite Periapical/terapia
9.
Pesqui. bras. odontopediatria clín. integr ; 23: e210078, 2023. tab, graf
Artigo em Inglês | LILACS, BBO - Odontologia | ID: biblio-1529122

RESUMO

ABSTRACT Objective: To evaluate the antibacterial effect of electrolytically generated hypochlorous acid on Streptococcus gordonii, Fusobacterium nucleatum, and Porphyromonas gingivalis. Material and Methods: In this in vitro experiment, the effect of hypochlorous acid (HOCl) on the strains S. gordonii, F. nucleatum, and P. gingivalis was evaluated using 4% sodium hypochlorite, 0.12% chlorhexidine, and distilled water as controls. The four groups were placed on each plate, and each group was replicated five times. The agar diffusion method by zones measurement was used. The data were processed with SPSS using the Kruskal-Wallis test and multiple comparison tests. Results: Hypochlorous acid showed an average inhibition halo of 9.28 mm on S. gordonii. As expected with distilled water, no zone of inhibition was noted for any of the bacteria, nor were zones of inhibition observed with HOCl for F. nucleatum and P. gingivalis. Conclusion: Hypochlorous acid showed antimicrobial properties against only S. gordonii and was less effective than 4% sodium hypochlorite and 0.12% chlorhexidine, although no significant differences were found between the latter.


Assuntos
Hipoclorito de Sódio , Antibacterianos/imunologia , Doenças Periapicais , Análise de Variância , Estatísticas não Paramétricas
10.
Braz Dent J ; 33(6): 1-12, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36477956

RESUMO

This study aimed to evaluate the association of the variables age, gender, arch position, tooth length, root canal amplitude, and periapical lesion size with the occurrence of postoperative signs and symptoms (pain, tenderness, and edema) and the use of postoperative analgesics following root canal treatment with foraminal enlargement in single-rooted teeth with apical periodontitis. This prospective longitudinal study included 105 patients requiring root canal treatment of maxillary or mandibular single-rooted teeth with periapical lesion. After root canal treatment in a single session, pain intensity and tenderness were recorded daily for 7 days and on days 14 and 30. Edema was evaluated by two independent evaluators within 48 h, 72 h, and 7 days after treatment. Ordinal and logistic regressions were performed (p < 0.05). Female gender (beta = 1.02; p < 0.01), mandibular teeth (beta = 25.50; p < 0.01), medium root canal amplitude (beta = 0.93; p = 0.03), and edema (beta = 1.88; p < 0.01) were associated with increased postoperative pain and tenderness, while the use of analgesics (beta = -1.82; p < 0.01) and time in days (beta = -0.23; p < 0.01) were associated with a decrease in these signs and symptoms. Edema was considered a risk factor for analgesic requirement (Odds Ratio [OR] = 61.46; p < 0.01). Factors such as gender, arch position, and root canal amplitude were associated with postoperative signs and symptoms. The use of analgesics was more required in edema and was associated with decreased pain.


Assuntos
Dor Pós-Operatória , Doenças Periapicais , Preparo de Canal Radicular , Tratamento do Canal Radicular , Feminino , Humanos , Estudos Longitudinais , Dor , Estudos Prospectivos , Doenças Periapicais/cirurgia , Retratamento
11.
Rev. ADM ; 79(6): 318-324, nov.-dic. 2022.
Artigo em Espanhol | LILACS | ID: biblio-1434701

RESUMO

Los antiinflamatorios no esteroideos (AINE) son un grupo de fármacos que han sido comúnmente prescritos por sus propiedades antiinflamato- rias, antipiréticas y analgésicas, mismas que se deben a la inhibición de la formación de prostaglandinas. Este mecanismo ha sido ampliamente respaldado en la literatura; sin embargo, en la actualidad poco se co- noce sobre las propiedades adicionales de estos medicamentos como el efecto antirresortivo y antimicrobiano. La función antirresortiva se debe principalmente al bloqueo de la producción de prostaglandinas en específico la PGE2, que posee gran potencial osteoclastogénico, esencial para la aparición de lesiones periapicales; asimismo, la acción antimicrobiana de los AINE está relacionada con la afectación directa de la perpetuación de biopelícula, potencian la acción de los antibióticos, entre otros. Dichos efectos combinados podrían contribuir en la cura- ción de lesiones periapicales. El objetivo de este estudio es recopilar información actualizada sobre estas funciones agregadas de los AINE, con el fin de dar a conocer a los profesionales estos beneficios en la terapéutica de las lesiones periapicales (AU)


Non-steroidal anti-inflammatory (NSAIDs) are a group of drugs that have been commonly prescribed for their anti-inflammatory, antipyretic and analgesic properties, which are due to the inhibition of prostaglandin formation. This mechanism has been widely supported in the literature; however, currently little is known about the additional properties of these drugs such as the antiresorptive and antimicrobial effect. The antiresorptive function is mainly due to the blockage of prostaglandin production, specifically PGE2, which has great osteoclastogenic potential, and is essential for the appearance of periapical lesions; likewise, the antimicrobial action of NSAIDs is related to the fact that they directly affect the perpetuation of biofilms, enhance the action of antibiotics, among others. These combined effects could contribute to the healing of periapical lesions. The aim of this study is to gather updated information on these added functions of NSAIDs, in order to inform professionals about these benefits in the therapy of periapical lesion (AU)


Assuntos
Doenças Periapicais/tratamento farmacológico , Anti-Inflamatórios não Esteroides , Infecções Bacterianas/tratamento farmacológico , Reabsorção de Dente/tratamento farmacológico
12.
Rev. Asoc. Odontol. Argent ; 110(3): 110123, sept.-dic. 2022. ilus
Artigo em Espanhol | LILACS | ID: biblio-1425181

RESUMO

Objetivo: La fibrosis periapical posendodóntica es un proceso reparativo asintomático, radiolúcido y no progresivo que se interpreta con frecuencia como una lesión patológica persistente. El diagnóstico de esta entidad suele ser dudoso y sólo puede definirse mediante la correlación de las obser- vaciones clínicas, radiográficas e histológicas. El objetivo de este informe es describir el caso de un paciente que presenta un área radiolúcida periapical persistente y asintomática en un incisivo lateral superior. Caso clínico: Luego de cuatro años y dos meses de ha- ber recibido un tratamiento endodóntico el paciente concurre a la consulta para un examen de rutina. El examen radiográfico del diente revela un área radiolúcida persistente y bien defini- da. A causa de una fractura radicular irreparable, se indicó la extracción de la pieza dentaria. Esto permitió realizar el estu- dio histológico del tejido blando que permanecía adherido en el ápice de la raíz, lo que confirmó y completó el diagnóstico de fibrosis periapical posendodóntica.(AU)


Aim: The postendodontic periapical fibrosis is an asymp- tomatic radiolucent and non-progressive healing process that is often interpreted as a persistent pathological lesion. The diagnosis of this entity is usually uncertain, and it is only de- fined by the correlation of clinical, radiographic and histo- logical observations.The aim of this report is to describe the case of a patient with a long-term persisting asymptomatic and radiolucent area in a upper lateral incisor. Clinical case: Four years and two months after receiv- ing an endodontic treatment the patient comes to our office for a routine control. Radiographic examination revealed the presence of a persistent well defined radiolucent area. Sur- gical tooth extraction was required due to the presence of a complicated root fracture.This allowed to perform a histolog- ical study of the soft tissue attached to the apex of the ex- tracted root, which confirmed and completed the diagnosis of postendodontic periapical fibrosis (AU)


Assuntos
Humanos , Masculino , Adulto , Doenças Periapicais/classificação , Doenças Periapicais/diagnóstico por imagem , Tratamento do Canal Radicular/efeitos adversos , Fibrose/diagnóstico por imagem , Extração Dentária/métodos , Diagnóstico Clínico , Seguimentos , Incisivo/lesões
13.
Rev. Asoc. Odontol. Argent ; 110(3): 1101251, sept.-dic. 2022. ilus
Artigo em Espanhol | LILACS | ID: biblio-1426046

RESUMO

La persistencia de lesiones perirradiculares luego del tra- tamiento endodóntico es un problema que requiere del clínico un conocimiento cabal de la histofisiología y de la histopato- logía del sistema de conductos radiculares del tejido pulpar y de los tejidos perirradiculares (periodonto y hueso); además de considerar siempre la posible existencia de enfermedades sistémicas que también pueden actuar como factores de in- fluencia. La presencia de bacterias remanentes a posteriori del tratamiento es considerada como una de las causas principales y más frecuentes para la perpetuación de las lesiones perirra- diculares. Sin embargo, existen otros factores causales, como la existencia de conductos laterales o accesorios infectados y no tratados, la reabsorción dentinaria interna, intercomunica- ciones, cul-de-sacs o istmos; que representan áreas de difícil acceso durante la instrumentación e irrigación. Cuando la cau- sa original se localiza en la zona perirradicular, como en los casos de actinomicosis, reacciones a cuerpo extraño, cristales de colesterol (CRCo) y granulomas o quistes con alto conte- nido de CRCo, la indicación más adecuada es el retratamiento y la cirugía periapical como complemento (AU)


The persistence of periradicular lesions after endodontic treatment is a problem that requires the doctor to have a thor- ough knowledge of the histophysiology and histopathology of the root canal system, the pulp tissue and periradicular tis- sues (periodontium and bone); as well as always considering the possible existence of systemic alterations that can also be influencing factors. Persisting bacteria within the root canal system after treatment is one of the major and most frequent causes for the perpetuation of periradicular lesions. Howev- er, there are other possible causal factors such as the exist- ence of untreated lateral or accessory canals, internal dentin resorption, intercommunications, cul-de-sacs or isthmuses; areas that represent a difficulty in access during instrumen- tation and irrigation. If the original cause is located in the periradicular area, in cases like actinomycosis, foreign-body reactions, cholesterol crystals (CRCo) and granulomas or cysts with high content of CRCo, retreatment coupled with periapical surgery is the best approach to treatment (AU)


Assuntos
Humanos , Doenças Periapicais/etiologia , Doenças da Polpa Dentária/etiologia , Infecção Focal Dentária/complicações , Infecção Persistente/complicações , Doenças Periapicais/cirurgia , Actinomicose/patologia , Cisto Radicular/complicações , Colesterol/efeitos adversos , Reação a Corpo Estranho/patologia , Retratamento/métodos , Bactérias Anaeróbias Gram-Negativas/patogenicidade
14.
Rev. Ciênc. Méd. Biol. (Impr.) ; 20(4): 654-660, fev 11, 2022. fig
Artigo em Inglês | LILACS | ID: biblio-1359530

RESUMO

Introduction: the major goal of endodontic treatment (ET) is the complete elimination and/or maximum possible reduction of bacteria and irritants in the root canal system (RCS). However, persistence of bacterial debris refractory to therapy may leading to ET failure, being necessary to realize conventional or surgical retreatment. Objective: this is a case report on the nonsurgical management of an extensive chronic periapical lesion in teeth 12 and 11 in an adult female patient with history of endodontic treatment failure. She presented with painless swelling and a fistula adjacent to tooth 11. Methodology: conventional ET combined with photodynamic therapy (PDT) was recommended, in addition to calcium hydroxide applications. Regular clinical and radiographic follow-up made over a 2-year period revealed progression of bone regeneration, without sign and symptoms, with a satisfactory outcome. Conclusion: this case report shows that the combination of conservative ET with PDT provided satisfactory results with the resolution of the chronic endodontic infection and bone repair of the extensive periapical lesion.


Introdução: o principal objetivo do tratamento endodôntico (TE) é a eliminação completa e/ou máxima redução possível de bactérias e irritantes no sistema de canais radiculares (SCR). Porém, a persistência de detritos bacterianos refratários à terapia pode levar ao insucesso do TE, sendo necessária a realização do retratamento convencional ou cirúrgico. Objetivo: este relato de caso descreve o manejo não cirúrgico de uma extensa lesão periapical crônica nos dentes 12 e 11 em paciente adulta do sexo feminino com histórico de fracasso endodôntico. A mesma queixava-se de inchaço indolor, com presença de fístula adjacente ao dente 11. Metodologia: preconizou-se a realização do TE convencional associado à terapia fotodinâmica (PDT), com três sessões de troca de hidróxido de cálcio, concluindo-se posteriormente o tratamento. Reavaliações clínicas e radiográficas periódicas ao longo de 2 anos revelaram a progressão da consolidação óssea, com um desfecho satisfatório. Conclusão: este relato de caso mostra que a combinação do TE conservador associado à PDT teve resultados satisfatórios na resolução de infecção endodôntica crônica e no reparo ósseo de lesão periapical extensa.


Assuntos
Humanos , Feminino , Adulto , Doenças Periapicais/terapia , Fotoquimioterapia , Tratamento do Canal Radicular/métodos , Lasers , Doença Crônica , Resultado do Tratamento
15.
J Endod ; 48(3): 375-378, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34952102

RESUMO

Postendodontic periapical fibrous scars (PFScs) comprise a type of radiolucent healing that is frequently misinterpreted as a pathological lesion. A combined clinical, radiologic, and histologic correlation is essential for a reliable diagnosis. This report presents a case of a patient with a long-term persistent asymptomatic postendodontic radiolucency that was misdiagnosed as endodontic failure and referred for endodontic retreatment and periapical surgery. To reach a definitive diagnosis, a core bone biopsy needle (CBBn) technique was performed on the area of the radiolucency. The material obtained was processed for histologic analysis and the lesion was determined to be a PFSc. In conclusion, the use of a CBBn before any invasive treatment allowed the clinician to distinguish between PFSc and other persisting pathosis, such as periapical granuloma or cystic lesions.


Assuntos
Doenças Periapicais , Granuloma Periapical , Biópsia , Cicatriz/etiologia , Cicatriz/patologia , Cicatriz/cirurgia , Humanos , Doenças Periapicais/diagnóstico por imagem , Doenças Periapicais/etiologia , Granuloma Periapical/diagnóstico por imagem , Tratamento do Canal Radicular/efeitos adversos , Cicatrização
16.
Lima; Perú. EsSalud; Oct. 2021. 102 p. tab.
Monografia em Espanhol | MINSAPERÚ | ID: biblio-1361314

RESUMO

La guía contiene recomendaciones para el manejo de las lesiones pulpares y periapicales en dentición permanente con el fin de contribuir a reducir su morbilidad, mejorar la calidad de vida, y reducir las complicaciones de los pacientes con esta condición.


Assuntos
Doenças Periapicais , Qualidade de Vida , Ferimentos e Lesões , Morbidade , Guias de Prática Clínica como Assunto , Guias como Assunto , Dentição Permanente , Doenças da Polpa Dentária
17.
Rev. Ciênc. Méd. Biol. (Impr.) ; 20(3): 431-435, dez 20, 2021. tab
Artigo em Português | LILACS | ID: biblio-1354283

RESUMO

Introdução: o tratamento endodôntico representa a terapia que trata as doenças pulpares e periapicais. O sucesso desse tratamento pode estar relacionado com o preparo do terço cervical e médio e a sua realização ou não contempla uma das vertentes da Endodontia contemporânea. Objetivo: identificar a prevalência de endodontistas que realizam o preparo cervical e médio, assim como as principais repercussões dentárias causadas por essa etapa, relacionando-as com instrumentos elencados neste estudo. Metodologia: trata ­ se de uma pesquisa observacional transversal que avalia, através de formulário online, a prevalência de endodontistas que realizam o pré-alargamento cervical e médio. O formulário foi enviado entre os dias 1º e 30 de junho de 2021, pela plataforma Google Forms. A amostra foi composta por 102 endodontistas de ambos os gêneros. O formulário apresenta questões de gênero, idade e questionamento sobre tempo de formação e trabalho. Resultados: verificou-se que 93,1% dos entrevistados alegaram realizar o preparo cervical e médio e a maioria, 67 respondentes, não acreditam que ele tem relação com o enfraquecimento dental. Para tal procedimento, a instrumentação rotatória é a mais utilzada com 54,9%. Conclusão: o preparo cervical e médio é uma etapa operatória presente na maioria dos tratamentos endodônticos e sua realização pode estar relacionada com o enfraquecimento dental, no entanto, isso não promove o insucesso do tratamento e, de acordo com os entrevistados, os instrumentos rotatórios são os mais utilizados para essa etapa.


Introduction: Endodontic treatment represents therapy that treats pulp and periapical diseases. The success of this treatment may be related to the preparation of the cervical and middle thirds and its realization or not contemplates one of the aspects of contemporary Endodontics. Objective: identify the prevalence of endodontists who perform cervical and middle preparation, as well as the main dental repercussions caused by this stage, relating them to the instruments listed in this study. Methodology: this is a cross-sectional observational study that assesses, through an online form, the prevalence of endodontists who perform cervical and mid-swelling pre-enlargement. The form was sent between June 1st and June 30th, 2021, by the Google Forms platform. The sample consisted of 102 endodontists of both genders. The form presents issues of gender, age and questions about training and work time. Results: it was found that 93.1% of respondents claimed to perform cervical and middle preparation and the majority, 67 respondents, do not believe that it is related to dental weakening. For this procedure, rotary instrumentation is the most used with 54.9%.Conclusion: cervical and middle preparation is an operative step present in most endodontic treatments and its performance ay be related to dental weakening, however, this does not promote treatment failure and, according to respondents, rotary instruments are the most used for this step.


Assuntos
Humanos , Masculino , Feminino , Doenças Periapicais , Cavidade Pulpar , Endodontia , Estudos Transversais , Estudo Observacional
18.
Lima; IETSI; versión extensa; oct. 1, 2021. 73 p. ilus, tab.
Não convencional em Espanhol | BIGG - guias GRADE | ID: biblio-1363272

RESUMO

Para el ámbito de esta GPC, consideramos preguntas sobre el tratamiento las principales lesiones pulpares y periapicales como pulpitis irreversible, necrosis pulpar, periodontitis apical y absceso apical agudo.


Assuntos
Humanos , Adulto , Doenças Periapicais/tratamento farmacológico , Pulpite/tratamento farmacológico , Dentição Permanente , Hidróxido de Cálcio/uso terapêutico , Clorexidina/uso terapêutico , Analgésicos/uso terapêutico , Anti-Inflamatórios/uso terapêutico
19.
Rev. ADM ; 78(3): 176-180, mayo-jun. 2021.
Artigo em Espanhol | LILACS | ID: biblio-1255021

RESUMO

La microendodoncia involucra la visualización a través de un microscopio operatorio de todas las fases del tratamiento de conductos y procedimientos de cirugía apical y correctiva por parte del endodoncista. Existe sobrada evidencia acerca de las mejoras que puede aportar la magnificación al tratamiento; la literatura demuestra que la capacidad del operador mejora si su visión del campo gana claridad y precisión, ambos recursos pueden ser proporcionados por el microscopio operatorio, aunado a que posibilita diagnósticos más certeros junto con mejoras en el pronóstico, lo que permite evitar posibles complicaciones. La calidad de los tratamientos endodóncicos involucra infinidad de factores, cada uno relevante en sí mismo pero, en determinados casos, el microscopio puede significar la diferencia entre un tratamiento exitoso o un fracaso clínico. En la actualidad, se ha convertido en un tema de lo más relevante, por lo que el objetivo del presente trabajo es revisar la literatura con el fin de ayudar al entendimiento basado en evidencia científica de los criterios que determinan la relevancia del uso del microscopio en el ámbito endodóncico (AU)


Microendodontics involves the visualization through an operating microscope of all phases of root canal treatment and apical and corrective surgery procedures by the endodontist. There is plenty of evidence about the improvements that magnification can provide, the literature shows that the operator's ability improves if his vision of the field gains clarity and precision, both resources can be provided by the operating microscope, added to the fact that it enables more accurate diagnoses together with improvements in the prognosis allowing to avoid possible complications. The quality of endodontic treatments involves countless factors, each relevant in itself, but in certain cases the microscope can mean the difference between a successful treatment or a clinical failure. At present, it has become a very relevant topic, so the objective of this work is to review the literature in order to help understand the criteria that determine the relevance of the use of the microscope in the endodontic field based on scientific evidence (AU)


Assuntos
Humanos , Tratamento do Canal Radicular/tendências , Aumento da Imagem/instrumentação , Microscopia/métodos , Doenças Periapicais/diagnóstico , Prognóstico , Resultado do Tratamento , Instrumentos Odontológicos , Doenças da Polpa Dentária/diagnóstico
20.
Braz Oral Res ; 35: e033, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33729278

RESUMO

The aim of this study was to investigate the epidemiological and clinical characteristics of chronic inflammatory periapical diseases in different regions of Brazil and to compare with data from the literature. A multicenter study was carried out in four Brazilian referral centers in oral diagnosis. Histopathological records were reviewed, and all cases diagnosed microscopically as periapical granuloma, radicular cyst, and periapical abscess were included. Demographic and clinical data were collected. Descriptive statistics and Pearson's chi-square test were performed. A total of 10,381 cases of chronic inflammatory periapical diseases were found (13.8% of 74,931 archived specimens) over a period of 65 years. Radicular cysts were the most common lesion (59.9%). Women (56.1%) with a mean age of 37.01 years old (range 13 to 100 ± 14.42) and people of white skin color (59.2%) were the most affected individuals by chronic inflammatory periapical diseases. The lesions were generally asymptomatic (28.1%), located in the maxilla (60.1%), and posterior region (49.8%). The radicular cysts were larger when compared to periapical granulomas (p < 0.001). The disagreement between the clinical and histopathological diagnoses was higher when the final diagnosis was a periapical granuloma (p < 0.001). Chronic inflammatory periapical diseases continue to be common lesions affecting mainly adults. This should be a consequence of the burden of untreated caries in permanent teeth. Women are more affected and radicular cyst was the most common lesion.


Assuntos
Abscesso Periapical , Doenças Periapicais , Granuloma Periapical , Cisto Radicular , Adolescente , Adulto , Brasil/epidemiologia , Doença Crônica , Feminino , Humanos , Estudos Multicêntricos como Assunto , Abscesso Periapical/epidemiologia , Doenças Periapicais/epidemiologia , Granuloma Periapical/epidemiologia , Cisto Radicular/epidemiologia , Adulto Jovem
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