Tooth discoloration caused by endodontic treatment: A cross-sectional study.

INTRODUCTION: This cross-sectional study evaluated the influence of endodontic filling material, cervical limit of root filling, and tooth location on the color variation (∆E00 ) from 1 to 60 months of follow-up. MATERIALS AND METHODS: Color records were obtained from 70 participants who received 83 endodontic treatments. CIEL*a*b* color coordinates were measured on the homologous tooth, which was considered as baseline, and on endodontic treated teeth with a spectrophotometer. ∆E00 was calculated by the CIEDE2000 method at three conditions (condition 1: homologous tooth vs endodontically treated tooth after ≤1 month; condition 2: homologous tooth vs endodontically treated tooth after >1-12 months; condition 3: homologous tooth vs endodontically treated tooth after >12 months up to 5 years) for each variable. The zinc oxide and eugenol mineral trioxide aggregate or resin-based filling materials, dental cervix or ≥2 mm in the apical direction cervical limit of root filling and anterior or posterior tooth location were considered in the comparisons. Confidence intervals for the means (95% CI) were calculated, ∆E00 values and CIEL*a*b* individual color coordinates were compared for each pair of variables using the Student t test or Welch test (α = .05). RESULTS: Greater ∆E00 values were generally observed in the condition 3 for cervical limit (∆E00 = 10.7), use of zinc oxide and eugenol and mineral trioxide aggregate-based filling materials (∆E00 = 10.7), and anterior teeth (∆E00 = 12.4). Only in the condition 1, the ∆E00 values of the filling materials did not show statistical differences (P = .198). CONCLUSIONS: Higher ∆E00 values were yielded from zinc oxide and eugenol and mineral trioxide aggregate-based filling materials, anterior teeth, and dental cervix cervical limit of root filling. CLINICAL SIGNIFICANCE: Tooth discoloration yielded by endodontic materials and procedures is a challenge to clinical practice resulting in aesthetic problems and discomfort to both patient and professional, especially when it occurs in anterior teeth.

Endodontic reintervention of a mandibular second premolar with four root canals: a case report / Reintervención endodóntica de un segundo premolar mandibular con cuatro conductos radiculares: reporte de caso / Reintervenção endodôntica de um segundo pré-molar mandibular com quatro condutos radiculares: relato de caso

Abstract Complex anatomical variations on root canals morphology are one of the most arduous challenges in the endodontic practice. The objective of this case report is to discuss the clinical management of a mandibular left second premolar with four root canals and four distinct apical foramina. This case report has been written according to Preferred Reporting Items for Case reports in Endodontics (PRICE) 2020 guidelines. A 74-year-old patient was referred to retreat a left mandibular second premolar. The patient complained of discomfort when chewing hard food. After obtaining consent from the patient to investigate the symptoms, a thorough clinical and radiographic examination was performed. The main clinical findings observed were a moderate sensitivity to vertical percussion and mild discomfort at palpation. The periapical radiograph showed a fusion-like root with multiple canals and unsatisfactory root canal fillings associated with apical radiolucency. Based on this investigation, a diagnostic of persistent apical periodontitis was made to the tooth, and nonsurgical root canal re-treatment was proposed to the patient. After written informed consent was obtained, the procedure was performed under magnification provided by a dental operating microscope with the aid of ultrasonic tips. During the access opening and fillings removal, four root canal orifices were observed. Therefore, state-of-the-art technology such as the dental operating microscope, ultrasonics, and cone-bean computed tomography image are strong allies to manage anatomical variations.

Resumen Las complejas variaciones anatómicas en la morfología de los conductos radiculares son uno de los desafíos más arduos en la práctica de la endodoncia. El objetivo de este reporte de caso es discutir el manejo clínico de un segundo premolar mandibular izquierdo con cuatro conductos radiculares y cuatro agujeros apicales distintos. Este informe de caso se ha escrito de acuerdo con Preferred Reporting Items for Case reports in Endodontics (PRICE) 2020. Paciente de 74 años que fue remitido para retirada de un segundo premolar mandibular izquierdo. El paciente se quejaba de malestar al masticar alimentos duros. Después de obtener el consentimiento del paciente para investigar los síntomas, se realizó un examen clínico y radiográfico completo. Los principales hallazgos clínicos observados fueron una sensibilidad moderada a la percusión vertical y una leve molestia a la palpación. La radiografía periapical mostró una raíz similar a una fusión con múltiples conductos y empastes de conductos radiculares insatisfactorios asociados con radiolucidez apical. Con base en esta investigación, se realizó un diagnóstico de periodontitis apical persistente en el diente y se propuso al paciente un nuevo tratamiento del conducto radicular no quirúrgico. Una vez obtenido el consentimiento informado por escrito, el procedimiento se realizó con un aumento proporcionado por un microscopio quirúrgico dental con la ayuda de puntas ultrasónicas. Durante la apertura del acceso y la remoción de los empastes, se observaron cuatro orificios del conducto radicular. Por lo tanto, la tecnología de punta, como el microscopio de operación dental, los ultrasonidos y la imagen de tomografía computarizada de haz cónico, son fuertes aliados para manejar las variaciones anatómicas.

Resumo Variações anatômicas complexas na morfologia dos canais radiculares são um dos desafios mais árduos na prática endodôntica. O objetivo deste relato de caso é discutir o manejo clínico de um segundo pré-molar inferior esquerdo com quatro canais radiculares e quatro forames apicais distintos. Este relato de caso foi escrito de acordo com as diretrizes do Preferred Reporting Items for Case reports in Endodontics (PRICE) 2020. Um paciente de 74 anos foi encaminhado para retirada de um segundo pré-molar inferior esquerdo. O paciente queixou-se de desconforto ao mastigar alimentos duros. Após obter o consentimento do paciente para investigar os sintomas, foi realizado um exame clínico e radiográfico completo. Os principais achados clínicos observados foram sensibilidade moderada à percussão vertical e leve desconforto à palpação. A radiografia periapical mostrou uma raiz fusionada com múltiplos canais e obturações de canais radiculares insatisfatórias associadas à radioluscência apical. Com base nesta investigação, um diagnóstico de periodontite apical persistente foi feito ao dente, e um retratamento não cirúrgico do canal radicular foi proposto ao paciente. Após a obtenção do termo de consentimento livre e esclarecido, o procedimento foi realizado sob magnificação fornecida por microscópio cirúrgico odontológico com auxílio de pontas de ultrassom. Durante a abertura do acesso e retirada das obturações, foram observados quatro orifícios do canal radicular. Portanto, tecnologia de ponta, como microscópio cirúrgico odontológico, ultrassom e imagem de tomografia computadorizada de feixes cônico, são fortes aliados para o gerenciamento de variações anatômicas.