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We report the challenges faced in the treatment of a large cystic lesion in the anterior maxilla. A 32-year-old woman presented herself to the urgency service, complaining about discomfort in the region of nonvital tooth #22. Endodontic treatment was started and the patient reported to the oral medicine discipline of the authors’ institution. Imaging and clinical examination revealed a large cystic lesion involving the hard palate, nasal cavity, and the anterior portion of the maxillary sinus. A cystic decompression was performed along with an incisional biopsy that led to a histopathologic diagnosis of periapical cyst. A second surgical approach tried to enucleate the lesion but the ostium of decompression remained open, thereby impairing bone formation. A third approach was performed along with allogeneic particulate bone graft and reabsorbable membrane barrier positioning. Radiographic follow-up showed the graft integration and good recovery of the lesion after 4 months of follow-up care.

Objective: This study aims at studying the influence of hypercementosis over root and root canal morphology us-ing different methods of observation (clearing technique, radiography, stereomicroscopy and optical microscopy). Methods: 130 teeth were selected for morphological com-parative evaluation; all teeth were previously radiographed and stereomicroscopically evaluated. Out of these, 60 teeth with hypercementosis and 30 without it were selected for clearing technique evaluation. The analysis was based on aspects such as: type of hypercementosis; root canal num-ber and configuration; root surface and presence of apical foramen and apical deltas. The remaining 20 teeth with hy-percementosis were microscopically compared to 20 teeth with normal root formation by means of the Hematoxylin and Eosin (H.E.) staining technique, so as to study the ce-mentum deposition pattern and morphological aspects of the root canal. The evaluation was performed by two ex-aminers and submitted to Kappa agreement test. The data obtained was compared through non-parametric Kruskal-Wallis one-way analysis of variance test, and the Dunn test was applied for individual comparisons. Results: The root clearing examination showed higher frequency of club shaped hypercementosis (65%) followed by focal hyperce-mentosis (35%). Teeth with hypercementosis showed sig-nificant increase in the presence of apical deltas (53.3%). A higher frequency of root canal constrictions (55%), and changes in the original root canal path (46.6%) were also observed. Microscopic evaluation supports the influence of hypercementosis over the morphological characteristics of root apical third formation. Conclusions: These findings show the existence of a complex root canal anatomy at the apical third of teeth with hypercementosis, which may hinder root canal treatment.Keywords: Hypercementosis. Dental pulp cavity. Endodontics.

A hipercementose é caracterizada pela formação excessiva de cemento além do limite necessário para cumprir suas funções normais resultando em espessamento anormal com alteração da forma macroscópica da raiz. Inicialmente, procedeu-se à realização do exame macroscópico e estereomicroscópico e radiográfico de 576 dentes permanentes humanos com hipercementose em espécimes pertencentes ao Departamento de Patologia da Faculdade de Odontologia de Bauru - Universidade de São Paulo. Os critérios morfológicos analisados radiograficamente foram o término do canal principal, canais secundários, acessórios, delta apical, constrição apical e observação da hipercementose e sua junção com a dentina. Selecionaram-se 28 dentes e analisaram-se seus ápices radiculares à microscopia eletrônica de varredura. Verificou-se que a progressão da hipercementose em forma de clava está diretamente associada ao fechamento gradativo das foraminas e forames apicais; a forma focal de hipercementose apresenta foraminas em sua superfície, mesmo quando lateralmente localizadas nas raízes dentárias; a hipercementose em forma de boca de manga de camisa acomete principalmente raízes residuais. Sendo assim, o clínico, nas várias especialidades, durante a escolha da técnica terapêutica, deve considerar as variações anatômicas interna e externa dos dentes portadores de hipercementose, visto que radiograficamente não é possível, com precisão e segurança, determinar essas variações e suas implicações Hypercementosis is characterized by the excessive formation of the cementum beyond its physiological limits resulting in abnormal thickening with alteration of the macroscopic root appearance. This study analyzed 576 permanent human teeth with hypercementosis though macroscopic and stereomicroscopy means. The teeth were radiographed and some morphologic aspects were observed such as: the end of the main root canal, secondary and accessories canals, apical delta, apical constriction, hypercementosis manifestation and its junction with the dentin. Out of these specimens 28 were selected and analyzed its root apexes through scanning electron microscopy. It was verified that the progression of hypercementosis in club form is directly associated to foraminas and apical foramen obstruction; the focal form of hypercementosis presents foraminas in its surface, even they are sidelong located in its dental roots; the hypercementosis in "shirt mouth sleeve form" attacks mainly residual roots. Based in these findings it must be considered during dental practice a proper therapeutic technique and also the teeth's anatomical variations due to hypercementosis, since it is not possible with accuracy and safety to determine radiographically, the anatomical modifications and its implications

O presente trabalho investigou microscopicamente o efeito da equistatina sobre o processo reabsortivo de dentes incisivos superiores de ratos, extraídos e reimplantados. Foram utilizados 42 animais, divididos em grupos com e sem equistatina. Os tempos extra-alveolares dos dentes foram de 30 e 60 minutos e os períodos experimentais pós-cirúrgicos foram 15, 60 e 90 dias. Os espécimes obtidos foram processados e corados em H.E. para observar os processos biológicos presentes. Os eventos microscópicos foram avaliados por dois examinadores, de modo quantitativo histomorfométrico e descritivo, de acordo com o tipo de infiltrado e intensidade da reação inflamatória; com o tipo, extensão e localização de reabsorção dentária; e presença de anquilose alveolodentária. O nível de concordância entre examinadores, determinado pelo índice Kappa, revelou-se quase perfeito para todas as variáveis avaliadas. A comparação entre os grupos testes e controle para as variáveis apresentadas foi feita por meio do teste Mann-Whitney e mostrou não haver diferença estatística entre a administração de equistatina e tempo extra-alveolar em relação à intensidade inflamatória nas diferentes porções radiculares. Quanto ao tipo de reabsorção estabelecida, notou-se que a presença de reabsorção inflamatória foi significativamente maior (p

Objective: To evaluate the effectiveness of the NaviTip FX, brush-covered irrigation needle, in removing calcium hydroxide from the root canal. Study Design: Thirty single-rooted teeth were randomly divided into three groups: A - irrigation with a hypodermic needle inserted as far as possible without binding and activation with #30 K-type file; B - Irrigation with a hypodermic needle without activation; C - irrigation with NaviTip FX needle. Sodium hypoclorite 1% was used in irrigation. The root canals were examined trough scanning electron microscopy. Calcium hydroxide removal was recorded at 1, 5, and 10mm from the working length (WL) and the data were analysed using one-way ANOVA test (p

The purpose of this study was to evaluate morphological characteristics of teeth with hypercementosis that are relevant to endodontic practice. Twenty-eight extracted teeth with hypercementosis had their root apexes analyzed by scanning electron microscopy (SEM). The teeth were divided according to tooth groups and type of hypercementosis. The following aspects were examined under SEM: the contour and regularity of the root surface; presence of resorption; presence and number of apical foramina, and the diameter of the main foramen. The progression of club shape hypercementosis was directly associated with the presence of foramina and apical foramen obstruction. Cases of focal hypercementosis presented foramina on the surface, even when sidelong located in the root. Circular cementum hyperplasia form was present in 2 out of 3 residual roots, which was the highest proportion among the tooth types. The detection of a large number of foramina in the apical third of teeth with hypercementosis or even the possible existence of apical foramen obliteration contributes to understand the difficulties faced during endodontic treatment of these cases.

the purpose of this study was to compare the quality of the obturation and the difference of penetration depth inside the root canal of the instruments Finger Spreader, file type Kerr, Flexofile and Nitiflex when used as spreaders during the filling by Active Lateral Condensation Technique.40 extracted permanent human teeth were instrumented by the Modified Goerig Technique and divided in four groups. In the group I the finger spreader was used; in the group II, files type Kerr was used; in the group III, files Flexofile was used and, in the group IV, files Nitiflex, all number 30, for space opening for placement of the secondary cones, during the Technique of Active Lateral Condensation. The radiographic quality of the obturation and the depth of penetration of the instruments was evaluated and analysed statisticaly (Kruskal-Wallis and Dunn's Test).with relationship to the radiograph analysis of the quality of the filling, the group II was what it presented the best result, followed by the groups I, IV and III, respectively. In relation to the depth of penetration of the instruments, the group IV approached more the desired distance, or, 1 millimeter less than the length of the work, followed, respectively, by groups II, III and I.