Search

Endodontic treatment is responsible for cleaning and shaping the root canals after they have been affected by diseases in their pulp. However, some clinical complications that are inherent to the treatment may occur, such as fracture of instruments inside the conduit, perforations, and anatomical anomalies. When this occurs and it is not possible to carry out an endodontic intervention, opt for endodontic surgery. The aim of this study is to report a clinical case of endodontic surgery in a lower molar with a fractured file and resorption process. A patient was assisted who had a necrotic dental element, symptomatic, mesial root with fractured file and distal root with resorption process proven in the initial radiograph. In the first session, anesthesia, access surgery, absolute isolation, irrigation with 2.5% sodium hypochlorite were performed and an attempt was made to remove the fractured instrument with an operating microscope and an ultrasound insert, but this was unsuccessful. In this way, the dental element instrumented with rotary files logic 25/05, dried and filled with thermoplasty technique, using bioceramic cement. In the second session, endodontic surgery was performed with removal of the fractured instrument. A 2-month follow-up was performed, analyzing the pathology and symptomatology regression. The patient was asymptomatic and undergoing tissue repair in the mesial and distal root. It is possible to conclude with this clinical case that endodontic surgery is feasible in cases of fractured instrument and resorption process, thus allowing the remission of the pathological process, paralysis of the infectious process and permanence of the function and aesthetics of the dental element.

Revascularization is a regenerative endodontic dental procedure, which aims to stimulate the penetration of periradicular tissue inside the root canal, allowing vascularization of necrotic teeth, leading to a tissue repair and regeneration. Currently, Biodentine cement has been used to perform this procedure. The aim of this study was to report a clinical case about the revascularization of a maxillary lateral incisor with incomplete root formation using Biodentine. The patient, male, 10 years old, attended the multidisciplinary clinic of CEULP/ULBRA accompanied by the responsible, asymptomatic, reporting trauma to element 22, sensitivity and vertical percussion tests were performed with negative results. Through periapical radiography, incomplete root formation and a radiolucent area in the periapical region were observed. The revascularization technique was performed, aiming to stimulate the root formation. In the first session, instrumentation with K-type instruments at working length and intracanal medication were performed. After 15 days, the revascularization procedure was performed with a 25/0.02 K file led beyond the working length to stimulate periapical bleeding, so the canal was filled with blood up to the cervical third. Blood clotting was awaited, Biodentine was placed, and the definitive restoration was performed with composite resin. Follow-up up to 1 year and four months was carried out and the root development was observed. Thus, in the reported case, the revascularization technique proved to be efficient, allowing the continuity of the root formation a compromised tooth.

O artigo apresenta uma revisão de literatura, com o intuito de explicar: a técnica de clareamento, os materiais utilizados, as contra-indicações, mecanismos da reabsorção radicular e o processo químico do clareamento de dentes não-vitais. A técnica clareadora em questão é um tratamento conservador, simples e que possui um alto índice de sucesso. O trabalho abordará, através de uma revisão crítica da literatura, quais são os materiais necessários e como é realizado o procedimento. As alterações de cor dos elementos dentários desvitalizados podem estar relacionadas à diversos fatores e, através da técnica do clareamento, é possível trazer de volta a autoestima do paciente e, consequentemente, uma melhor qualidade de vida.

The access ionization attempt may occur during the coronary period, which may lead to a posterior dental access. The maintenance of the primary tooth is important, especially in cases of permanent tooth agenesis. The aim of this study is to report a clinical case about perforation sealing, endodontic retreatment, and installation of a fixed prosthesis in a lower molar. A patient was selected from the dental clinic of Fapac/Itpac Porto Nacional - TO, asymptomatic, negative sensitivity test and vertical percussion, need for retreatment and perforation in the furcation region. In the first session, anesthesia, access surgery, absolute isolation, irrigation with 2% chlorhexidine gel, identification of the perforation and its conditioning, odontometry, removal of gutta percha with rotary instruments (Logic RT system), drying and insertion of intracanal medication (calcium hydroxide) in root canals and perforation. In the second session (after 15 days), the intracanal medication was removed and the root canals were filled with gutta percha and plasticized technique, and the perforation was sealed with mineral trioxide aggregate (MTA). The clinical case was continued for 2 years, and during the follow-up, asymptomatic, periodontal tissues were clinically and radiographically normal and the dental element performed its masticatory functions satisfactorily. It is possible to conclude with this clinical case that even with a perforation in the furcation region and the need to insert a prosthetic rehabilitation in the dental element, the sealing of the perforation with the aggregate mineral trioxide allowed the maintenance of the dental element.

Access surgery is an important procedure performed during endodontic treatment as it allows the dental surgeon to access the pulp chamber and locate the root canals. During this procedure, spherical and conical stem diamond tips with inactive end are used to remove caries, establish a contour shape and refine the walls of the pulp chamber. Inserts coupled to dental ultrasound are constantly used to help refine the floor of the pulp chamber. However, depending on the vibration provided by the ultrasound device and incorrect handling of the insert, it will cause depressions and perforations in the floor of the pulp chamber. Given the context, this research aims to assess the quality of pulp chamber floor refinement by different ultrasound devices. This is a research with the principle of applied investigation, qualitative and quantitative approach, with an exploratory character, where 100 upper and lower human molars will be selected distributed in 4 groups, where the floor refinement will be carried out with TRA 24 ultrasound insert ( Trinks, São Paulo, Brazil) however, coupled to different ultrasonic devices: G1 (No. 25) CvDentus, G2 (No. 25) Sonic Plus Ecel, G3 (No. 25) Sonic Air Scaler and G4 (No. 25) Denshine . After completion of the access surgery, a visual inspection will be performed to assess the presence of excessive wear, depressions and identification of root canals. The results were tabulated, analyzed and it was found that there was no significant difference between the groups regarding the presence of excessive wear, depressions and identification of root canals. Thus, it is possible to conclude that all ultrasonic devices showed satisfactory results in the refinement of the floor of the analyzed teeth.

Irreversible hydrocolloids, or simply alginates, are the most used molding materials in different areas of dentistry, due to their ease of handling, low cost and good reproducibility. The present work aims to analyze the dimensional stability of different types of alginates at different time intervals. It is applied research, in which its approach was qualitative-quantitative, of an exploratory nature. Three different brands of alginate were used, where a standard dummy was molded and the leakage happened immediately: G1 (n: 10) Hydrogun, G2 (n: 10) Jet Plus and G3 (n: 10) Ava gel. With the digital caliper, the distances were measured and compared with the standard model, the data obtained were tabulated, analyzed using parametric tests and the areas of each model were added. As a result, the area of the standard model was similar in both groups. It is possible to conclude that the type of alginate did not interfere with the distortion of the standard model.

Endodontic treatment aims at the chemical and mechanical preparation of a dental element that has inflammation or pulp necrosis. During endodontic intervention, postoperative pain may develop, as well as difficulty in the regression of the periradicular lesion. Given the context, the present work is a clinical case report with the objective of evaluating whether the type of irrigating solution used in the endodontic treatment of filled teeth in a single session and single cone influences the postoperative symptomatology and regression of the periradicular lesion. This is a clinical, exploratory, qualitative and descriptive case study, where 2 patients were treated. They were divided into two groups: G1 (n:01) (irrigation with 2.5% sodium hypochlorite) and G2 (n:01) (irrigation with 2% chlorhexidine gel and saline). All dental elements were anesthetized, access surgeries were performed, initial exploration with K file # 10 or 15 was performed until the apparent length of the tooth. Instrumentation technique was performed with hand files and confirmation of working length through Root foraminal locator. Final irrigation was performed with 3 ml of 17% EDTA. The canals were dried with capillary tips, attached to a high-power suction device and with absorbent paper cones and filled, in the same session, by the Tagger Hybrid technique and restored with composite resin. Patients were followed for a period of 24h, 48h, 2, 3 and 6 months for postoperative pain assessment and periradicular lesion regression. Through the results obtained, it was noted that although both irrigating solutions are effective, it was observed that 2.5% sodium hypochlorite caused grade 3 pain according to the patient's pain scale during the first 24 hours, compared with 2% chlorhexidine gel, which had no painful symptoms at any time after completion of treatment and follow-up. In conclusion, in this study, 2.5% sodium hypochlorite may cause more postoperative pain compared to 2% chlorhexidine gel, but there was no significant difference in pain levels between the groups.

Cavernous hemangiomas are benign malformations of vascular origin, usually well circumscribed and slow to grow. These lesions can be asymptomatic, being discovered unintentionally in imaging exams or symptomatic, indicated mainly by the presence of proptosis, diplopia, and visual disturbances by optic nerve compression. The complementary exams involve computed tomography associated with contrast, color Doppler, magnetic resonance, and angiography. Treatment can be conservative or surgical depending on the case, and the open therapy usually involves lateral, supraorbital, transconjunctival, transantral, pterional, transnasal, and extradural endoscopic orbitotomy. The present study aimed to report a recurrent case of hemangioma in the orbital cavity signaled by ocular proptosis, hyperemia, and ocular pain.The lesion was achieved through the Weber-Ferguson access with zygomatic osteotomy and preservation of the infraorbital nerve. The excision of the lesion was performed, and the previously displaced fragments were fixed with 1.5 mm mini plates. The patient has a chance of progressing with visual impairment due to considerable manipulation of the optic nerve and is being followed up.The reported case showed a successful diagnosis and therapeutic conduct, remaining now in the evolution and follow-up scenario.

Objective This study compared the shaping ability of the Hyflex CM and XP-endo Shaper rotary file systems in curved mesial canals of mandibular molars using micro-computed tomography. Material and Methods Seventeen mesial roots of extracted first mandibular molars with two independent mesial canals were scanned before and after root canal preparation with the tested rotatory file systems. Each mesial canal from the same specimen was prepared with one of the two systems. The parameters analyzed were canal centering (transportation) for the cervical, middle, and apical segments, as well as for the entire canal (0–10 mm from the apex); and canal volume increase, canal surface area increase, and unprepared canal walls for two segments, 0 to 4 mm and 0 to 10 mm from the apex. Results There was no significant difference between both systems regarding canal centering (transportation), volume increase, and unprepared canal walls for the 0 to 10 mm segment (p> 0.05); however, a significant difference was observed for the 0 to 4 mm segment (p Conclusions The shaping ability of the two tested rotatory file systems in mesial roots of first mandibular molars was similar for all parameters in all the segments evaluated, except for the 0 to 4 mm segment, where XP-endo Shaper left a smaller area of unprepared canal walls than Hyflex CM.

The total elimination of microorganisms during endodontic therapy, although it is desired, is difficult to achieve. Even after canal filling, microorganisms can be in the dentin mass and periapical region. This study aims to evaluate in vitro the antibacterial efficacy of different intracanal medications on an Enterococcus faecalis biofilm. It was used reference microorganisms, Enterococcus faecalis NEWP0012, where the bacterial suspension was seeded uniformly on Mueller Hinton (MH) agar. The plates were incubated under aerobic conditions, at a constant temperature in the range of 35°C-37°C, for 24 hours. The intracanal medications tested were: G1 Calcium hydroxide associated with 2% Chlorhexidine, G2 Calcium hydroxide associated with ozone stratum, G3 Calcium hydroxide associated with paramonochlorophenol, G4 Calcium hydroxide associated with Otosporin®, G5 Calcium hydroxide, G6 2% Chlorhexidine, G7 Ozone extract, G8 Paramonochlorophenol, G9 Otosporin®, G10 Saline solution, G11 Calcium hydroxide associated with iodoform, G12 Iodoform, G13 Calcium hydroxide associated with NDP, G14 NDP. After handling the materials, they were impregnated on 5 mm diameter absorbent paper discs and distributed equidistantly on the plates seeded with the microorganism. The experimental data were obtained by measuring the zone of inhibition within 24 h, 72 h, and 7 days. In this way, the microorganism was classified as resistant or sensitive to the different products. The test was reproduced 3times. After analysis, it was observed that within 24 hours, 7 hours, and 7 days, only the groups G1 Calcium hydroxide associated with 2% chlorhexidine (18mm of halo of inhibition), G5 Calcium hydroxide (13mm of halo of inhibition), G6 2% chlorhexidine (16mm of halo of inhibition) and G9 Otosporin® (9 mm of halo of inhibition) showed a halo of inhibition in the time intervals. However, the groups did not show halo of inhibition, being ineffective against E. faecalis. According to the obtained data, chlorhexidine gel 2% showed larger halos of inhibition, however, calcium hydroxide was associated with chlorhexidine gel 2%, calcium hydroxide and Otosporin®. Therefore, new research with different methods should be used to verify the efficacy of the medications used, since they presented divergence compared to another research already carried out.

Objective This study aimed to evaluate the influence of chelating agents (EDTA, citric acid and Tetraclean) on glass fiber posts adhesion to root dentin. Materials and Methods Forty mandibular premolars single canals, with complete apical root, straight, circular cross sections were selected, accessed and had the cervical third prepared with Gates-Glidden drills, then included in resin, instrumented with ProTaper Universal and the root canal obturation was carried out. After, the samples were randomly divided into 4 groups (n = 10) to test the final irrigation solutions: G1:17% EDTA; G2:10% citric acid; G3: Tetraclean and G4: saline solution (control). After 30 days of storage (36.5° C and 100% humidity), the post preparation was performed leaving 4 mm of apical endodontic filling. Then, a fiber-glass post previously selected was coated with ED Primer adhesive system and resin sealer Panavia, installed and stored for 24 hours at 37°C. The samples were subjected to a tensile test with a constant speed of 1 mm/min with 2000 Kgf. The results were analyzed with the ANOVA test. Results The statistical analyzes indicated no significant differences between the groups (p > 0.05). Conclusion The type of chelating agent used in the final irrigation of the endodontic treatment did not influence the tensile strength of the fixation system used to sealer the glass fiber posts to the intracanal dentin.

The endodontic treatment aims to heal the periapical tissues after the elimination of infected remains of the root canals systems, providing function to the tooth in oral environment. However, the prevalence of failure in these treatments becomes common, occasioning discomfort to the patient, due to the emergence of extensive lesions in the periodontium and painful symptomatology, consequently. In this way, the endodontic should plan comprehensively, analyzing all the diagnostic possibilities, treatment and prognostic. Basing on this, this study aims to report a case, about these perspectives, in what an extensive lesion in the periapex, of low predictability, regressed one year after conventional endodontic treatment in a single session. For this treatment we opted for radiographic methods and computerized tomography for diagnostic and control of the lesion. Therefore, basing on the therapeutic success of this case, it was verified that a precise diagnostic with an indicated endodontic treatment, can avoid an unnecessary surgical intervention and enable a favorable prognostic long-therm.

Endodontic practice is indicated as intervention for diagnosed teeth with pulp involvement, such as necrosis and irreversible pulpitis. The success of treatment is related to the professional's technical ability, to the understanding of pathological idiosyncrasies and elaboration of strategies covering diagnosis, treatment and prognosis to solve the case within each particularity, besides of the patient's biological principles and pulp and periradicular condition. It is undeniable that technological advances in endodontics, such as rotary, microscope and ultrasound contributed in an indispensable way to the increase of the success rates of the endodontic treatments, however the failure portion triggers the need for other procedures, such as retreatment and paraendodontic surgery. In this sense, paraendodontic surgery presents itself as an intervention for elements in which the root canal filling did not obtain a satisfactory result, being justified curettage of the lesion and removal of the apex of the dental element. Accordingly, The present study aimed to report the case of a patient who, in a routine consultation, presented in the radiographic examination a radiolucent area extended by elements 11, 21 and 22, 21 being endodontically treated three years ago. For the best visualization, diagnosis and planning, computed tomography was chosen to subsequent paraendodontic surgery. Follow-up of the case completed one year and four months with evidence of success, ensuring the efficiency of the surgery paraendodontic as an option to prevent dental organ extraction and rehabilitation through implants or prosthesis.

Ameloblastic fibroma is an unusual, benign, mixed, odontogenic tumor, usually asymptomatic, with prevalence in the first two decades of life, posterior region of the mandible. Because it is silent, it is usually discovered by routine imaging exams and requires a surgical approach for diagnosis and treatment, as they have characteristics similar to other tumors and cysts, in addition to having the potential to expand, reabsorbing bone and dental tissue. Treatment is widely discussed between a conservative and radical approach, and the choice must be made based on a thorough analysis of the lesion, as it may recur. Based on this, the present study aims to present a case with 2 years of follow-up of this rare pathology with enucleation and curettage of the region of the right mandibular angle and removal of tooth 47 germ from a 6-year-old child.Conservative treatment of ameloblastic fibroma in young patients presents itself as an effective option, since it has several advantages such as reduced morbidity and favors rehabilitation in an aesthetic and functional way.

This report aims to present a clinical case of endodontic re-treatment performed on a left inferior premolar with two canals of difficult localization. The importance of anatomical knowledge and the use of an operating microscope, especially in complex reintervention are discussed. An endodontic re-treatment was performed on element 34, which had a prosthetic restoration and vestibular fistula. In clinical examination, it was observed a negative result to the sensitization test and a positive result to vertical percussion test. After all the obturating material was removed, an operating microscope was requested to assess a possible fracture or the presence of another canal. It was noticed the presence of another canal that was treated and obturated as the existing canal. After 12 months, a new radiographic exam was performed, whose result was found asymptomatic and radiographically normal. In complex peculiar anatomy cases, the operating microscope is vital for the localization of extra canal to guarantee treatment success. O artigo tem como objetivo apresentar um caso clínico de retratamento endodôntico realizado em um pré-molar inferior esquerdo com dois canais de difícil localização, onde é discutida a importância dos conhecimentos anatômicos e o uso do microscópio operatório, sobretudo em reintervenções complexas. Realizou-se um retratamento endodôntico no elemento 34, possuidor de restauração protética e fístula por vestibular. No exame clínico, constatou-se resultado negativo ao teste de sensibilidade e resultado positivo ao teste de percussão vertical. Após remoção de todo o material obturador existente, o microscópio operatório foi solicitado para avaliação de uma possível fratura ou presença de outro canal. Foi constatada a presença de outro canal, o qual foi tratado e obturado como o já existente. Após 12 meses, novo exame radiográfico foi feito e constatou-se normalidade radiográfica e assintomatologia. Em casos mais complexos e com anatomia peculiar torna-se imprescindível a utilização do microscópio operatório no auxílio à localização de um canal extra para o sucesso do tratamento.

This study sought to evaluate how instrumentation techniques and irrigating solutions affected the bond strength of glass fiber posts. For this study, 80 human maxillary central incisors were selected. Endodontic access was obtained, root canal length was measured, and the coronal third was prepared using Gates-Glidden drills. The specimens were embedded in acrylic resin and randomly assigned to 8 groups (n = 10): manual instrumentation only (Group 1), rotary instrumentation only (Group 2), irrigation with 2.5% sodium hypochlorite (NaOCl) (Group 3), irrigation with 2% chlorhexidine (CHX) (Group 4), manual instrumentation and irrigation with 2.5% NaOCl (Group 5), manual instrumentation and irrigation with 2% CHX (Group 6), rotary instrumentation and irrigation with 2.5% NaOCl (Group 7), and rotary instrumentation and irrigation with 2% CHX (Group 8). Specimens in Groups 5-8 also received a 1 minute final rinse with ethylenediaminetetraacetic acid. Canals were filled and the specimens stored for 30 days in distilled water. The restoration material was removed down to the apical 4 mm of the root canal. The glass fiber posts were luted with resin cement and stored for 24 hours at 37°C. Specimens were subjected to a tensile strength test at a constant speed of 1.0 mm/minute and a load of 2,000 kgf. The results were analyzed by analysis of variance and Tukey's test. Irrigation with 2.5% NaOCl reduced the bond strength of fiber posts significantly (P0.01), while CHX showed no effect (P0.05). It was concluded that irrigation with 2.5% NaOCl has a negative effect on micromechanical retention of glass fiber posts, whether manual or rotary instrumentation is used.