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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.

Child violence considered a global problem which negatively affects infant victims across their life course. In cases of physical violence, dentistry professionals are in a privileged position to identify possible victims, due to the frequent involvement of structures of the head / neck region and the oral cavity. However, the perception, knowledge and attitude of dentistry students in relation to the cases of maltreatment against children and adolescents have not yet been systematically examined. A systematic review was conducted using the PubMed, Web of Science, LILACS, SciELO, Google Scholar and OpenGrey electronic databases up to November 2021. In order to avoid any selection bias, the “Grey Literature” was verified through Google Scholar and Open Grey searches. There was no restriction on date of publication and language, cross-sectional (observational) studies were included. The systematic search resulted in 2.756 studies in the first selection phase, but only nineteen articles were included. All the studies used a questionnaire, to evaluate the knowledge, perception and attitudes of dentistry students regarding cases of child maltreatment. It was concluded that there are deficiencies in relation to teaching-learning methodology, reinforcing the need for improvements in undergraduate curricula of dentistry. All forms of approach by dentists towards child maltreatment should be considered important. The awareness of the serious long-term consequences of child maltreatment should encourage better identification of child violence victims by these health professionals and the development of effective interventions to protect children from the exposure to any kind of violence.

An umbrella systematic review to evaluate different types of treatment for infantile hemangioma and to compare the effectiveness of these therapies.

The aim of the present study is to systematically review the literature to identify intra-hole sealing materials used subsequent to root canal filling. A systematic review was conducted using the PUBMED/MEDLINE, WEB OF SCIENCE, SCOPUS, COCHRANE and EMBASE electronic databases. The merging of searches and removal of duplicate articles was performed in the Rayyan QCRI software. To extract data from the included articles, an Excel spreadsheet was used. The risk of bias of the included studies was verified following the checklist of in vitro studies (CRIS guidelines) in order to avoid overestimating the results of the selected studies.

The dental environment can be considered a stressor for children, and can trigger unwanted behaviors. Pediatric Dentistry is a specialty that requires professionals to know preventive measures and restorative skills to perform dental treatment in children or adolescents. In addition, it is especially important that the professional is concerned with the child’s feelings and reactions, allowing the pediatric dentist to identify situations that may generate stress for the patient during the care, and manage the presented behaviors. Recent studies have measured children’s reactions and feelings during dental treatments using projective techniques. Given the importance of drawing to identify children’s emotions, the objective of this study was to search the literature about the use of drawings as a projective technique in Pediatric Dentistry. Therefore, projective techniques, with an emphasis on drawing, have proved to be an effective instrument to be used in clinical practice to better understand the reactions presented by children during dental care and their relationship with dentists. Thus, avoiding unexpected situations in the office and allowing greater chances of obtaining a positive return from the patient., O ambiente odontológico pode ser considerado um estressor para o público infantil, capaz de desencadear comportamentos indesejados. A Odontopediatria é uma especialidade que exige do profissional o conhecimento de medidas preventivas e de habilidades restauradoras para a realização do tratamento odontológico na criança ou no adolescente. Além disso, é muito importante que o profissional se atente aos sentimentos e às reações da criança, e identifique situações que possam desencadear estresse para o paciente durante o atendimento odontopediátrico, e maneje os comportamentos apresentados. Estudos recentes têm mensurado as reações das crianças e seus sentimentos durante tratamentos odontológicos por meio de técnicas projetivas. Diante da importância do desenho como meio para identificar as emoções das crianças, o objetivo deste estudo foi fazer uma busca na literatura acerca do uso de desenhos como técnica projetiva em Odontopediatria. As técnicas projetivas, com ênfase no desenho, revelaram-se um instrumento eficaz a ser utilizado na prática clínica a fim de melhor compreender as reações apresentadas pelas crianças durante o atendimento odontológico e seu relacionamento com os dentistas. Elas evitam situações inesperadas no consultório e possibilitam maiores chances de se obter um retorno positivo do paciente.