Endodoncia

... Base de datos de artículos de revistas, ... la colocación de pastas de hidróxido de calcio con diferentes vehículos, como medicación intraconducto, sobre el sellado apical de la obturación endodóntica Autores: Alvaro Cruz, G.; Holland, R.; Alfaro, JF Revista: Endodoncia, 2001 OCT ...

Aim To evaluate the incidence of root dentinal microcracks after two extraction techniques through micro-computed tomographic (micro-CT) analysis.
Methodology Thirty pairs of premolars, extracted for orthodontic reasons, were assigned to 2 experimental groups, following a split-mouth design (n = 30): traumatic technique group (TTG) - teeth extracted following a conventional protocol using forceps, and atraumatic technique group (ATG) - teeth extracted following an atraumatic technique protocol in which the root was gently detached from the
periodontal ligament using a periotome. All teeth were immediately immersed in distilled water and scanned in a micro-CT device within 72 hours following the extraction. The assessment of the images was done on cross-section images by 2 masked evaluators. The Mann-Whitney test was used to assess the significant differences between the groups regarding the number of cross-sections displaying microcracks while Fischer’s exact test was used to assess differences in the frequency of specimens with defects (P<0.05).
Results A total of 52,750 micro-CT cross-sectional images were evaluated. A total of 352 cross-sections had at least one dentinal defect. Microcracks were observed in 5 teeth of the TTG group (n = 352 slices) and in 2 teeth of the ATG group (n=103 slices). The statistical analysis used was unable to detect a significant difference between the groups in terms of the number of dentinal microcracks (P=0.233) and in the frequency of teeth displaying microcracks (P=0.424).
Conclusion A small number of sound teeth without endodontic treatment had dentinal microcracks regardless of the extraction technique applied. No difference was noticed between the traumatic or atraumatic techniques in the incidence of microcracks.

This is a successfully managed clinical case report of a young lady whose tooth # 11 was root treated in 2010 which reinfected after three years. The root treatment was repeated but was iatrogenically perforated because of the operating dentist&apos;s error. The tooth was therefore opened for surgical correction. During the procedure, it was found that labial wall of the tooth was missing in the mid-root area. The labial wall was built using glass ionomer cement keeping the endodontic file in the canal to avoid obliteration of canal space by glass ionomer. The rebuilt canal was treated with Calcium Hydroxide dressings at an interval of 7 days. In two weeks as the sinus healed, swelling subsided and the canal became effortlessly dryable using just two absorbent points, the canal was obturated with a custom made gutta percha cone, employing glass ionomer as a canal sealer.

Objectives This study evaluated the danger zone (DZ) in mesial roots of mandibular molars and the correlation between anatomical references of the DZ and some anatomical landmarks including tooth/root length, depth of mesial and distal grooves, and inter-canal orifices distance. Material and methods Twenty-eight mesial roots of mandibular molars with 2 independent canals were scanned and divided into 2 groups according to root length. The anatomical landmarks were correlated (Pearson or Spearman coefficients) with root level, thickness, and position of the DZ and also compared (independent samples t or Mann-Whitney tests) between the 2 groups at α = 5%. Results No statistical difference was observed between groups regarding DZ parameters and depth of mesial and distal grooves (P > 0.05). Orifice distance in group 2 (4.49 ± 0.75 mm) was significantly greater than group 1 (3.76 ± 0.89 mm) (P < 0.05). Significant correlations (P < 0.05) were found between (i) DZ level and root/tooth length (r = 0.54 and 0.49, respectively), (ii) DZ thickness and distal groove depth (r = − 0.45), and orifice distance (r = 0.38), and (iii) DZ position and depth of mesial (r = 0.39) and distal (r = 0.40) grooves. Other variables such as root length and distal groove depth (r = 0.28), and orifice distance and mesial groove depth (r = 0.36) were also correlated (P < 0.05). Conclusions The length of tooth/root, the distance of canal orifices, and the depth of mesial/distal grooves of mesial roots of mandibular molars might be predictive factors for the root level, position, and thickness of the DZ. Clinical relevance The length, distance of mesial canal orifices, and the depth of mesial and distal grooves of the mesial roots of mandibular molars might be moderate predictive factors for the root level, position, and thickness of the DZ.

Aim To evaluate the influence of ultraconservative endodontic access cavities (UEC) on gaps and void formation in resin composite restorations in extracted 2-rooted maxillary premolars after root canal
treatment. Traditional endodontic access cavities (TEC) were used as a reference for comparison.
Methodology Two-rooted maxillary premolars were scanned in a micro-computed tomographic (micro-CT) device, matched based on similar anatomical features and allocated in two groups (n = 10) according
to the design access of the tooth: TEC or UEC. Teeth were mounted on a mannequin head and a single operator performed the treatment, including endodontic access cavity preparation, root canal detection,
preparation, filling and restoration procedures, under magnification. For restorative procedure, a bulk fill flowable layer was applied initially followed by an overlaying of regular composite. After restoration procedures, a new micro-CT scan was performed to check the quality of the coronal restoration by analyzing the percentage volume of empty spaces present in the tooth-restoration interface (gaps) and inside the restoration (voids). Data were analyzed statistically using Shapiro-Wilk and Student’s t-tests with a significance level of 5%.
Results All specimens had gaps and voids. There were significant differences between the access cavity designs regarding the formation of voids with more voids in the UEC (P < 0.05). Gap formation did not
differ between groups (P > 0.05)
Conclusion The access cavity design used during root canal treatment interfered with the adaptation of the restorative material. The minimally invasive access cavity design was associated with a greater number of
voids within the restoration.

Introduction: This study evaluated the microbiological conditions of the apical root canal system of teeth with posttreatment apical periodontitis and correlated them with observations from cone-beam computed tomography (CBCT), micro-computed tomography (micro-CT) and histopathology.
Methods: Root apices were obtained from 36 root canal-treated teeth subjected to perirradicular surgery. CBCT exam was available before surgery. The apical root specimens were scanned in a micro-CT device and then cryopulverized. The powder was subjected to DNA extraction for real-time polymerase chain reaction quantification of total bacteria, Streptococcus species, members of the phylum Actinobacteria, and Enterococcus faecalis. Microbiological findings were evaluated for associations with CBCT, micro-CT and histopathologic data. An association between lesion size and the proportion of unfilled apical canal system volume was also assessed.
Results: All cryopulverized specimens were positive for total bacteria. Actinobacteria and streptococci occurred in 35 and 33 specimens, respectively, and were usually dominant in the community.  Actinobacteria counts were 2.23 times higher in granulomas than in cysts. Streptococcus were significantly more present in small lesion cases. E. faecalis was detected in only 7 samples, always as a dominant
community member. Association of total bacteria, streptococci and Actinobacteria counts with the unfilled canal volume was significant in the univariate analyses, but not confirmed in the adjusted analyses. Large lesions were significantly associated with a higher volume of unfilled apical canal.
Conclusions: Bacterial infection occurred in all root apices, with high prevalence and dominance of Actinobacteria and streptococci. The volume of unfilled apical canal system was significantly associated with the lesion size and possibly with bacterial counts. Findings illustrate the need to thoroughly disinfect and fill the apical root canal of infected teeth during endodontic therapy.

Paciente masculino de 18 años de edad, sin antecedentes médicos o sistémicos que contribuyan al caso. Un examen clínico y radiográfico reveló una extensa lesión periapical, tumefacción intraoral, fístula; relacionada con una sobre- extensión de la obturación con conos de gutapercha en el diente 21, conducto radicular amplio y falta de constricción apical. El paciente reportó una historia previa de trauma dental que involucró este cuadrante. el diagnóstico fue de una periodontitis apical crónica supurativa del diente 21. Durante la desobturación del conducto radicular fue drenado a través del conducto un exudado sanguinolento y un exudado seroso amarillo. Seguido a la preparación biomecánica un apósito de hidróxido de calcio fue aplicado y reemplazado 3 veces en un perìodo de 12 meses. Las características clínico- patológicas demostraron resolución de la lesión durante este período. Un tapón apical con MTA blanco fue colocado en la porción apical del conducto radicular. Una semana después el conducto fue obturado con gutapercha. Los exámenes clínico- radiográficos a los 16 meses revelaron normal contorno del hueso y una significativa resolución de la radiolucidez apical. El propósito de este artículo fue reportar la reparación de una extensa lesión periapical relacionada con una sobre-extensión de la obturación con conos de gutapercha.

RESUMEN Los incisivos centrales inferiores son las piezas dentarias más pequeñas de la arcada dentaria, sin embargo, debido a que su raíz es achatada en sentido mesio distal puede presentar dos conductos radiculares, un conducto vestibular, el que por lo general el odontólogo localiza y otro conducto lingual el cual es pasado por alto siendo el tratamiento endodóntico de pronostico dudoso. Este trabajo de investigación tiene como objetivo concientizar a los estudiantes de 5º año de la Carrera de Odontología en las dificultades que se pueden presentar en este tipo de piezas dentarias por desconocimiento de su anatomía. Se trabajaron con 40 incisivos centrales inferiores a los cuales se les realizó una radiografía preoperatoria ortorradial. A continuación, se procedió a realizar la apertura cameral y la localización de el o los conductos radiculares que según el alumno presentaba la pieza dentaria a tratar. Posteriormente, al determinar la longitud de trabajo se efectuó una radiografía ortorradial y disociada, para poder determinar si la pieza dentaria exhibía otro conducto radicular. En este trabajo, el 88% de los incisivos centrales inferiores presentaron 2 conductos radiculares mientras que el 12% restante uno sólo. No hubo diferencia estadísticamente significativa entre conductos encontrados (57%) y no encontrados (43%). DESCRIPTORES: Cavidad pulpar. Incisivo. Educación en Odontología. ENDODONTIA EM INCISIVOS CENTRAIS INFERIORES: OMISSÃO DO CONDUTO LINGUAL RESUMO Os incisivos centrais inferiores são os dentes menores das arcadas dentárias, no entanto, a sua raiz é achatada no sentido mesiodistal podendo ter dois condutos radiculares, o conduto vestibular, geralmente o dentista localiza e o outro conduto lingual que é negligenciado sendo o tratamento endodôntico do prognóstico duvidoso. Este trabalho de pesquisa visa conscientizar os alunos do 5º ano da carreira de Odontologia sobre as dificuldades que podem surgir neste tipo de dentes devido ao desconhecimento de sua anatomia. Trabalhamos com 40 incisivos centrais inferiores, nos quais foi realizada uma radiografia ortorradial pré-operatória. Em seguida, abertura cameral e localização do canal radicular ou condutos que segundo o estudante, apresentavam o dente a ser tratado. Posteriormente, ao determinar o comprimento de trabalho, foi realizada uma radiografia ortorradial e dissociada, a fim de determinar se o dente apresentava outro canal radicular. Neste trabalho, 88% dos incisivos centrais inferiores apresentavam 2 canais radiculares, enquanto os 12% restantes apresentavam apenas um. Não houve diferença estatisticamente significante entre os condutos encontrados (57%) e não encontrados (43%). DESCRITORES: Cavidade pulpar. Incisivo. Educação em Odontologia.

De la fisiología al metaboloma, de la etiología bacteriana al concepto del biofilm y la disbiosis en el microbioma humano. La caries y las enfermedades periodontales son infecciones donde el biofilm es un reconocido factor de riesgo microbiano que determina el inicio y progresión de una lesión. Las bacterias que causan estas enfermedades están organizadas en estructuras denominadas biofilm, que son comunidades de complejos microbianos compuestos por una gran variedad de microorganismos con diferentes requerimientos ecológicos y un alto potencial patogénico. El biofilm es un neologismos científico que no merece ser traducido y sobre todo mal interpretado. La placa bacteriana es en realidad un biofilm microbano...

V 2018 REVISTA DE LA ASOCIACIÓN DE ENDODONCISTAS DEL AZUAY.
Volume: V
Page Numbers: 4-6
Publication Date: 2018
Publication Name: REVISTA DE LA ASOCIACIÓN DE ENDODONCISTAS DEL AZUAY

Improving the “Implications for Practice/Research” section of a Cochrane Review using a survey questionnaire
Background: Irreversible pulpitis, characterized by acute and intense pain, is one of the most frequent reasons patients attend for emergency dental care. Apart from tooth removal, pain relief is achieved by drilling into the tooth, removing the inflamed pulp (nerve) and cleaning the root canal. However, although many dentists continue to prescribe systemic antibiotics for irreversible pulpitis our Cochrane review [CD 004969] found that there was no evidence for their effectiveness.
Objectives: To use the results of our Cochrane review on the lack of effectiveness of antibiotics for irreversible pulpitis to design a survey that can be used to help inform the “Implications for Practice and Research” section of the Cochrane Review.
Methods: On-line survey: clinical vignette, single question with a choice of one of 6 treatment options, one of which indicates a preference for prescribing of antibiotics for irreversible pulpitis. Participants surveyed were a global sample of general dentists, specialist endodontists and post-doc endodontic residents. The survey was distributed via email, online professional public forums and social networks. Responses were imported into Excel and analyzed. 
Further ongoing analysis will explore survey responders’ awareness of the Cochrane Review CD 004969 and any related clinical guidelines.
Results: 255 completed questionnaires (March 2014), Responders: General dentists (205); specialist endodontists (32); Post-doc residents (18). Country of origin: 15 countries across the globe. 64 (25%) would prescribe antibiotic for irreversible pulpitis; 86% of those would prescribe antibiotics plus analgesics, remainder (9) antibiotics alone.
Conclusions: Antibiotics continue to be prescribed for irreversible pulpitis by some general dentists and endodontists at global level. This survey provided additional contextual information which has been discussed and included in the Implications for Research/Practice section of our Cochrane Review.

Introduction: Root canal disinfection is critical for successful endodontic treatment. Objective: To evaluate the antibacterial efficacy of photodynamic therapy using different protocols in root canals infected with Enterococcus faecalis. Material and methods: Thirty- two human teeth were used. The canals were contaminated with E. faecalis for 72 hours. After this period, the root canals were filled with a 25-μg/mL methylene blue solution and activated with a low power diode laser and then divided into four experimental groups (n = 8) according to the protocol of the use of the laser: group I) activated for 3 minutes at a wavelength of 660 nm with 40 mW total power; group II) activated for 5 minutes at a wavelength of 660 nm with 40 mW total power; group III) 3 minutes at a wavelength of 780 nm at 40 mW total power; group IV) 5 minutes at a wavelength of 780 nm with 40 mW total power. Bacteriological samples were collected before (A1) and after (A2) the specific procedure of each group. The number of colonies forming units was counted. Results: A significant reduction in the number of colonies forming units was observed. There was a statistically significant difference between the groups, and the protocol of group II obtained the greatest reduction in the number of viable cells after the use of photodynamic therapy. Conclusion: It was seen, with the methodology employed, that the use of photodynamic therapy leads to the reduction of intracanal contamination, but it was not able to completely eradicate the contaminating bacteria.

The aim of this systematic review was to evaluate the influence of several methodological variables on the push-out resistance to dislodgment of root filling materials by a meta-regression analysis of the literature. A systematic review was performed by searching the PubMed database using the terms 'push-out' and 'pushout'. Laboratory studies published before March 2015 were included. Two reviewers extracted data regarding country of origin, year of publication, tooth type, smear layer removal, root canal sealer, core material, obturation technique, sample storage, tooth portion, test machine load velocity and slice thickness. Pooled mean resistance to dislodgement of all groups from the included studies was used in a linear meta-regression of random effects (α = 0.05). Of the 850 identified studies, 53 met the inclusion criteria. A meta-regression of the 341 groups extracted from these articles was performed to analyse the influence of each variable on resistance to dislodgement (in MPa). The sealer, core material, obturation technique, slice thickness, storage time, load velocity and tooth portion significantly influence the results (P < 0.05). Irrigant solution and smear layer removal did not influence the resistance to dislodgement of the root filling materials (P > 0.05). Methodological variables such as sealer, core material, root filling technique, tooth type, tooth portion, slice thickness, storage time and load velocity influenced the resistance to dislodgment. The inclusion and standardization of all related variables could lead to a more comparable and reproducible analysis of the resistance to dislodgment of the root canal sealers.

The aim of this study was to evaluate age-related morphological canal changes in mesial root of mandibular first molars of know ages…….Concluded that there is a correlation between aging and morphological changes in the mesial root canals of mandibular first molar.