Apexification with white MTA in an immature permanent tooth with dens invaginatus

Dens invaginatus, also known as dens in dente, is a developmental dental anomaly resulting in an invagination of the enamel organ into the dental papilla. These cases present technical difficulties to the root canal treatment. Apexification using an apical plug of mineral trioxide aggregate (MTA) has been indicated as an alternative to long-term intracanal use of calcium hydroxide in immature permanent teeth. It is considered as a simple and rapid technique. This paper reports a case of Oehlers' Type 1 dens invaginatus in an immature permanent maxillary right lateral incisor, which presented pulp necrosis secondary to dental trauma and was treated by apexification with white MTA apical plugging followed by conventional root canal therapy. The operative procedures are described and the technique is discussed. The physical and biological properties of MTA, associated with appropriate instrumentation and obturation techniques, make this material an excellent option in the endodontic therapy of immature permanent teeth with dens invaginatus.

Combined therapy with mineral trioxide aggregate, and guided tissue regeneration for a large radicular cyst: A 13-year follow-up

Biomaterials such as membrane barriers and/or bone grafts are often used to enhance periapical new bone formation. A combination of apical surgery and these biomaterials is one of the latest treatment options for avoiding tooth extraction. In case of periapical lesions, guided tissue regeneration (GTR) is attempted to improve the self-regenerative healing process by excluding undesired proliferation of the gingival connective tissue or migration of the oral epithelial cells into osseous defects. In many cases, GTR is necessary for achieving periodontal tissue healing. This report describes the healing process after surgery in a challenging case with a long-term followup. In this case report, endodontic surgery was followed by retrograde sealing with mineral trioxide aggregate (MTA) in the maxillary right central incisor and left lateral incisor. Apicectomy was performed in the maxillary left central incisor and a 1-mm filling was removed. The bone defect was filled with an anorganic bone graft and covered with a decalcified cortical osseous membrane. No intraoperative or postoperative complications were observed. After 13 years of follow-up, the patient showed no clinical signs or symptoms associated with the lesion and radiographic examination showed progressive resolution of radiolucency. In conclusion, the combination of apical surgery and regenerative techniques can successfully help the treatment of periapical lesions of endodontic origin and is suitable for the management of challenging cases.

Influence of presence or absence of teeth adjacent to implants installed immediately into extraction sockets on peri-implant hard tissue levels: An experimental study in the dog

Aim: To evaluate the influence of the presence or absence of adjacent teeth on the level of the mesial and distal alveolar bony crest following healing at sites where implants were installed immediately into extraction sockets. Material and methods: Six Labrador dogs were used. In the right side of the mandible, full-thickness flaps were elevated, and the second, third, and fourth premolars and first molars were extracted. In the left side of the mandible, endodontic treatments of the mesial roots of the third and fourth premolars as well as of the first molars were performed. Full-thickness flaps were elevated, the teeth were hemi-sected, and the distal roots were removed. The second premolars were extracted as well. Subsequently, implants were bilaterally installed with the implant shoulder flush with the buccal bony crest. Implants were placed in the center of the alveoli, but at the fourth premolars, they were placed toward the lingual bony plate of the alveoli. After 3 months of healing, the animals were euthanized and histological sections of the sites prepared. Results: Larger bony crest resorption was observed at the test compared with the control sites, both at the bucco-lingual and mesio-distal aspects. The differences between test and controls for the coronal level of osseointegration were smaller than those for resorption. When data from all mesial and distal sites facing an adjacent tooth were collapsed and compared with those opposing an edentulous zone, lower bony crest resorption and deeper residual marginal defects were found at the sites with neighboring teeth. Conclusion: The extraction of teeth adjacent to a socket into which implants were installed immediately after tooth extraction caused more alveolar bone resorption both for the bucco-lingual and at the mesio-distal aspects compared with sites adjacent to a maintained tooth. © 2012 John Wiley & Sons A/S.

Biocompatibility and biomineralization assessment of a new root canal sealer and root-end filling material

Objective: This study investigated the short-term subcutaneous tissue reaction and biomineralization ability of two epoxy-based root canal sealers containing calcium hydroxide (MBP and MBPc) and ProRoot MTA. Materials and methods: Polyethylene tubes containing the materials were implanted into the dorsal connective tissue of Wistar rats (n = 52) for 7 or 30 days; empty implanted tubes served as controls. Specimens were stained with hematoxylin-eosin and von Kossa stain or left unstained for observation under polarized light. Qualitative and quantitative evaluations of all tissue reactions were performed. One-way anova and the Kruskal-Wallis test were used for statistical analysis (P < 0.05). Results: No significant differences were observed among the groups. All three materials induced mild-to-moderate tissue reactions at 7 days, which decreased over time. Dystrophic mineralization and birefringent structures were observed only in the ProRoot MTA ® group. Conclusion: Both MBP and MBPc appear to be biocompatible but do not stimulate biomineralization. © 2012 John Wiley & Sons A/S.

A method for the geometric standardization of intraoral radiographs for long-term follow up of replanted teeth: A case report

The interpretation of the set of radiographs taken during the follow-up period after tooth replantation might pose several difficulties, especially the inability to adequately reproduce the projection geometry of the exposures. This article describes a method for the geometric standardization of intraoral radiographs using a custom-made apparatus comprising a film-holder attached to an occlusal splint for the long-term follow up of dentoalveolar trauma. The method was applied in a patient who suffered an avulsion of the maxillary central incisors and had the teeth replanted after 4 h in saline storage. Endodontic treatment started 7 days after the trauma with changes of a calcium hydroxide intracanal medication every 15 days in the first 2 months and thereafter at 30-day intervals for 8 months. Root canal filling was carried out after this period. The radiographic exposures taken at the follow-up visits were standardized to identify the possible alterations during the repair process, such as root resorptions. A maxillary arch impression was made with alginate, and the model was cast in stone for fabrication of an acetate occlusal splint. The custom-made apparatus used for standardization of the radiographic exposures was fabricated by fixing a Rinn X-C-P film-holder and a 5-mm-long piece of 0.7-mm orthodontic wire to the occlusal splint with autopolymerized acrylic resin. Radiographs were taken at 4-month intervals, starting 10 months after replantation up to 76 months. The images were digitized and analysed using the Digora system. The length of the central incisors was determined to verify the reproduction of the projection geometry of the exposures and the orthodontic wire served to assess accuracy during length estimations in the radiographs. The method described in this article for geometric standardization of intraoral radiographs provided a consistent reproduction of the geometric exposure parameters, being indicated for use in the radiographic follow up of cases of dentoalveolar trauma. © 2012 John Wiley & Sons A/S.

The platform switching concept revisited. An experimental study in dogs

Objective: To evaluate the influence of the configuration of the marginal aspect of implants placed immediately into extraction sockets on peri-implant hard tissue adaptation. Material and methods: In 6 Labrador dogs, endodontic treatments of the mesial roots of 1M1 were performed and the distal roots were removed. 2P2 was extracted as well. Implants were immediately placed in the center of the distal alveoli. Cylindrical straight implants were installed in the right side of the mandible (Control), while, in the left side, implants with a reduced diameter in the coronal portion, yielding an indentation in the surface continuity (Test), were installed. Cover screws were affixed, and the flaps were sutured to allow non-submerged healing. After 4 months of healing, histological slides were obtained for assessments. Results: A buccal resorption of 1.58 ± 1.28 and 1.90 ± 1.93 mm at the control and of 0.26 ± 0.90 and 0.14 ± 0.66 mm at the test sites was observed at the premolar and molar regions, respectively. The buccal coronal level of osseointegration was located apically to the margin of the smooth/rough surface border by 2.40 ± 0.90 and 3.70 ± 0.87 mm at the control sites and 1.19 ± 0.45 and 2.16 ± 0.96 mm at the test sites at the premolar and molar sites, respectively. All differences yielded statistical significance. Conclusions: The use of implants with a reduced diameter in their coronal aspect may contribute to preservation of the buccal bony crest in a more coronal level compared with conventional implants. Thus, the study confirmed the efficacy of the platform switching concept. © 2013 John Wiley & Sons A/S.

Histologic Characterization of Engineered Tissues in the Canal Space of Closed-apex Teeth with Apical Periodontitis

Introduction: The aim of this study was to investigate the capacity of endodontic regenerative procedures combining an induced blood clot, platelet-rich plasma (PRP), and bone marrow aspirate (BMA) to regenerate dental pulp in canine closed-apex necrotic teeth. Methods: Apical periodontitis was induced in 20 upper and lower premolars of 2 dogs. After biomechanical preparation, enlargement to a #60 file, and disinfection with a triantibiotic paste for 28 days, the roots were randomly assigned to 4 treatment groups: blood clot (BC), BC + PRP gel, BC + BMA gel, and BC + BMA/PRP gel. Negative controls were also included. After a 3-month follow-up period, the animals were killed. Results: Histologic analysis showed the presence of newly formed vital tissues (connective, cement-like, and bone-like tissue) in 23 of the 32 treated roots (71.87%). There was no statistically significant difference between the treatment groups. Conclusions: New vital tissues were formed and characterized as connective, cementum-like, or bone-like, but not as pulp-like tissue; PRP and/or BMA did not improve the tissue ingrowth. © 2013 American Association of Endodontists.

Associação de enterococcus faecalis, candida albicans e escherichia coli em canais radiculares e avaliação dos efeitos de extratos naturais sobre os microrganismos e endotoxinas

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Estudo de propriedades físicas e químicas de um novo cimento selador endodôntico

Pós-graduação em Ciência dos Materiais - FEIS

Análise do processo de reparo no reimplante tardio de dente de rato após curativo de demora com hidróxido de cálcio associado ao paramonoclorofenol canforado ou à clorexidina

Pós-graduação em Odontologia - FOA

Detecção de microrganismos, quantificação de endotoxinas e ação in vivo do Zingiber officinale em dentes com necrose pulpar e lesão periapical

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Comparação entre a capacidade de desobturação de canais radiculares obturados com cimentos à base de MTA, polímero da mamona e resina epóxica utilizando instrumento manual ou rotatório

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Citotoxicidade e genotoxicidade de cimentos endodônticos

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Avaliação microscópica da adaptação de diferentes materiais obturadores às paredes do canal radicular

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Detecção e ação antimicrobiana e antiendotóxica do extrato glicólico de gengibre utilizado como substância química auxiliar durante o retratamento endodôntico

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)