Avaliação e correlação da presença de endotoxinas e MMP-3, -8 e -9 em canais radiculares com necrose pulpar submetidos ao tratamento endodôntico - estudo in vivo

It is know that endotoxin and various matrix metalloproteinases (MMPs) are involved in the development of periapical lesions. The purpose of this study was to evaluate and correlate the presence of endotoxins and MMP- 3, MMP-8 and MMP-9 in root canals of teeth with necrotic pulp and periapical lesion before, during and after the biomechanical preparation (PBM) using a combination of different irrigations solutions and intracanal dressing. Thirty-three single-root teeth with a diagnosis of pulp necrosis and periapical lesion radiographically visible were selected. Immediately after the coronal opening was collected the first sample from the root canal content. Then, all canals were prepared (cervical and middle thirds) by oscillatory instruments (EndoEze) and irrigated by 2.5% NaOCl. After, a manual preparation was made for the apical third and the teeth were divided into three groups according to the irrigation protocol: G1) 2.5% NaOCl (4 manual files); G2) 2.5% NaOCl (2 manual files) + [Ca (OH)2 0.14%] (2 manual files) and G3) 2.5% NaOCl (2 manual files) + polymyxin B (2 manual files). After the PBM, the second sample was collected; then the third collect was performed after using EDTA final flush. The fourth sample was collected 14 days after placing the dressing [2% chlorhexidine gel + Ca(OH)2]. Quantification of endotoxins was performed by a kinetic chromogenic lysate from amoebocytes of Limulus (LAL) and quantification of MMPs by ELISA assay. The results were analyzed statistically by Kruskal-Wallis and Dunn's test (5%) and ordinal Spearman correlation. Presence of endotoxin was observed in 100% of cases and G3 showed the greatest reduction of endotoxins from the 1st to the 2nd samples (97%), being statistically similar to G2 (84.2%) and different from G1 (49.4%) (p<0.05). The intracanal dressing promoted a significant reduction of endotoxin, no difference among the groups. For...

Radiopacity evaluation of contemporary luting cements by digitization of images

The aim of this study was to evaluate the radiopacity of two conventional cements (Zinc Cement and Ketac Cem Easymix), one resin-modified glass ionomer cement (RelyX Luting 2) and six resin cements (Multilink, Bistite II DC, RelyX ARC, Fill Magic Dual Cement, Enforce and Panavia F) by digitization of images. Methods. Five disc-shaped specimens (10×1.0 mm) were made for each material, according to ISO 4049. After setting of the cements, radiographs were made using occlusal films and a graduated aluminum stepwedge varying from 1.0 to 16 mm in thickness. The radiographs were digitized, and the radiopacity of the cements was compared with the aluminum stepwedge using the software VIXWIN-2000. Data (mmAl) were submitted to one-way ANOVA and Tukey's test (=0.05). Results. The Zinc Cement was the most radiopaque material tested (<0.05). The resin cements presented higher radiopacity (<0.05) than the conventional (Ketac Cem Easymix) or resin-modified glass ionomer (RelyX Luting 2) cements, except for the Fill Magic Dual Cement and Enforce. The Multilink presented the highest radiopacity (<0.05) among the resin cements. Conclusion. The glass ionomer-based cements (Ketac Cem Easymix and RelyX Luting 2) and the resin cements (Fill Magic Dual Cement and Enforce) showed lower radiopacity values than the minimum recommended by the ISO standard.

Influence of irrigation and intracanal dressing on the healing process of dogs' teeth with apical periodontitis.

Dogs' teeth with apical periodontitis were treated endodontically, Dakin's solution being used in an experimental group as the irrigation solution, and camphorated paramonochlorophenol as an intracanal dressing. For a second group of teeth, the irrigation solution used was physiologic saline, dry cotton only being placed into the pulpal chamber to take the place of an intracanal dressing. In a second visit, overinstrumentation and a new application of the same kind of dressing were performed, the root canals being then filled with gutta-percha cones and zinc oxide-eugenol cement. Other specimens were treated, in one visit, where physiologic saline or Dakin's solution were the irrigation solutions. The animals were sacrificed 6 months after the obturation of the root canals. Histologic exams showed better results for the experimental group where Dakin's solution and camphorated paramonochlorophenol had been used, with signs of repair characterized by newly formed cementum and bone tissue, as well as a marked reduction in size of the periapical lesions. No differences were seen in the results with physiologic saline or Dakin's solution as irrigants.

Quarto molar retido: a importância do diagnóstico precoce

Introductions: A supernumerary tooth is one that is additional to the normal series and can be found in almost any region of the dental arch. Its etiology is not fully understood. With regard to its prevalence, it occurs more commonly in permanent dentition and twice as often in men than in women. Supernumerary teeth are classified according to their morphology and location. Their presence can cause problems such as failure of eruption, displacement of teeth, crowding and odontogenic cysts and tumors. The diagnosis is usually by routine radiographs, for the majority of such teeth are impacted and asymptomatic. Objective and Case report: The purpose of this study was to make a brief review of the relevant literature and report one clinical case of the female patient, 23 years, melanoderma, featuring three quarters molars. Final considerations: The early diagnosis proved to be important for the resolution of the case in order to minimize or even prevent the development of complications and thus establish a proper plan of treatment.

Estudo radiográfico de terceiros molares inferiores retidos e parcialmente irrompidos e revisão de literatuda

Introduction: Pathology associated with retained or partially erupted teeth are common in the general population. Objective: the aim was to evaluate the measurement of pericoronal space of retained third molars and partially erupted teeth in panoramic radiographs. Method: a retrospective study was carried on on the frequency of tooth retention and the problems it can cause in 107 radiographs of patients where the width was measured to verify the presence or absence of diseases associated with the involved teeth. Results: in the 107 panoramic radiographs analyzed the most frequent measurement was of 1.0 mm with 32.71% of cases followed by 2.0 mm with 29.91% of cases. Conclusion: The measurement of the pericoronal sapce of retained third molars and partially retained through its greatest width is in a practical and effective technique for application in routine clinical practice, which suggests the presence or absence of eraly odontogenic pathology

Tomografia computadorizada Cone Beam em Ortodontia - evolução ou revolução? visão geral, aplicações, vantagens/desvantagens e dose de radiação

Introduction: The request of three-dimensional images (3D) of the dentomaxillofacial complex has increased. Hence, new possibilities for assessment, treatment as well as follow-up after treatment have increased their importance with the use of cone beam computed tomography (CBCT). The images in two dimensions (2D) have inherent problems that can be solved with treedimensional images assessment. Objectives: To clarify the main doubts about the operational mechanism of complementary diagnostic method; to explain the advantages and disadvantages, to discuss the effective radiation dose and possible applications in orthodontia. Conclusion: The information generated by 2D images from the CBCT does not show differences that may endanger the orthodontic planning when compared with the images of 2D conventional radiographs. The effective radiation dose received by the patient should not be considered as a limiting factor of the tomography exam request.

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

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

Root reconstructed with mineral trioxide aggregate and guided tissue regeneration in apical surgery: a 5-year follow-up

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Influência do hipoclorito de sódio no processo de reparo de dentes de cães tratados em sessão única

Introdução: a eliminação de bactérias dos canais radiculares é essencial no tratamento endodôntico de dentes com polpas necrosadas, desde que bactérias não só causam, mas também mantêm, as lesões periapicais. Objetivo: analisar in vivo a influência de soluções irrigantes (NaOCl 1%, NaOCl 2,5%, solução salina estéril 0,9%) no tratamento de dentes de cães com lesão periapical crônica em sessão única. Métodos: quarenta canais radiculares de três cães da raça Beagle permaneceram expostos à cavidade bucal para permitir a contaminação e a formação de lesões periapicais crônicas. Em seguida, os canais radiculares foram preparados biomecanicamente. Durante a instrumentação, três soluções irrigantes foram utilizadas: G1 – NaOCl 2,5%; G2 – NaOCl 1%; G3 – solução salina estéril 0,9%. O grupo controle (G4) não recebeu tratamento nem selamento coronário. Os canais radiculares foram obturados com cones de guta-percha e Sealapex. As aberturas coronárias foram seladas com IRM e amálgama. Após 6 meses, os animais foram sacrificados e blocos de tecido processados histologicamente para serem corados com hematoxilina e eosina, ou Brown e Brenn. Resultados: não houve diferença histológica significativa entre a utilização de hipoclorito de sódio a 1% ou 2,5% (p>0,05), mas houve entre eles e a solução salina estéril a 0,9% (p<0,05). Conclusão: concluiu-se que o uso de soluções irrigantes com potencial antibacteriano (hipoclorito de sódio a 1% e 2,5%) proveu condições mais favoráveis ao processo de reparo.

Tratamento tardio de traumatismo dentário anterior pela técnica de apicificação

Introdução: paciente do sexo masculino, 37 anos de idade. Após a anamnese, foi constatado que o dente 11 apresentava abertura coronária e presença de hidróxido de cálcio com histórico de trauma dentário nesse dente. Radiograficamente, o dente 11 apresentava formação radicular incompleta, paredes dentinárias finas e frágeis, com divergência foraminal associada a imagem radiolúcida periapical. Objetivo: relatar um caso clínico de apicificação, realizado com trocas de curativo de hidróxido de cálcio. Métodos: o tratamento de escolha foi a apicificação, a qual teve início na segunda sessão, após 15 dias, por meio de desbridamento químico-mecânico de todo o canal radicular, com limas tipo K e irrigação com uma solução de hipoclorito de sódio a 2,5%. Em seguida, pasta de hidróxido de cálcio (hidróxido de cálcio, iodofórmio e propilenoglicol) foi aplicada e trocada de 15 em 15 dias, durante 4 meses. O exame radiográfico foi novamente realizado e demonstrou o fechamento completo da abertura foraminal e regressão da radiolucência periapical. O canal radicular foi obturado utilizando-se um cone confeccionado a partir da união de três cones #60 e pela técnica de condensação lateral com Sealapex. Resultados: seis meses após a obturação, exames revelaram tecidos periapicais normais e ausência de sintomas. Conclusão: concluiu-se que o tratamento do traumatismo dentário associado à necrose do tecido pulpar e à lesão periapical, com trocas sucessivas de pasta de hidróxido de cálcio, foi adequado para se obter a regressão da lesão periapical, formação de barreira mineralizada e promoção de saúde ao paciente.

Considerações sobre o sucesso do tratamento endodôntico

The follow up after endodontic treatment is the most effective tool for evaluating the quality of treatments performed, as well as, it lets to examine the procedures used at different stages of endodontic therapy. Clinical and radiographic findings must be taken into consideration to determine the percentage of endodontic success. Clinical findings include: absence of pain or positive examinations for percussion and palpation, swelling, tooth mobility and fistula. Regarding the radiographic findings it is possible to report absence of periapical radiolucent areas suggestive of periapical lesions and presence of bone cortical. Thus the aim of this study was to perform a bibliographic revision and a discussion about the factors of endodontic treatment follow up.

Estudo de alterações dimensionais da mandíbula medidas em radiografias panorâmicas

Rotational panoramic radiograpy is a widely used procedure for examination of the jaws. Then, the aim of this study was analyse the mandibular growth from images obtained on panoramic radiographs of male and female children with chronological age between 7-10 years old. Craniometrics points were identifyed and linear measurements obtained from mandibular body and ramus. The results showed an increase in mandibular body lenght and mandibular ramus height in both sexes. Statistically significant correlation was found between the total mandibular lenght (from codilion to mental) and mandibular body lenght (from gonion to mental), in male and female children.

Lesão fibro-óssea na mandíbula associada à osteomielite

A displasia cemento-óssea é o tipo mais comum dentre as lesões fibro-ósseas, podendo apresentar-se de 3 maneiras: periapical, focal e florida. Paciente parda, de 53 anos, compareceu com queixa de “secreção na gengiva” e histórico de exodontia na região há 8 meses. À inspeção apresentou uma leve tumefação na região vestibular posterior esquerda da mandíbula e uma pequena fístula drenando pus. Realizou-se uma radiografia panorâmica, que revelou uma lesão de radiopacidade mista na região de molares inferiores direitos, medindo 2 cm de diâmetro; outra lesão radiopaca na região de pré-molares esquerdos, de 6mm de diâmetro - ambas bem delimitadas; e outra área radiolúcida com radiopacidade central, com halo radiopaco na região infectada, medindo 1,5 cm de diâmetro. O diagnóstico presuntivo foi de displasia cemento-óssea infectada, cisto periapical infectado associado à displasia e osteomielite. Após antibioticoterapia, realizou-se biópsia e curetagem da área. Microscopicamente apresentou áreas de tecido cemento-ósseo em forma trabecular e no local onde deveria haver tecido fibroso, presença de biofilme bacteriano, conteúdo hemorrágico e restos necróticos. No tecido de granulação removido observou-se intenso infiltrado inflamatório e áreas de calcificação cementóide. As características microscópicas juntamente com os achados clínicos e radiográficos levaram ao diagnóstico de osteomielite aguda supurativa secundária a lesão fibro-óssea, sugestiva de displasia cemento-óssea florida.

Infecções odontogenicas: relato de caso clínico e implicações terapêuticas

Acute infections maxillo-facial are of great importance, both for its high population, as the risk of complications. The aim of this study was to present a clinical case of extensive odontogenic abscess in a patient of 31 years of age attended the Service of Surgery and Maxillo-Facial, Faculty of Dentistry of Araçatuba - UNESP in Araçatuba, SP. Complications of infections odontogências although infrequent can lead the patient to death.

Cisto ósseo simples: relatos de casos

Usually diagnosed in routine radiographs, the simple bone cyst occurs infrequently. Etiology is unknown and differential diagnosis has to be made with dentigerous cyst, keratocystic odontogenic tumor, adenomatoid odontogenic tumor, ameloblastoma and central giant cell granuloma. Treatment is surgical, by perforating the cortical bone. In most cases an empty cavity, without any capsule or epithelial covering, is encountered, but it may have a liquid content. Perforation of the mandibular cortical bone elicits a response that results in bone repair of the empty cavity. This article reviews the subject and presents two cases of this entity and discusses the possible factors that could interfere in healing course.