Comparação entre soluções irrigadoras na endodontia: clorexidina x hipoclorito de sodio

The objective of this review was reporting an overview about the properties of two irrigating solutions, solution of sodium hypochlorite and chlorhexidine, used in the treatment of root canals. A solution must submit irrigating antimicrobial action, dissolve waste tissue, promote wetting to facilitate the instrumentation, and present biocompatibility with the adjacent tissues. The sodium hypochlorite used in different concentrations has been the solution of choice among professionals by presenting antimicrobial action and act as a solvent tissue. However, today, chlorhexidine has been widely used as an irrigating solution due to specific properties that enable its use, such as substantivity, antimicrobial effectiveness, and low toxicity. Thus the solution of chlorhexidine with different concentrations is presented as an alternative to irrigating solution for the treatment of root canals.

Incomplete vertical root fracture associated with lateral compaction technique: a microscopic analysis

Objective: This study evaluated the effects of root canal obturation employing lateral compaction technique and spreader load of 1.5 kg on the incidence of complete (CVRF) or incomplete vertical root fractures (IVRF). Material and Methods: Twenty-seven distal roots of extracted human mandibular molars were used. All root canals were prepared by biomechanical step-back technique and obturated by lateral compaction technique. The prepared roots were distributed into two groups: G1- experimental (n = 17) and G2- control (n = 10). During obturation, load of 1.5 kg was applied to a size # 30 finger spreader. Pre- and post-obturation images of the coronal portion of the roots were captured by inverted digital microscopy and analyzed by one trained examiner. Data were evaluated by Fisher’s test (p < 0.05) using GrapH Pad Prism 5.0. Results: No roots exhibited CVRF. All fractures observed before and after obturation were IVRF or “other defects”. In G2 (control group), there was no increase of IVRF number. Interestingly, G1 presented an increase in the IVRF number to 70.59% in the 12 teeth out of 17 teeth studied. The statistical analysis showed that the mean of IVRF increased significantly in G1 when compared to G2 (p < 0.05). Conclusion: The application of a 1.5 kg spreader load during lateral compaction technique does not produce complete vertical root fractures, but may produce incomplete fractures or “other defects”.

Aspectos atuais do tratamento da infecção endodôntica

Endodontics is a science that embodies etiology, diagnosis, prevention, and treatment of apical periodontitis and its repercussion in the organism. Technological resources in diagnosis and root canal negotiation, and new strategies , associated to mainly cleaning and eliminating the infection of the root canal system, shaping, and filling the endodontic space, according to biological bases, will allow us to reach higher standards of post-treatment success.

Avaliação da eficácia de limpeza de quatro agulhas irrigadoras endodônticas

The irrigation of root canals aims to their cleaning and disinfection, improving endodontic treatment success. OBJECTIVE: To investigate the influence of the diameter and type of irrigation needle and the root canal enlargement on the mechanical efficacy of endodontic irrigation. MATERIAL AND METHODS: Twelve human single-rooted mandibular incisors were used. During some instrumentation stages (enlargement by #20, #30, and #40 K file), root canals were filled with radiographic contrast solution mixed to propyleneglycol and zinc oxide. Needles with different diameters and designs were employed: G1 – 23G and lateral opening; G2 – 22G and apical opening; G3 – 30G and lateral opening; G4 – 30G and apical opening. The needles were inserted up to resistance, with 1 mm step-back to avoid root canal obliteration. The irrigation was performed with 2 mL of distilled water. Before and after irrigation/aspiration, teeth were radiographed at bucco-lingual and mesiodistal direction, using a digital radiographic system. Then, root canal areas, before (filled by contrast solution) and after irrigation (remnant of contrast solution), were submitted to image subtraction with Adobe Photoshop CS4 software. Subsequently, the areas were measured by Image Tool 3.0 software, allowing the obtaining of the cleaning percentage for each modality. Data were analysed by using Anova and Tukey's test. The level of significance was set at P < 0.05. RESULTS: For all root canal enlargements, 30G needles (G3 e G4) presented a better cleaning efficacy. In all groups, higher cleaning efficacy percentage was observed at #30 and #40 K file enlargement. CONCLUSION: Regardless their design, thinner needles were more effective; a better cleaning efficacy occurred in more enlarged root canals.

Coroas estéticas anteriores em cerâmica metal-free: relato de caso clínico

Society's change of parameters for health and aesthetics has resulted in an increased demand for dental treatments. Nowadays, ceramics systems have shown a substantial development, becoming more reliable and predictable. Dental ceramics, besides being chemically stable, present excellent optical properties when compared to dental structures, thus assuring a special position in the list of aesthetic restorative materials. OBJECTIVE, CASE REPORT AND CONCLUSION: This article describes a successful clinical procedure involving the anterior teeth aesthetics, which were restored with all-ceramic crowns (IPS e.max® Ivoclar Vivadent).

Resolução por retratamento não cirúrgico de dente com lesão periapical: relato de caso clínico

The development and maintenance of periapical lesion occurs as a result of bacterial infection of the root canal system. Faced with the failure of endodontic treatment, retreatment is the first option with great potential for success, when performed with proper disinfection of the root canal system. Case report: Patient aged 39 years needing dental care show at clinical examination moderate gingival bleeding in the region of tooth 22 and the presence of radiographic periapical bone rarefaction due to unsatisfactory endodontic treatment. It was indicated the endodontic retreatment. We performed procedures to remove the filling material, root canal preparation using manual and mechanical techniques and completion with the use of root canal medication based on calcium hydroxide. After root canal filling, clinical and radiographic success were demonstrated for the case. Conclusion: We conclude that the non-surgical retreatment with disinfection and proper use of medication to the base of calcium hydroxide promoted success after outcome monitoring for 2 years and 8 months (AU)

Associação de microabrasão e fechamento de diastemas com resina composta: relato de caso clínico

Com o avanço das técnicas e materiais restauradores, o cirurgião-dentista tornou-se capaz de solucionar problemas estéticos de forma conservadora. Esse relato de caso descreve a associação das técnicas de microabrasão e fechamento de diastemas com resinas compostas diretas. A paciente do sexo feminino, 16 anos de idade, foi encaminhada pelo ortodontista à clínica de Dentística Restauradora para o fechamento de diastema. Após anamnese e exame clínico detalhado, constatou-se, também, a presença de manchas brancas de fluorose na face vestibular dos dentes anterossuperiores, sendo também proposto o procedimento de microabrasão. Por meio de modelos de estudo da paciente, foi realizado o enceramento diagnóstico, de forma a simular o fechamento dos diastemas. O modelo encerado foi moldado com silicona de condensação para servir como guia de orientação durante os procedimentos restauradores. O tratamento resultou na elevação da autoestima da paciente, pela obtenção de um sorriso mais harmonioso por meio da associação de técnicas estéticas conservadoras.

Influence of the rotary and/or oscillatory reciprocating systems in the morphological changes of narrow and curved molar root canals anatomy

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Influência da geometria oclusal e material restaurador na carga para fratura e distribuição de tensões em coroas totais

Pós-graduação em Odontologia Restauradora - ICT

Estudo da diversidade microbiana e níveis de endotoxinas em lesões endo-periodontais

Pós-graduação em Odontologia Restauradora - ICT

Estudo in vitro da efetividade do hidróxido de cálcio e da polimixina B na eliminação das endotoxinas presentes nos canais radiculares

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

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...

Atividade antimicrobiana de cimentos endodônticos

The antimicrobial activity is a fundamental property of root-canal sealers due to persistence of residual microorganisms in the root canal system, even after the chemo-mechanical preparation and using of intracanal dressing. The aim of this study is to review the literature about the antimicrobial properties of some of the main root-canal sealers. Although there is controversy regarding this property, probably due to differences in the methodologies used in the studies, it was concluded that the sealers with the best antimicrobial activity were (in ascending order): Endofill, Ketac Endo, Sealapex, AH Plus, Endo CPM Sealer, Sealer 26 and Epiphany. Activ GP still needs scientific research to evaluate this property.

Caries formation around restorative composite and glass ionomer cement

This in vitro study evaluated the demineralization around restorations class V made on the buccal and lingual surfaces of teeth when using different restorative materials. Thirty extracted teeth were randomly divided into 3 groups (n=10) according to the restorative material: Group I - Fuji II LC (GC America Inc., Alsip, Illinois, USA), Group II - Tetric (Ivoclar Vivadent AG, Schaan, Liechtenstein) and Group III - Chelon Fil (3M/ESPE., Seefeld, Germany). The teeth were submitted to a pH-cycling model associated to a thermocycling model. Sections were made and the specimens were analyzed under a polarized light microscopy as for the presence of demineralization. Measurements were performed and the results were subjected to statistical analysis using Anova and Tukey´s Test (α=0.05). Mean values of demineralization depth (µm) according to each positions showed that the demineralization was significantly reduced when Chelon Fil (Group III) was used for all depths, when compared to fluoridated resin materials. Also, it was verified that non-fluoridated resin material, composite resin Tetric, had the lowest inhibitory effect on the development of demineralization.

Emprego de ma teriais rest auradores adesivos direto no ângulo incisal de incisivos centrais fra turados

A case report of a patient who presents as chief complaint presence of stained restorations in the anterior teeth. After analysis and discussion of the clinical therapeutic approaches to be adopted, it was observed the presence of type class IV restorations on teeth 11 and 21, due to an oblique coronal fracture in the past. But the patient was not satisfied with the aesthetic result, then where was planned the realization of the removal of the restorations, for subsequently be used direct restorative materials for the correction of form, function and esthetics. The final result showed that the restorations were able to return the form, function and aesthetic dental, thereby evidencing the proven development of restorative dentistry in the solution of aesthetic problems.