Retratamento endodôntico cirúrgico

Introdução: O presente trabalho tem como tema Microcirurgia Endodôntica sendo esta um tipo de Retratamento Endodôntico Cirúrgico (RTEC). Este tipo de procedimento está indicado em casos de insucesso prévio no Tratamento Endodôntico Não Cirúrgico (TENC). Embora atualmente os índices de sucesso do TENC sejam elevados, existem ainda alguns casos, que não atingem os resultados desejados mesmo realizando corretamente todas as etapas do tratamento. Quando assim é, há necessidade de abordar o sistema de canais radiculares por outra via: recorrer à cirurgia endodôntica e à obturação retrógrada. Objetivos: Esta dissertação tem como objetivo principal abordar uma técnica de Retratamento Endodôntico Cirúrgico: a Microcirurgia Endodôntica. Procedeu-se a uma revisão bibliográfica, analisando literatura que versa o tema, a evolução da técnica, o protocolo cirúrgico em toda a sua extensão, a sua utilidade e aplicabilidade na prática clínica. Materiais e métodos: Na execução desta revisão bibliográfica, os motores de pesquisa on-line utilizados foram os seguintes: b-On, Pubmed, Scielo, Science Direct e Google Académico. Os critérios de inclusão limitaram o uso de artigos publicados entre 2000 e 2016 e nos idiomas de português, inglês e espanhol. Os critérios de exclusão rejeitaram artigos dos quais o teor não teria relevância para a concretização do trabalho e artigos fora dos limites temporais. Conclusão: Na literatura científica, quando a técnica Microcirurgica é comparada com a técnica convencional de RTEC mostra uma taxa de sucesso de excelência e que maioritariamente, os autores defendem que esta deverá ser usada apenas como retratamento, e não isoladamente ou como primeira abordagem terapêutica. Nas últimas décadas, o crescente desenvolvimento científico e tecnológico da cirurgia endodôntica leva à introdução da microcirurgia graças ao recurso da magnificação e iluminação, instrumentos adaptados à nova realidade da cirurgia endodôntica, novos equipamentos e novos materiais associados à retrobturação. É de salientar que este processo cirúrgico é menos invasivo para o paciente e que se obtém um aumento das taxas de sucesso.

Use of computerized tomography for diagnosis and follow-up after endodontic surgery: clinical case report with 8 years of follow-up

Computerized tomography (CT) is a valuable tool for diagnosis and planning in conventional and surgical endodontic therapy. This case report describes the use of CT in the diagnosis of a periapical lesion undetected by periapical radiography in the mandibular molar area. The CT also showed a possible mesial root perforation associated with the lesion. Following CT, surgical planning, periradicular curettage, and sealing of the root perforation were performed. Eight years after surgery, cone beam CT revealed periapical bone repair. Computerized tomography can be an important resource for diagnosis and planning in conventional and surgical endodontic therapy, as well as for evaluation of post-treatment bone repair. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010; 109: 629-633)

Periapical Repair Following Endodontic Surgery: Two- andThree-Dimensional Imaging Evaluation Methods

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Cirurgias do Periápice

Apical surgeries are part of a segment of root canal treatment by which we can correct or eliminate iatrogenic deficiencies arising from conventional endodontic treatment. Currently no consensus among authors regarding to the factors linked to the surgery success as the execution of an apex resection followed by retropreparation and retrofilling. The apex resection performed 3mm from apical vertex allows the elimination of most apical ramifications, and it is a consensus part of the treatment. The preparation of cavities using ultrasonic tips has advantages over those made with drills such as better cleaning of the cavity, the possibility of lower cutting angle of the apical resection and deeper retropreparation. Another detail to consider is the type of tip, since the diamond tips in a more angulated inclination have higher cutting efficiency but causing increased formation of debris on the dentin walls. Finally, filling the cavity with an apical filling material allows proper sealing of the intracanal contents favoring apical healing.

Proximity of premolar roots to maxillary sinus: a radiographic survey using cone-beam computed tomography.

INTRODUCTION The proximity of the roots of the posterior maxillary teeth to the maxillary sinus is a constant challenge to the dental practitioner. Because the majority of studies have assessed the relationship regarding molars, the present study focused on premolars. METHODS Cone-beam computed tomographic images of 192 patients were reconstructed in sagittal, coronal, and axial planes to quantify the distances between the root apices of the maxillary premolars and the adjacent maxillary sinus. Measurements were taken for each root, and data were correlated with age, sex, side, and presence of both or absence of 1 of the 2 premolars. RESULTS A total of 296 teeth (177 first and 119 second premolars) were evaluated. The mean distances from buccal roots of the first premolars to the border of the maxillary sinus in the sagittal, coronal, and axial planes ranged from 5.15 ± 2.99 to 8.28 ± 6.27 mm. From palatal roots, the mean distances ranged from 4.20 ± 3.69 to 7.17 ± 6.14 mm. The mean distances of second premolars were markedly shorter in buccal roots between 2.32 ± 2.19 and 3.28 ± 3.17 mm and in palatal roots between 2.68 ± 3.58 and 3.80 ± 3.71 mm, respectively. The frequency of a premolar root protrusion into the maxillary sinus was very low in first premolars (0%-7.2%) but higher in second premolars (2.5%-13.6%). Sex, age, side, and presence/absence of premolars failed to significantly influence the mean distances between premolar roots and the maxillary sinus. CONCLUSIONS Based on the calculated mean distances of the present study, only few premolars (and if so second premolars) would present a risk of violating the border of the maxillary sinus during conventional or surgical endodontic treatment or in case of tooth extraction.

Desinfeção aplicada aos cones de guta-percha

Introdução: Ao longo do tempo o Tratamento Endodôntico Não Cirúrgico tem sido das áreas da Medicina Dentária que mais tem evoluído. Todos os passos do tratamento têm sido revistos de forma a aumentar a taxa de sucesso. O controlo microbiológico é crucial para que o tratamento seja um sucesso a curto, médio e longo prazo. A assepsia deve ser mantida em todas as fases deste tratamento para que este seja um sucesso. Objetivo: Ao longo do meu percurso académico pude concluir que a fase da descontaminação dos cones, aquando a obturação (fase final do Tratamento Endodôntico Não Cirúrgico) era desvalorizada, o que me levou a efetuar uma revisão bibliográfica de modo a poder melhorar os meus conhecimentos e técnica. Material e Métodos: Para a elaboração deste trabalho foi realizada uma pesquisa bibliográfica recorrendo aos seguintes motores de busca: B-on, PubMed, Scielo e ScienceDirect, com as seguintes palavras-chave: “decontamination in endodontics”;” disinfection in endodontics”; “root canal irrigants”; “endodontics microbiology”; “Candida albicans“; “Enterococcus faecalis”; “sodium hypochlorite ”; “alcohol”; “contamination during Obturation”; “clorohexidine”; “filling materials endodontics”; “termoplastic gutta-percha”; “obturation material”; “Mineral Trioxide Aggregate”; “resilon”; “resin cement”; “resin material for root canal obturation”; “resin sealer”; “root canal”; “root canal sealing”; “root canal filling materials”; “condensation in endodontics”; “lateral condensation”; “gutta-percha”; “microlekeage”; “system B”; “fluid filtration model”;“dye penetration”. Como critério de inclusão estabeleceu-se que os artigos deveriam ser em Português, Inglês ou Espanhol e publicados entre 1995 e 2015. Dos resultados apresentados foram utilizados 110 artigos, pesquisados entre Maio de 2015 e 20 de Outubro de 2015. Foram ainda consultados livros de referência nestes mesmos locais. Conclusão: a presença de bactérias e os seus subprodutos no sistema tridimensional de canais está diretamente implicado com o insucesso do Tratamento Endodôntico. A descontaminação dos cones de guta-percha, é, portanto, um processo importante no Tratamento Endodôntico pois impede que os cones sejam colocados nos canais radiculares, estando contaminados por microorganismos que inviabilizam o tratamento efetuado. A submersão dos cones durante um minuto em clorohexidina a 2% ou hipoclorito a 5,25% está indicado e comprovado como um processo eficiente de desinfeção dos cones.

Novas tecnologias associadas ao retratamento endodôntico não cirúrgico

Introdução: O trabalho elaborado desenvolve o tema seguinte: Novas tecnologias associadas ao retratamento endodôntico não cirúrgico. Desde o início da medicina dentária que somos deparados com o insucesso nos tratamentos realizados, na endodôntia sendo um acontecimento regular na prática diária. Quando o tratamento Endodontico não cirúrgico não é eficaz na resolução de patologias pulpares e ocorre recidiva da patologia, é necessário a realização do retratamento endodôntico não cirúrgico. Uma vez que o retratamento endodôntico, respeita os mesmos princípios do tratamento Endodontico, sendo estes a desinfeção do sistema de canais radiculares, a sua instrumentação e obturação. Esta prática está indicada por vários motivos, anatómicos, microbiológicos, erros de instrumentação, erros de obturação e as próprias limitações dos materiais. Objetivos: Esta dissertação tem como objetivo analisar, e verificar as razões que levam a necessidade da realização de retratamentos endodônticos não cirúrgicos, aos métodos utilizados na realização de retratamentos comparando-os entre si. Tendo sido realizada uma revisão bibliográfica de modo a verificar: as causas de insucesso, limitações dos materiais, técnicas de obturação, agentes químicos e sistemas de instrumentação. Materiais e Métodos: Para a obtenção da informação necessária para a elaboração da presente dissertação, foi realizada uma pesquiza bibliográfica nas bases de dados da Pubmed, B-on, Scielo, Science Direct e no Google Académico. Através das seguintes palavras-chave: “Root canal treatment”, “Endodontic sucess”, “Endodontic retreatment”, “Endodontic Failure causes”, “Root canal retreatment materials”, “Endodontic retreatment metods”, “Chloroform”, “ProTaper, Reciproc”, “Haloten”, “Orange oil”, “Eucaliptol”, “Ultrassonic instrumentation”, “obturation material”, “root filling”. Conclusão: No trabalho realizado é possível concluir que o insucesso tem múltiplas causas, que hoje em dia existem novos métodos e técnicas que nos permitem a resolução das falhas nos tratamentos primários, sendo que estes novos métodos e técnicas se revelaram mais eficazes que os tradicionais, demonstrando uma maior probabilidade de eliminação dos fatores causais das reinfeções.

Evaluation of subcutaneous and alveolar implantation surgical sites in the study of the biological properties of root-end filling endodontic materials

Objective: The aim of this study was to compare two methodologies used in the evaluation of tissue response to root-end filling materials in rats. Material and Methods: Forty rats were divided into 4 groups: in Groups I and II (control groups), empty polyethylene tubes were implanted in the extraction site and in the subcutaneous tissue, respectively; in Groups III and IV, polyethylene tubes filled with ProRoot MTA were implanted in the extraction site and in the subcutaneous tissue, respectively. The animals were killed 7 and 30 days after tube implantation, and the hemi-maxillas and the capsular subcutaneous tissue, both with the tubes, were removed. Specimens were processed and evaluated histomorphologicaly under light microscopy. The scores obtained were analyzed statistically by the Kruskal-Wallis test (p<0.05). Results: There were no statistically significant differences between the implantation methods (p=0.78033, p=0.72039). It was observed that the 30-day groups presented a more mature healing process due to smaller number of inflammatory cells. Conclusions: The present study showed no differences in tissue responses as far as the implantation site and the studied period were concerned. Alveolar socket implantation methodology represents an interesting method in the study of the biological properties of root-end filling endodontic materials due to the opportunity to evaluate bone tissue response.

Changes in heart period during endodontic treatment

Background: Tooh extraction was demonstrated to increase sympathetic modulation of the heart, however, it is not understood the effects of endodontic treatment on cardiac autonomic regulation. We evaluated heart rate variability (HRV) during endodontic treatment. Method: 50 male and female patients aged between 18 and 40 years old and diagnosed with irreversible pulpitis or pulp necrosis of the lower molars with indication of gender endodontic treatment were analyzed. HRV was analyzed in the time (SDNN, RMSSD, pNN50) and frequency (LF, HF and LF/HF ratio) domains recorded in the first session of root canal treatment. The indices were analyzed in the following periods: T1) ten minutes before the endodontic treatment, T2) ten minutes after the administration of anesthesia before endodontic treatment, T3) during the entire period of endodontic treatment and T4) thirty minutes after the end of the endodontic treatment. Results: The SDNN, RMSSD and pNN50 indices increased at T2 compared to T1, the pNN50 and RMSSD indices increased at T3 and T4 compared to T2. The LF in normalized units increased at T4 compared to T2 and in absolute units it was increased at T4 compared to T1. The HF in normalized units was reduced at T4 compared to T2 and in absolute units was reduced at T1, T3 and T4 compared to T2. The LF/HF ratio was higher at T4 compared to T2. Conclusion: The global modulation of heart increases after local anesthesia and vagal tone reduce during surgery procedures and after the surgical procedures.

18-Year Follow-up of Dens Invaginatus: Retrograde Endodontic Treatment

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

Treatment of traumatic dental intrusion by surgical repositioning: clinical case report

The prevalence of dental trauma and its consequences are challenging. This article presents a clinical case of a 9-year-old female who was in a bicycling accident and had a dental intrusion of the left maxillary lateral incisor with extensive dislocation. In the emergency department, surgical repositioning of the intruded tooth and a splinting with steel wire and composite resin was performed and the soft-tissue lesions were sutured. Two weeks after the first visit, pulp necrosis was found and endodontic treatment of the intruded tooth was started with a calcium hydroxide dressing. Despite the traumatic nature of the dental injury, the result of treatment was favorable. After 3 years of follow-up, repair of the resorptions and no signs of ankylosis of the teeth involved were evident. Considering the patient's age and the extent of intrusion, it was concluded that surgical repositioning associated with adequate endodontic therapy was an effective alternative treatment for this case.

Oral focal mucinosis: clinical case presentation with a focus on aesthetic and functional surgical resolution

Introduction: When planning excisional surgery, alterations in the oral mucosa, particularly in esthetically important areas, represent a challenge. For cases involving an exophytic lesion with a vegetative tumoral aspect, a clinician may prioritize obtaining a definitive diagnosis by histopathologic and histochemical examinations over the preservation of esthetics or maintenance of the involved tooth. Case Presentation: A painless, hard lesion with normal coloration was present in the maxillary left central incisor of a patient for at least 6 years. A biopsy was performed to preserve oral mucosa and a treatment plan was established that included endodontic retreatment and prosthetic restoration. The histopathologic diagnosis was oral focal mucinosis, an uncommon and poorly characterized type of lesion. Conclusion: A conservative biopsy of the lesion facilitated an accurate diagnosis, promoted the patient’s comfort, and achieved satisfactory esthetic results.

Orbital Abscess during Endodontic Treatment: A Case Report

Introduction: Orbital infections may result in permanent morbidity because of the severity of infection. Furthermore, delayed diagnosis or treatment of orbital infections can lead to intracranial complications and even death. The majority of orbital infections develop from paranasal sinus infections, cutaneous infections, and periorbital trauma. Dacryocystitis and odontogenic infection are also accounted as potential etiologies but are scarcely reported in scientific literature. Methods: The patient revealed a history of having endodontic treatment on left maxillary second molar performed 2 weeks previously. Moreover, she exhibited signs of facial pain accompanied by sinusitis symptoms, fever, and nasal obstruction the week after this endodontic procedure. The patient presented proptosis, impairment of ocular motility to the right side, facial tenderness, palpebral erythema, and referred decreased visual acuity. Intraoral exam revealed root fragments of left maxillary first molar and an extensive carious lesion on left maxillary second molar. Computed tomography enabled the observation of frontal sinus, left-sided maxillary, opacity of sphenoidal and ethmoidal sinuses, and apical lesion of left maxillary first and second molars, all suggesting the presence of their apex in the maxillary sinus. In addition, images revealed ocular proptosis and presence of high-density areas suggestive of pus in the medial orbital wall region. Results: The patient was submitted to surgical drainage under general anesthesia approximately 8 hours after the clinical evaluation. Conclusions: Early detection of orbital infection, proper diagnostic tests, and treatment may provide successful outcomes of this rarely occurring disease. (J Endod 2012;38:1541-1543)

Anterior Stafne's bone cavity mimicking a periapical lesion of endodontic origin: report of two cases

INTRODUCTION: This report of 2 cases describes the diagnostic procedures used to identify 2 Stafne's bone cavities (SBC) found in unusually anterior locations in the mandible, both mimicking periapical lesions of endodontic origin. METHODS: In the first patient, a 47-year-old man, an SBC was diagnosed in the area of teeth #27, 28, and 29. In the second patient, a 62-year-old man, the SBC was a fortuitous finding, because this patient was referred for dental implant therapy. RESULTS: In both cases, the final diagnosis was achieved by using limited cone beam computed tomography (CBCT) and magnetic resonance imaging (MRI). In both patients, the lingual bone cavity was found to be occupied by accessory salivary gland tissue. CONCLUSIONS: The combination of CBCT and MRI as noninvasive diagnostic techniques seems ideal to avoid surgical explorations, incisional biopsies, or enucleations of the lesion for diagnostic purposes.

Conservative endodontic management of teeth associated with extensive periapical pathology: report of two cases

Traditionally, long-term calcium hydroxide dressings have been recommended for the conservative management of large periapical lesions. However, calcium hydroxide therapy has some disadvantages such as variability of treatment time, difficulties with patient follow-up and prolonged treatment periods that increase the risk of root canal contamination via microleakage and crown fractures. This paper reports the healing of large periapical lesions following conservative non-surgical treatment with calcium hydroxide dressings.