RESUMEN
BACKGROUND: Orthodontic tooth movements are performed by applying forces on teeth, which may cause alterations within the dental pulp. Previously published systematic reviews on the subject only included a small number of studies that assessed pulp status through reliable diagnostic methods. Since then, new evidence has been published, and a further systematic review on the subject is necessary. OBJECTIVES: To evaluate whether there is scientific evidence to support the possibility that orthodontic tooth movements could induce pulp necrosis. METHODS: A systematic search of articles published until June 2020 was performed using MeSH and free terms in the PubMed, Cochrane Library, LILACS, SciELO, Web of Science, EMBASE, Open Grey and Grey Literature databases. Randomized clinical trials (RCTs), nonrandomized clinical trials (nRCTs) and longitudinal (prospective or retrospective) studies that evaluated the pulp status of teeth subjected to orthodontic movements using laser Doppler flowmetry or pulse oximetry were included. The revised Cochrane risk of bias tools for randomized trials (RoB 2) and nonrandomized interventions (ROBINS-I) were used to assess the quality of the included studies. Relevant findings were summarized and evaluated. The overall quality of evidence was assessed through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. RESULTS: Initial screening of databases resulted in 353 studies. In total, 285 studies were excluded because they were duplicates. Of 68 eligible papers, fourteen met the inclusion criteria and were selected for full-text reading. Two studies were excluded due to the methods used to evaluate pulp status. Twelve studies (five RCTs, one nRCT and six prospective) were included. Four RCTs were classified as having an unclear risk of bias and one as having a high risk of bias. The nRCT was classified as having a low risk of bias. Two prospective studies were classified as having a moderate risk of bias and four as having a serious risk of bias. The GRADE analysis demonstrated a low to very low quality of evidence. DISCUSSION: Significant limitations regarding the randomization processes within the included RCTs and a lack of control of confounders on most nonrandomized and longitudinal studies were verified. CONCLUSIONS: This systematic review indicates that orthodontic movements do not induce loss of pulp vitality with low to very low certainty of evidence.
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Necrosis de la Pulpa Dental , Técnicas de Movimiento Dental , Humanos , Flujometría por Láser-Doppler , Técnicas de Movimiento Dental/efectos adversosRESUMEN
AIM: (i) To quantify biofilm removal from a simulated isthmus and a lateral canal in an artificial root canal system during syringe irrigation with NaOCl at different concentrations and delivered at various flow rates (ii) to examine whether biofilm removal is further improved by a final high-flow-rate rinse with an inert irrigant following irrigation with NaOCl. (iii) to simulate the irrigant flow in these areas using a computer model (iv) to examine whether the irrigant velocity calculated by the computer model is correlated to biofilm removal. METHODOLOGY: Ninety-six artificial root canals with either a simulated isthmus or lateral canal were used. A dual-species in vitro biofilm was formed in these areas using a Constant Depth Film Fermenter. NaOCl at various concentrations (2, 5 and 10%) or adhesion buffer (control) was delivered for 30 s by a syringe and an open-ended needle at 0.033, 0.083, or 0.166 mL s-1 or passively deposited in the main root canal (phase 1). All specimens were subsequently rinsed for 30 s with adhesion buffer at 0.166 mL s-1 (phase 2). The biofilm was scanned by Optical Coherence Tomography to determine the percentage of the remaining biofilm. Results were analysed by two 3-way mixed-design ANOVAs (α = 0.05). A Computational Fluid Dynamics model was used to simulate the irrigant flow inside the artificial root canal system. RESULTS: The flow rate during phase 1 and additional irrigation during phase 2 had a significant effect on the percentage of the remaining biofilm in the isthmus (P = 0.004 and P < 0.001). Additional irrigation during phase 2 also affected the remaining biofilm in the lateral canal significantly (P ≤ 0.007) but only when preceded by irrigation at medium or high flow rate during phase 1. The effect of NaOCl concentration was not significant (P > 0.05). Irrigant velocity in the isthmus and lateral canal increased with increasing flow rate and it was substantially correlated to biofilm removal from those areas. CONCLUSIONS: The irrigant flow rate affected biofilm removal in vitro more than NaOCl concentration. Irrigant velocity predicted by the computer model corresponded with the pattern of biofilm removal from the simulated isthmus and lateral canal.
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Cavidad Pulpar , Irrigantes del Conducto Radicular , Biopelículas , Hidrodinámica , Preparación del Conducto Radicular , Hipoclorito de Sodio , Jeringas , Irrigación TerapéuticaRESUMEN
AIM: To investigate the influence of biofilm structure on the biofilm removal capacity of endodontic irrigants and to study changes in the architecture of the remaining biofilms. METHODOLOGY: Streptococcus oralis J22 and Actinomyces naeslundii T14V-J1 were cocultured under different growth conditions on saliva-coated hydroxyapatite discs. A constant depth film fermenter (CDFF) was used to grow steady-state 4-day biofilms. Biofilms were grown under static conditions for 4 and 10 days within a confined space. Twenty microlitres of 2% NaOCl, 2% Chlorhexidine (CHX), 17% Ethylene-diamine-tetra-acetic acid (EDTA) and buffer were applied statically on the biofilms for 60 s. Biofilm removal was evaluated with optical coherence tomography (OCT). Post-treated biofilms were assessed via low load compression testing (LLCT) and Confocal laser scanning microscopy (CLSM). Optical coherence tomography data were analysed through a two-way analysis of variance (ANOVA). Low load compression testing and CLSM data were analysed through one-way ANOVA and Dunnett's post hoc test. The level of significance was set at a < 0.05. RESULTS: The initial biofilm structure affected the biofilm removal capacity of the irrigants. NaOCl demonstrated the greatest chemical efficacy against the biofilms and was significantly more effective on the static than the CDFF biofilms (P < 0.001). CHX was ineffective and caused a rearrangement of the biofilm structure. Ethylene-diamine-tetra-acetic acid exhibited a distinct removal effect only on the CDFF biofilms. Biofilm age influenced the structure of the remaining biofilms. The 4-day grown remaining biofilms had a significantly different viscoelastic pattern compared to the respective 10-day grown biofilms (P ≤ 0.01), especially in the NaOCl-treated group. Confocal laser scanning microscopy analysis confirmed the CHX-induced biofilm structural rearrangement. CONCLUSIONS: Biofilm structure is an influential factor on the chemical efficacy of endodontic irrigants. Optical coherence tomography allows biofilm removal characteristics to be studied. NaOCl should remain the primary irrigant. Ethylene-diamine-tetra-acetic acid was effective against cell-rich/EPS-poor biofilms. Chlorhexidine did not remove biofilm, but rather rearranged its structure.
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Irrigantes del Conducto Radicular , Tomografía de Coherencia Óptica , Biopelículas , Clorhexidina , Microscopía ConfocalRESUMEN
AIM: To evaluate the influence of three engine-driven NiTi file systems manufactured from different NiTi alloys for the preparation of second mesiobuccal (MB2) canals in extracted maxillary first molars using a micro-computed tomographic (micro-CT) scanner. METHODOLOGY: Thirty maxillary molars with two canals in the mesiobuccal root were selected and randomly divided into three groups (n = 10): Reciproc [REC; size 25, .08 taper; VDW, Munich, Germany], ProDesign R [PDR; size 25, .06 taper; Easy, Belo Horizonte, Brazil] and Mtwo [MO; size 25, .06 taper; VDW, Munich, Germany]. Before and after root canal preparation of the MB2 canal, the teeth were scanned using a micro-CT to evaluate canal transportation, centring ability, dentine thickness and volume change. The working time to achieve working length was also evaluated. All parameters were compared statistically using the Kruskal-Wallis and Dunn test for multiple comparisons, with a significance level of 5%. RESULTS: There was no significant difference amongst the groups regarding canal transportation and centring ability (P > 0.05). However, the PDR size 25, .06 taper group had significantly lower canal volume and volume of dentine removal compared with a MO size 25, .06 taper and REC size 25, .08 taper (P < 0.05). A root perforation was detected in MO size 25, .06 taper and REC size 25, .08 taper groups, respectively. Regarding the working time, the PDR size 25, .06 taper required a significantly longer time to achieve working length than MO size 25, .06 taper and REC size 25, .08 taper (P < 0.05). CONCLUSIONS: All NiTi systems had similar canal transportation, centring ability and increase in apical volume after preparation of MB2 canals. However, the PDR size 25, .06 taper had less volume of dentine removal, absence of root canal perforation and required a longer time to accomplish the root canal preparation.
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Níquel , Titanio , Aleaciones , Brasil , Cavidad Pulpar , Alemania , Diente Molar , Preparación del Conducto Radicular , Microtomografía por Rayos XRESUMEN
AIM: To evaluate the torsional properties of pathfinding nickel-titanium (NiTi) rotary instruments manufactured from several NiTi alloys, ProGlider (M-wire), Hyflex GPF (conventional NiTi Wire and controlled memory wire), Logic (conventional NiTi wire and controlled memory wire) and Mtwo (conventional NiTi wire). METHODOLOGY: A total of 56 NiTi instruments from Glidepath rotary systems (n = 8) were used: Logic (size 25, .01 taper), Logic CM (size 25, .01 taper), ProGlider (size 16, .02 taper), Hyflex GPF (size 15, .01 taper), Hyflex GPF CM (size 15, .02 taper; size 20, .02 taper) and Mtwo (size 10, .04 taper). The torsion tests were performed based on ISO 3630-1 (1992). Three millimetres of each instrument tip was clamped to a small load cell by a lever arm linked to the torsion axis. Data were analysed using a one-way analysis of variance (anova) and Tukey test with a significance level at a = 5%. RESULTS: The Logic size 25, .01 taper had significantly higher torsional strength values (P < 0.05). The ProGlider was significantly different when compared with Hyflex GPF size 15, .01 taper and size 15, .02 taper (P < 0.05). The Logic CM size 25, .01 taper had significantly higher torsional strength than Hyflex GPF size 15, .01 taper and size 15, .02 taper (P < 0.05). No difference was found amongst Mtwo size 10, .04 taper and Hyflex GPF groups (size 15, .01 taper; size 15, .02 taper; size 20, .02 taper). In relation to the angle of rotation, Logic CM size 25, .01 taper and Hyflex GPF size 15, .01 taper had the highest angle values (P < 0.05). The ProGlider had the lowest angle values in comparison with all the groups (P < 0.05) followed by Mtwo size 10, .04 taper. The Logic size 25, .01 taper had significantly higher angle of rotation values than ProGlider and Mtwo size 10, .04 taper (P < 0.05). CONCLUSION: The Logic size 25, .01 taper instrument made of conventional NiTi alloy had the highest torsional strength of all instruments tested. In addition, the ProGlider instrument manufactured from M-Wire alloy had the lowest angle of rotation to fracture in comparison with the other instruments.
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Aleaciones Dentales/química , Instrumentos Dentales , Níquel/química , Titanio/química , Torsión Mecánica , Diseño de Equipo , Falla de Equipo , Ensayo de Materiales , Microscopía Electrónica de Rastreo , Tratamiento del Conducto Radicular/instrumentación , Estrés MecánicoRESUMEN
AIM: To evaluate the effectiveness of isopropyl alcohol, saline or distilled water to prevent the precipitate formed between sodium hypochlorite (NaOCl) and chlorhexidine (CHX) and its effect on the bond strength of an epoxy-based sealer in radicular dentine. METHODOLOGY: The root canals of 50 extracted human canines (n = 10) were instrumented. In G1, root canals were irrigated with 17% EDTA and 2.5% NaOCl; G2, as G1, except that 2% CHX was used as the final irrigant. In the other groups, intermediate flushes with isopropyl alcohol (G3), saline (G4) or distilled water (G5) were used between NaOCl and CHX. The specimens were submitted to SEM analysis to evaluate the presence of debris and smear layer, in the apical and cervical segments. In sequence, fifty extracted human canines were distributed into five groups (n = 10), similar to the SEM study. After root filling, the roots were sectioned transversally to obtain dentine slices, in the cervical, middle and apical thirds. The root filling was submitted to a push-out bond strength test using an electromechanical testing machine. Statistical analysis was performed using Kruskal-Wallis and Dunn's tests (α = 5%). RESULTS: All groups had similar amounts of residue precipitated on the canal walls (P > 0.05). The push-out bond strength values were similar for all groups, independently of the root third evaluated (P > 0.05). CONCLUSIONS: Isopropyl alcohol, saline and distilled water failed to prevent the precipitation of residues on canal walls following the use of NaOCl and CHX. The residues did not interfere with the push-out bond strength of the root filling.
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Precipitación Química , Clorhexidina/química , Resinas Epoxi/química , Irrigantes del Conducto Radicular/química , Hipoclorito de Sodio/química , 2-Propanol/química , Diente Canino , Cavidad Pulpar , Análisis del Estrés Dental , Dentina/química , Humanos , Técnicas In Vitro , Microscopía Electrónica de Rastreo , Preparación del Conducto Radicular , Capa de Barro Dentinario , Cloruro de Sodio/química , Agua/químicaRESUMEN
The aim of this ex vivo study was to evaluate, by scanning electron microscopy (SEM), the presence of gaps at the interface between filling material and three root-end filling materials. Thirty human upper molars disto-buccal roots were instrumented and filled with gutta-percha and eugenol-based sealer. The apicoectomy was performed 2 mm from the apex and retrograde cavities were prepared with ultrasonic points (3 mm in deep). The samples were divided into three experimental groups (n = 10): Group I-white mineral trioxide aggregate (MTA); Group II-Super EBA; and Group III-Portland cement. The root-end filling materials were inserted into the retocavities using a MTA carrier. After 48 h, the roots were transversally sectioned in order to obtain the apical 5 mm. Next, each specimen was prepared longitudinally with crescent granulation of abrasives water-wet sandpapers in order to expose the filling and root-end filling materials. Then, the specimens were subjected to slow dehydration with silica gel, mounted onto specific stubs and coated with paladium coverage for SEM analysis of the interface between filling and root-end filling materials. The percentage of gaps at the interfacial area was calculated by using Image Tool 3.0 software. Super EBA presented the higher percentage of gaps (1.5 ± 0.67%), whereas MTA presented the lowest values (0.33 ± 0.20%; p = 0.0004). Despite the statistical differences observed between Super EBA and MTA, all the root-end filling materials presented great adaptation to the filling material, presenting small amount of gaps.
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Restauración Dental Permanente/métodos , Materiales de Obturación del Conducto Radicular , Humanos , Procesamiento de Imagen Asistido por Computador , Microscopía Electrónica de Rastreo , Diente Molar/ultraestructura , Obturación del Conducto RadicularRESUMEN
La cirugía endodóntica con obturación simultánea de los conductos radiculares consiste en la eliminación de los factores etiológicos locales concomitante con la instrumentación y obturación del sistema de conductos radiculares. Esta técnica está indicada cuando no existe la posibilidad de obturación por los métodos convencionales. Algunos inconvenientes pueden dificultar los procedimientos clínicos operatorios, tales como la interpretación radiográfica del caso en cuestión. La radiografía periapical no debe ser usada como principal recurso de diagnóstico debido a sus desventajas, tales como la distorsión y superposición sobre otras estructuras anatómicas. El objetivo de este relato de caso clínico es mostrar la limitación del examen radiográfico en el plan de tratamiento quirúrgico, donde la perforación radicular no era visible en la imagen radiográfica, así como el cono de gutapercha no está relacionado con la real localización clínica.
The apical surgery with simultaneous root filling consists in the elimination of the local etiologic factors concomitant with the shaping and obturation of the root canal system. This technique is indicated when there is no possibility of obturating the root canal by conventional methods. Some adverse factors may difficult the clinical procedures, such as the radiographic interpretation. Periapical radiographs must not be used as the main diagnostic resource due to their inherent disadvantages, such as distortion and superimposition with other anatomical structures. The aim of this clinical case report is to show the limitations of radiographic examination in an apical surgery in which a root perforation was not visible in the radiographic image, as well as the gutta-percha was not related to its real clinical location.
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Humanos , Adulto , Femenino , Cavidad Pulpar/lesiones , Obturación del Conducto Radicular , Cirugía Bucal , Procedimientos Quirúrgicos Orales , Radiografía Dental DigitalRESUMEN
AIM: To assess the dentine/fibreglass-bonded interface by scanning electron microscopy and the push-out bond strength of four luting cements. METHODOLOGY: Forty root-filled human canines, with similar root lengths, were restored with fibreglass posts and randomly divided into four groups according to the cements employed (CG Gold Label I, RelyX ARC, BisCem and RelyX U100). After standardized post-space preparation, the root dentine was pre-treated for dual-polymerizing resin cements and untreated for the other cements. The mixed luting cement paste was inserted into root canals with a spiral filler and applied to the post-surface that was seated into the root canal. After 7 days, the teeth were sectioned perpendicular to their long axis into 1-mm-thick sections and submitted to a push-out test (1 mm min(-1)). Statistical analyses were carried out by two-way anova and Tukey's tests (P < 0.05). RESULTS: The bond strength was significantly affected by the type of cement (P < 0.001) and by the longitudinal region of the root canal (P < 0.031). All cements exhibited gaps at the dentine/cement interface. CONCLUSIONS: The self-adhesive materials and the glass ionomer cements had the highest push-out bond strength values when compared with the dual-curing resin cement.
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Cementos Dentales , Dentina , Vidrio , Ensayo de Materiales , Humanos , Microscopía Electrónica de RastreoRESUMEN
AIM: To present the case of a maxillary left lateral incisor with Oehlers' type III dens invaginatus in which cone beam computed tomography (CBCT) was used as an adjunctive resource in the diagnosis as well as in the planning and 2-year follow-up of the nonsurgical/surgical treatment. SUMMARY: The tooth had two root canals: a primary (main) canal with vital pulp that appeared to be closed apically and an invaginated canal that was necrotic, wide-open at the portal of exit and associated with a large chronic periapical lesion extending to the apex of the maxillary left central incisor. Radiographic tracking of a sinus tract in the labial gingiva of the affected tooth with a gutta-percha point revealed its origin to be the invagination. The CBCT scans revealed that the periapical radiolucency was significantly larger than seen radiographically as well as an increased thickness of the buccal cortical plate. Conventional root canal treatment of the primary canal was undertaken. As nonsurgical access to the invaginated canal was not possible, endodontic surgery was performed for curettage of the lesion, root-end cavity preparation using ultrasonic tips and root canal filling with white mineral trioxide aggregate (MTA). CBCT scanning after 17 months and clinical and radiographic follow-up after 24 months revealed complete periapical repair and absence of symptoms. KEY LEARNING POINTS: The combination of nonsurgical and surgical treatments produced periapical repair in a tooth with type III dens invaginatus with two root canals. CBCT may aid the diagnosis as well as the management plan and follow-up of teeth with this developmental anomaly.
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Tomografía Computarizada de Haz Cónico , Dens in Dente/diagnóstico por imagen , Incisivo/anomalías , Planificación de Atención al Paciente , Compuestos de Aluminio/uso terapéutico , Compuestos de Calcio/uso terapéutico , Niño , Dens in Dente/terapia , Fístula Dental/diagnóstico por imagen , Fístula Dental/terapia , Cavidad Pulpar/anomalías , Cavidad Pulpar/diagnóstico por imagen , Necrosis de la Pulpa Dental/diagnóstico por imagen , Necrosis de la Pulpa Dental/terapia , Combinación de Medicamentos , Estudios de Seguimiento , Humanos , Incisivo/diagnóstico por imagen , Masculino , Óxidos/uso terapéutico , Periodontitis Periapical/diagnóstico por imagen , Periodontitis Periapical/terapia , Obturación Retrógrada/métodos , Materiales de Obturación del Conducto Radicular/uso terapéutico , Preparación del Conducto Radicular/métodos , Tratamiento del Conducto Radicular/métodos , Silicatos/uso terapéuticoRESUMEN
AIM: To analyse the anatomy of the root canal system of maxillary premolars with three distinct roots using high-resolution computed tomography (µCT). METHODOLOGY: Ten three-rooted human maxillary premolars were scanned transversally from crown to apex at 42µm intervals using a high-resolution desktop µTC system (Skyscan 1072). The images were processed and analysed for the following features: cross section of the roots and canals in the apical, middle and coronal thirds; location of the apical foramen; distance from the pulp chamber roof to the bifurcation and trifurcation of the canals and anatomic variations of the root canal system. The results were expressed descriptively. RESULTS: The cross-sectional shape of canals was heterogeneous along the length of the roots. The location of the apical foramen varied, tending to lie palatally or distally. The buccal pulp horn was larger than the palatal. The mean distance from the most cervical region of the pulp chamber roof to the bifurcation and trifurcation of the canals was 3.13 and 5.08mm, respectively. CONCLUSIONS: Features of the internal anatomy of the pulp cavity of three-rooted maxillary premolars were identified with the use of µCT. The results revealed the heterogeneity of three-rooted maxillary premolars.
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Diente Premolar/anatomía & histología , Cavidad Pulpar/anatomía & histología , Anatomía Transversal , Diente Premolar/diagnóstico por imagen , Cavidad Pulpar/diagnóstico por imagen , Humanos , Maxilar , Tomografía Computarizada por Rayos X/métodosRESUMEN
AIM: To evaluate, by scanning electron microscopy, the deformation and fracture of NiTi RaCe and K3 size 25, 0.04 taper instruments. METHODOLOGY: Ten sets of instruments from RaCe and K3 NiTi rotary systems were used to prepare 100 simulated canals in epoxy resin blocks with 20 or 40 degree curvatures beginning 8 or 12 mm from the orifice. Each instrument set was used to prepare five simulated canals using a crowndown technique. The size 25, 0.04 taper instruments were analysed by SEM when new and again after each use. Three observers scored images of the instruments after each use for distortion of the spirals (no distortion, distortion of one spiral or distortion of more than one spiral), wear (no wear, small, moderate or severe wear) and fracture (yes or no). Two-way anova was used to analyse differences between instruments for distortion and wear; Fisher's exact test looked for differences related to fracture of instruments. RESULTS: No fractures occurred with K3 instruments, whereas six RaCe instruments fractured (P = 0.005). A statistically significant difference occurred between RaCe and K3 instruments in terms of distortion of spirals and surface wear (P < 0.001). Distortion of spirals and wear increased with progressive use of RaCe instruments, whereas K3 instruments remained relatively undamaged after their fifth use. The simulated canals with smaller radii of curvature were positively associated with fracture of RaCe instruments. CONCLUSIONS: A significant difference was found between RaCe and K3 in terms of deformation and fracture of size 25, 0.04 taper instruments; K3 instruments had more favourable results.