RESUMEN
Objetivou-se investigar ex vivo o diâmetro anatômico e conicidade do canal mesiopalatino de primeiros molares superiores. Para tanto, trinta e três primeiros molares superiores humanos foram acessados, explorados para confirmação da existência do canal mesiopalatino, identificados, suas raízes mesiovestibulares seccionadas transversalmente em três níveis e, então, os fragmentos foram fotografados com microscópio digital, que permitiu a realização das determinações dos diâmetros anatômicos deste canal em cada amostra. Os resultados foram calculados em função dos valores médios e de desvio padrão dos diâmetros em cada nível, obtendo-se respectivamente 0,20 mm e ±0,09 mm (nível cervical), 0,20 mm e ±0,08 mm (nível médio) e 0,17 mm e ±0,06 mm (nível apical). Nas condições deste estudo, de acordo com caráter atrésico e baixa conicidade do conduto mesiopalatino, sugere-se a necessidade de uso de instrumentos de diâmetro de ponta mínimo de 0,25 mm e conicidade 0,03 para o seu preparo.
The aim was to investigate ex vivo the anatomical diameter and taper of the mesiopalatine canal of maxillary first molars. To this end, thirty-three human maxillary first molars were accessed, explored to confirm the existence of the mesiopalatine canal, identified, their mesiobuccal roots transversely sectioned at three levels and then the fragments were photographed using a digital microscope, which allowed the anatomical diameters of this canal to be determined in each sample. The results were calculated according to the mean and standard deviation values of the diameters at each level, obtaining 0.20 mm and ±0.09 mm (cervical level), 0.20 mm and ±0.08 mm (middle level) and 0.17 mm and ±0.06 mm (apical level) respectively. Under the conditions of this study, given the atresic nature and low taper of the mesiopalatine canal, it is suggested that instruments with a minimum tip diameter of 0.25 mm and a taper of 0.03 should be used for its preparation.
Asunto(s)
Raíz del Diente , Preparación del Conducto Radicular , Endodoncia , Anatomía , Diente MolarRESUMEN
OBJECTIVE: This study evaluated the force system generated by the Memory Titanol® spring (MTS) with different preactivation bends using an orthodontic force tester (OFT). METHODS: Three preactivations were tested using a 0.017 × 0.022-in stainless steel (SS) wire and a 0.018 × 0.025-in NiTi segment, with an activation of 30º in the posterior segment (ß), with 0º (Group 1 [G1]), 45º (Group 2 [G2]), and 60º (Group 3 [G3]) in the anterior segment (α). RESULTS: The molars showed extrusion values of -1.33 N for G1 and -0.78 N for G2, and an intrusion value of 0.33 N for G3. The force in the premolars was intrusive with a variation of 1.34 N for G1 and 0.77 N for G2; and extrusive with a variation of -0.31 N for G3. Regarding the upright moment (Ty) of the molar, a distal moment was observed with values of 53.45 N.mm for G1 and 19.87 N.mm for G2, while G3 presented a mesial moment of -6.23 N.mm. G1, G2, and G3 all exhibited distal premolar moments (Ty) of 3.58, 2.45, and 0.68 N.mm, respectively. CONCLUSIONS: The tested preactivations exerted an extrusive force in G1 and G2 and an intrusive force in G3 during molar vertical movement. The premolar region in G1 and G2 showed intrusive force and distal moment.
Asunto(s)
Alambres para Ortodoncia , Acero Inoxidable , Titanio , Técnicas de Movimiento Dental , Acero Inoxidable/química , Técnicas de Movimiento Dental/instrumentación , Titanio/química , Humanos , Diseño de Aparato Ortodóncico , Análisis del Estrés Dental , Ensayo de Materiales , Diente Premolar , Níquel/química , Aleaciones Dentales/química , Diente Molar , Estrés MecánicoRESUMEN
One fourth of teeth affected by molar incisor hypomineralisation (MIH) have required or will require treatment due to pain, sensitivity, or posteruptive breakdown. Restorative treatment becomes necessary in cases of severe MIH, characterized by posteruptive breakdown, which exhibits a wide range of clinical characteristics. Until approximately 20 years ago, all techniques, materials, and research were developed for treating caries lesions, not hypomineralisation. Research attempting to evaluate approaches to MIH treatment is recent and inconclusive. Therefore, there is still insufficient high-quality scientific evidence to establish a definitive clinical protocol for treating this condition. Recommendations based on best clinical practices can be provided rather than conclusions supported by a high level of evidence. To assist in clinical judgment regarding the best treatment strategy, eligible therapeutic options for restoring MIH-affected molars will be presented based on the strength and adhesive potential of the remaining hypomineralised enamel. The literature presents options for restorative materials ranging from direct alternatives such as glass ionomer cement and resin composite, through prefabricated devices, such as stainless-steel crowns and orthobands, to indirect restoration alternatives. However, it is essential to understand the indications of each restorative alternative and to know the restorative techniques, many of which are specifically developed to mitigate the difficulties encountered with the use of conventional techniques. Emphasis will be placed on the importance of adopting a personalized approach to restorative decision-making, considering the philosophy of minimal intervention dentistry and potential benefits for the patient's well-being and the family's needs.
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Restauración Dental Permanente , Diente Molar , Humanos , Restauración Dental Permanente/métodos , Diente Molar/patología , Hipoplasia del Esmalte Dental/terapiaRESUMEN
The dental professional is exposed to complex challenges daily, posed by molar incisor hypomineralisation (MIH). These range from understanding its etiology through to determining the most effective strategies for clinical management of the problem. Beyond any doubt, the choice of the diagnostic scoring system to be used for recording the condition is included among these challenges. To a certain degree, this is understandable since the development of specific diagnostic tools for recording the occurrence of MIH takes place parallel to the ongoing discoveries about the problem. Therefore, the aim of this chapter is to present different MIH scoring systems that have previously been proposed in the literature for detecting MIH and discuss their applications, advantages, and limitations.
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Hipoplasia del Esmalte Dental , Humanos , Hipoplasia del Esmalte Dental/diagnóstico , Hipoplasia del Esmalte Dental/patología , Hipoplasia del Esmalte Dental/clasificación , Diente Molar/patología , Incisivo/patología , Hipomineralización MolarRESUMEN
This review aims to present scientific knowledge regarding the demarcated opacities of molar incisor hypomineralisation (MIH) and factors that clarify the occurrence of posteruptive enamel breakdown. The demarcated opacities have distinct boundaries with the adjacent nonaffected enamel and may vary in color among white, creamy, yellow, and brownish. The hypomineralised enamel is more porous and less organized than the nonaffected enamel. As a result of the reduced mineral content and higher protein content, the hypomineralised enamel shows a progressive reduction in its mechanical properties according to the opacity feature. Chemically, the protein content of MIH opacities is abnormally high, mainly composed by albumin, which is a serum protein usually not found in mature enamel. The highest protein content is seen in brown opacities, followed by yellow and white opacities, both with higher protein content than nonaffected enamel. The fact that the hypomineralised enamel is more fragile than the nonaffected enamel is supported not only by laboratorial findings but also by clinical prospective studies that observed an aggravation of MIH over time, as well as the correlation between the color of the demarcated opacities and the risk of posteruptive enamel breakdown. A better understanding about the microstructure of the hypomineralised enamel has relevant implications for the clinical approach of the condition. In the clinic, besides a comprehensive assessment of anamnesis and clinical data, it is advisable to record the color and the location of the opacities by tooth surface in order to support the treatment decisions and estimate a prognosis for MIH patients.
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Hipoplasia del Esmalte Dental , Esmalte Dental , Desmineralización Dental , Humanos , Esmalte Dental/patología , Esmalte Dental/metabolismo , Hipoplasia del Esmalte Dental/patología , Desmineralización Dental/patología , Desmineralización Dental/metabolismo , Incisivo/patología , Diente Molar/patología , Hipomineralización MolarRESUMEN
Oral health-related quality of life (OHRQoL) is a multifaceted concept that surpasses an exclusively clinical perception and includes functional, social, emotional, and environmental issues. The measure of OHRQoL represents a holistic approach for research and clinical practice. Negative impacts of oral conditions on OHRQoL in childhood can reflect on health development, especially in a life stage marked by social and cognitive maturation. Therefore, such problems can impact negatively on the daily lives of the individuals and their families. Individuals with molar incisor hypomineralisation (MIH) experience more frequent posteruptive breakdown, an elevated risk of tooth decay, filling failures, the need for recurrent dental treatment, and a higher prevalence of dental hypersensitivity. Children with severe MIH may struggle with everyday activities, such as brushing their teeth, speaking, smiling, chewing, and consuming hot or cold foods. MIH-affected incisors may exhibit opacities that can impact the aesthetics of their smiles. This condition may discourage children from smiling and can indirectly affect their parents as well. The management modalities are focused on solving functional, aesthetic, and hypersensitivity problems and to evaluate OHRQoL values before and after therapies. Therefore, this chapter aims to discuss how MIH affects the OHRQoL of children and the questionnaires that can be used to evaluate that impact.
Asunto(s)
Hipoplasia del Esmalte Dental , Calidad de Vida , Humanos , Niño , Hipoplasia del Esmalte Dental/psicología , Salud Bucal , Encuestas y Cuestionarios , Diente Molar/patología , Incisivo/patología , Hipomineralización MolarRESUMEN
The condition known as molar incisor hypomineralisation (MIH) has been featured in the dental literature for some time. However, the condition itself, characterized by demarcated opacities, had been observed and documented in various forms before the official terminology was coined. The awareness and understanding of MIH have increased over the years, and there has been ongoing research to explore its prevalence, etiology, clinical implications, care, and treatment. In summary, MIH is not a recent condition, but the terminology and recognition of this dental phenomenon have been refined and formalized in the relatively recent past. This chapter reflects on our clinical experience, juxtaposing it with information from scientific literature and personal insights, as well as identifying gaps in understanding this enamel defect. Furthermore, another aim was to foster contemplation for potential research advancements in the MIH field.
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Hipoplasia del Esmalte Dental , Humanos , Hipoplasia del Esmalte Dental/patología , Diente Molar/patología , Hipomineralización MolarRESUMEN
This study employed e-Vol DXS cone beam computed tomography (CBCT) software to assess dentin remnants in the furcation area of mesial canals in mandibular molars during root canal retreatment (RCR). Four groups (Reciproc®, ProTaper Next®, Race Evo®, Protaper Gold®) were subjected to RCR, and CBCT images were captured before (T1) and after (T2) treatment. Measurements of remaining dentin thickness at 1 mm and 3 mm below the furcation were scrutinized. Results revealed no significant differences in mean thicknesses of mesiobuccal (MB) and mesiolingual (ML) canals at 1 mm and 3 mm from the furcation pre-treatment (T1). Post-treatment (T2) showed analogous findings, with no significant differences in mean thicknesses. However, disparities were found between MB and ML canals at both distances, both before and after retreatment. In essence, the evaluated instruments exhibited safety in RCR, implying that they are appropriate for use in critical areas of mandibular molars without inducing excessive wear. This study underscores the reliability of these instruments in navigating danger zones during RCR, and contributes valuable insights for dental practitioners who handle complex root canal scenarios in mandibular molars.
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Tomografía Computarizada de Haz Cónico , Cavidad Pulpar , Dentina , Mandíbula , Diente Molar , Retratamiento , Humanos , Tomografía Computarizada de Haz Cónico/métodos , Diente Molar/diagnóstico por imagen , Diente Molar/anatomía & histología , Retratamiento/métodos , Mandíbula/diagnóstico por imagen , Mandíbula/anatomía & histología , Reproducibilidad de los Resultados , Cavidad Pulpar/diagnóstico por imagen , Cavidad Pulpar/anatomía & histología , Dentina/diagnóstico por imagen , Instrumentos Dentales , Tratamiento del Conducto Radicular/métodos , Tratamiento del Conducto Radicular/instrumentación , Valores de Referencia , Preparación del Conducto Radicular/instrumentación , Preparación del Conducto Radicular/métodos , Diseño de Equipo , Estadísticas no ParamétricasRESUMEN
OBJECTIVE: The primary goal is to evaluate the effects of two different intracanal medicaments, calcium hydroxide [Ca(OH)2] and double antibiotic paste (DAP), on radiographic outcomes during regenerative endodontic procedures (REP) of immature permanent mandibular first molars with symptomatic irreversible pulpitis and symptomatic apical periodontitis (SIP/SAP). Additionally, the secondary goal was to evaluate MMP-8 levels during REP using two different intracanal medicaments. METHODOLOGY: The study included 20 patients with immature mandibular first molars exhibiting SIP/SAP. Participants were randomly assigned into two groups based on the applied intracanal medicament. Ca(OH)2 (n=10) was prepared by mixing it with sterile distilled water, while the same amount of powdered metronidazole and ciprofloxacin were mixed and combined with sterile distilled water for DAP (n=10). MMP-8 in periapical samples were measured at baseline and on the 14th day using immunofluorometric assay. Image-J software with TurboReg plug-in was utilized to determine changes in root length, root width, radiographic root area (RRA) during the 12-month follow-up period. Data were analyzed by SPSS 25.0 (p<.05). RESULTS: Significant increase in MMP-8 on the 14th day compared to baseline in both groups (p<0.001). There was no significant difference between the two groups in terms of the increase in MMP-8 (p>0.05). Root length significantly increased in both groups (p=0.001), with Ca(OH)2 showing a greater increase (p=0.046). Root width and RRA increased similarly in both groups at 12th month. CONCLUSION: Both Ca(OH)2 and DAP applications resulted in a significant increase in periapical MMP-8 levels. Increase in radiographic root width and root area was similar between two groups, but Ca(OH)2 led to a significantly greater increase in root length. Further studies with larger sample sizes are necessary to validate our findings during REP of vital immature permanent mandibular molars. Clinical Trials database: NCT05581706.
Asunto(s)
Antibacterianos , Hidróxido de Calcio , Ciprofloxacina , Metaloproteinasa 8 de la Matriz , Metronidazol , Periodontitis Periapical , Endodoncia Regenerativa , Irrigantes del Conducto Radicular , Humanos , Hidróxido de Calcio/uso terapéutico , Hidróxido de Calcio/farmacología , Metaloproteinasa 8 de la Matriz/análisis , Metronidazol/uso terapéutico , Metronidazol/farmacología , Ciprofloxacina/farmacología , Masculino , Femenino , Resultado del Tratamiento , Irrigantes del Conducto Radicular/uso terapéutico , Irrigantes del Conducto Radicular/farmacología , Periodontitis Periapical/terapia , Periodontitis Periapical/diagnóstico por imagen , Endodoncia Regenerativa/métodos , Factores de Tiempo , Adolescente , Pulpitis/terapia , Pulpitis/diagnóstico por imagen , Diente Molar/efectos de los fármacos , Estadísticas no Paramétricas , Valores de Referencia , Reproducibilidad de los Resultados , NiñoRESUMEN
INTRODUCTION: Symmetry is balance, some correspondence in the size, form, and arrangements of parts on opposite sides of a plane, line, or point. The opposite of this concept is asymmetry, or imbalance. OBJECTIVE: This retrospective study compared two methods for assessing arch symmetry with linear measurements based on triangles, to determine their applicability and efficiency. METHODS: Two groups were enrolled: children (n=20) and adults (n=20), and the arch symmetry was assessed from linear measurements. Method 1: the incisor-canine (INC), canine-molar (CM), and incisor-molar (INM) distances (paired t-test and Pearson correlation). Method 2: a mathematical equation between the cusps measurements of the canines and the distobuccal of the first molars leading to result 1 (t-test for one sample and bootstrapping analysis). Dental casts were digitized and analyzed using a software program. The Bland-Altman test compared the methods (α=0.05). RESULTS: The Bland-Altman test revealed concordance between the methods; however, separately the results were different: In method 1, the mandibular arch did not demonstrate correlation (children, INC r=0.33; CM r=0.45; INM r=0.51; adults, CM r=0.46; INM r=0.35), however, the maxilla revealed a strong correlation in children and a strong/moderate correlation in adults. In method 2, both arches were symmetrical (p>0.05). CONCLUSION: Method 1 may be appropriate during orthodontic treatment, and method 2 may be indicated for final treatment. These methods are useful; however, only method 1 identified the side of asymmetry. The methods can contribute to future studies in syndromic and non-syndromic patients, before and after orthognathic surgeries and orthodontic treatment, comparing results.
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Diente Canino , Arco Dental , Incisivo , Diente Molar , Humanos , Arco Dental/anatomía & histología , Estudios Retrospectivos , Niño , Adulto , Diente Canino/anatomía & histología , Diente Canino/diagnóstico por imagen , Femenino , Diente Molar/anatomía & histología , Incisivo/anatomía & histología , Masculino , Modelos Dentales , Mandíbula/anatomía & histología , Maxilar/anatomía & histología , Cefalometría/métodos , Adolescente , Adulto JovenRESUMEN
Numerous therapeutic approaches are available for managing molar incisor hypomineralisation (MIH); however, the cost-effectiveness of these strategies is underexplored. Economic evaluations are crucial for determining the optimal treatment approach to individual patients' requirements. We systematically reviewed the literature on the topic to have a more comprehensive discussion about these issues. Systematic searches were carried out. After a two-stage selection, 11 studies were included for synthesis. These studies could be divided into three groups according to the type of information given on costs: assumptions or deductions based on the literature (n = 6), cost collection on the available sources (n = 3), and cost-effectiveness evaluations (n = 2). The economic evidence on MIH management is still scarce and incipient. However, some important findings were produced for this evidence synthesis. A database of costs valuable in different contexts for therapeutic approaches related to MIH and its consequences was created. Furthermore, compiling and digesting the evidence on the cost-effectiveness of different approaches for managing severe MIH cases points out possible directions to be considered in decision-making that should consider these economic outcomes in different contexts and their powers of generalizability and also other aspects of evidence-based practice (e.g., professional and patients' preferences). Finally, there is an imminent need for economic evaluations focused on investigating the potential efficiency of preventive approaches for managing minor-compromised MIH teeth to postpone/avoid the severe consequences, which are more critical, complex, and costly to treat.
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Análisis de Costo-Efectividad , Hipoplasia del Esmalte Dental , Humanos , Hipoplasia del Esmalte Dental/economía , Hipoplasia del Esmalte Dental/terapia , Diente MolarRESUMEN
This study aimed to assess the fatigue resistance of molars lacking a coronary remnant, using zero, one, two, or three fiberglass posts. Forty caries/crack-free human molars with coronal portions removed at the pulp chamber floor were randomly allocated into four groups (n=10). Following endodontic treatment, posts (Whitepost DC/DC.E 0.5, 1.0, FGM) were silanized (silane agent, Angelus) and cemented with a resin cement (RelyX U200, 3M ESPE). Resin composite cores (Z350, 3M ESPE) were built, and metal crowns were fabricated and cemented using the same luting system. Samples underwent cyclic fatigue testing at 45°, applying load in the occlusal surface at 10 Hz and 100 N initial load for 10,000 cycles, with 50 N increments every 10,000 cycles until failure. Fatigue failure load and cycles for failure data were recorded and subjected to survival analysis through Kaplan-Meier and Mantel-Cox post hoc tests, and Weibull analysis. Fractography patterns of failed crowns were qualitatively analyzed. The group without posts exhibited the lowest fatigue performance (p < 0.05) for both fatigue failure load and cycles to failure. Superior fatigue performance was observed in the three-post group, followed by groups with one or two posts, corroborated by the Weibull characteristic strength parameter. Weibull moduli were similar among conditions. All specimens exhibited failure involving detachment of the restorative set (posts/core/crown) with a portion of the dental remnant, without tooth fracture. Thus, when restoring mandibular molars without crown remnants, the use of fiberglass posts promotes greater fatigue resistance to oblique loads.
Asunto(s)
Vidrio , Diente Molar , Técnica de Perno Muñón , Humanos , Análisis del Estrés Dental , Fracaso de la Restauración Dental , Coronas , Ensayo de MaterialesRESUMEN
OBJECTIVE: To analyze the prevalence of hypomineralized second primary molar (HSPM) and its association with socioeconomic characteristics and dental caries in a Brazilian population of preschoolers. MATERIAL AND METHODS: 603 preschoolers, enrolled in public preschools in Itajaí (state of Santa Catarina, Brazil), took part in the study. To assess the participants' socio-economic characteristics, an original questionnaire was formulated and sent to the children's parents. The clinical evaluation was carried out by a calibrated examiner using the deft/DMFT index for dental caries and Ghanim et al. (Ghanim et al., Eur Arch Paediatr Dent, 2015) criteria for HSPM. The data were analyzed through Poisson regression, using STATA statistical software, and the association analyses were presented by prevalence ratios (PR). RESULTS: The prevalence of at least one HSPM-affected second molar was 24.5%. The prevalence of HSPM was associated to the city's geographical regions of the Educational hubs (p < 0.001). A significant association was found between dental caries and HSPM (p = 0.003; PR: 1.31; 95% CI 1.09-1.56). Children with HSPM were 31% more likely to experience dental caries than children without HSPM. Geographical regions of educational hubs were also significantly associated with HSPM (p < 0.001). None of the socioeconomic characteristics was associated with HSPM (p > 0.05). CONCLUSION: HSPM is a common developmental defect of enamel in children in our study. The HSPM distribution was associated with the city's geographic regions. Children with HSPM are more likely to experience dental caries. Socioeconomic characteristics were not associated with HSPM.
Asunto(s)
Caries Dental , Hipoplasia del Esmalte Dental , Diente Molar , Factores Socioeconómicos , Diente Primario , Humanos , Brasil/epidemiología , Caries Dental/epidemiología , Estudios Transversales , Prevalencia , Preescolar , Masculino , Femenino , Hipoplasia del Esmalte Dental/epidemiología , Índice CPORESUMEN
OBJECTIVE: To evaluate the fracture behavior of human molars with extensive MOD restorations using short-fiber-reinforced resin composite of varying viscosities. MATERIALS AND METHODS: Human molars were randomly divided into seven groups (n = 12): intact teeth (control); restoration using conventional high-viscosity resin composite without (Filtek Z350XT, 3M) or with fibers (everX Posterior, GC); conventional low-viscosity resin composite without (Filtek Supreme Flowable, 3M) or with fibers (everX Flow Dentin Shade, GC); bulk-fill low-viscosity resin composite (Filtek Bulk Fill Flow, 3M) or with fibers (everX Flow Bulk Shade, GC). Restorations were performed on extensive MOD preparations, following the manufacturers' recommendations for each material. Specimens underwent fracture strength testing (N) and fracture pattern (%) categorized as repairable, possibly repairable, or non-repairable. Results were analyzed using a generalized linear model (N) and Fisher's exact test (%), with α = 0.05. RESULTS: Restorations performed with high-viscosity materials showed fracture strength values similar to the control and higher than those of restorations using low-viscosity resin composites (p < 0.0001), except for the bulk-fill low-viscosity resin composite with fibers (p > 0.05). Teeth restored using low-viscosity resin composite with fibers showed a higher % of repairable and possibly repairable fractures than the control (p = 0.0091). CONCLUSIONS: The viscosity of materials mediated the fracture strength, with restorations using high-viscosity resin composites promoting values similar to the intact tooth; however, the presence of fibers influenced the fracture pattern. CLINICAL SIGNIFICANCE: Teeth with MOD cavities restored with high-viscosity resin composites showed similar fracture strength to intact teeth. Fiber-reinforced low-viscosity resin composite for the base of restoration resulted in a more repairable/possibly repairable fracture pattern.
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Resinas Compuestas , Diente Molar , Resinas Compuestas/química , Humanos , Viscosidad , Fracaso de la Restauración Dental , Restauración Dental Permanente/métodos , Análisis del Estrés Dental , Ensayo de Materiales , Fracturas de los Dientes/terapiaRESUMEN
La terapéutica endodóntica se apoya básicamente en dos modelos teóricos o paradigmas: el concepto de "tubo hueco" técnico y quirúrgico esencialmente mecanicista, y el modelo terapéutico para conductos radiculares, que busca la restitución ad integrum de los tejidos apicales y el hueso alveolar que los rodea. La instrumentación debe complementarse con la limpieza por irrigación abundante y la obturación con un biomaterial bioactivo, con características reológicas que permitan su adaptación plástica a las paredes del conducto radicular y module la respuesta de los tejidos hacia la regeneración con aposición de tejido calcificado en el foramen apical (AU)
Endodontic therapy is basically based on two theoretical models or paradigms, which are the concept of the technical and surgical "hollow tube", essentially mechanistic, and the therapeutic model of root canals, which seeks the ad integrum restitution of the apical tissues and bone. alveolar that surrounds them. The instrumentation must be complemented with cleaning by abundant irrigation, and with a bioactive biomaterial, with rheological characteristics that allows its plastic adaptation to the walls of the root canal and modulates the response of the tissues towards regeneration with apposition of calcified tissue in the apical foramen (AU)
Asunto(s)
Humanos , Femenino , Adulto , Materiales Biocompatibles , Preparación del Conducto Radicular/instrumentación , Retratamiento , Enfermedades Periapicales/complicaciones , Irrigantes del Conducto Radicular/uso terapéutico , Ápice del Diente , Diente MolarRESUMEN
El «conducto en C¼ es un tipo de anatomía dentaria compleja que debe ser evaluado previo a la realiza- ción de un tratamiento endodóntico. Esta variación anatómica es vista principalmente en segundos mola- res inferiores aunque también puede encontrarse en premolares y molares, tanto superior como inferior. Para su diagnóstico se solicitan distintos tipos de estudios imagenológicos. Debemos tener en cuenta que este tipo de anatomía no es observado fácilmen- te en imágenes bidimensionales por lo cual es muy importante considerar para estos casos complejos, la solicitud de un estudio de alta complejidad como lo es la tomografía computada de haz cónico, la cual nos permitirá explorar este tipo de anatomía para tenerlo en cuenta al momento de realizar un correcto aborda- je del conducto en C (AU)
The "C-canal" is a type of complex dental anatomy that must be evaluated prior to performing endodontic treatment. This anatomical variation is seen mainly in lower second molars although it can also be found in premolars and molars, both upper and lower. For its diagnosis we can use different types of imaging studies. We must keep in mind that this type of anatomy is not easily observed in two-dimensional images, which is why it is very important to consider, for these complex cases, the request for a highly complex study such as cone beam computed tomography, which will allow us to explore this type of anatomy to take it into account when performing a correct approach to the C-duct (AU)
Asunto(s)
Cavidad Pulpar/anatomía & histología , Tomografía Computarizada de Haz Cónico , Interpretación de Imagen Asistida por Computador , Diente Molar/anatomía & histologíaRESUMEN
Both root canal sealer-based and supplementary protocols may influence removal of filling material during endodontic retreatment. Mesial root canals of extracted mandibular molars were prepared using HyFlex EDM 25/.08, and filled with a calcium silicate sealer (Bio-C Sealer), or an epoxy resin (AH Plus), using the single cone technique (n = 12). Retreatment was performed using ProDesign Logic (PDL) RT and PDL 35/.05. The specimens were randomly divided into two experimental groups (n = 12), and the sealers were distributed similarly. A supplementary protocol was performed with PDL 50/.01 or XP-endo Finisher. Root canal transportation and volume, in addition to the remaining filling material percentage were evaluated using high-resolution (5 µm voxel size) micro-CT. Statistical analysis was performed using t-tests (α = 0.05). Root canals filled with AH Plus presented high residual filling material (p < 0.05). Both protocols decreased residual volume of filling material in the apical third (p < 0.05). PDL 50/.01 increased the apical root canal volume (p < 0.05). No difference was observed between the systems regarding canal transportation (p > 0.05). In conclusion, AH Plus is more difficult to remove from the apical third than Bio-C Sealer. PDL 50/.01 and XP-endo Finisher enabled greater removal of filling materials in the apical third, in the retreatment of curved root canals, without promoting apical transport.
Asunto(s)
Resinas Epoxi , Ensayo de Materiales , Retratamiento , Materiales de Obturación del Conducto Radicular , Microtomografía por Rayos X , Materiales de Obturación del Conducto Radicular/química , Materiales de Obturación del Conducto Radicular/uso terapéutico , Humanos , Retratamiento/métodos , Resinas Epoxi/química , Resinas Epoxi/uso terapéutico , Preparación del Conducto Radicular/métodos , Preparación del Conducto Radicular/instrumentación , Cavidad Pulpar/diagnóstico por imagen , Cavidad Pulpar/efectos de los fármacos , Compuestos de Calcio/uso terapéutico , Silicatos/química , Reproducibilidad de los Resultados , Obturación del Conducto Radicular/métodos , Diente Molar , Valores de ReferenciaRESUMEN
OBJECTIVE: To evaluate the postoperative sensitivity (POS), as well as the clinical performance of posterior restorations using a new chemically-cured bulk-fill composite (Stela Automix and Stela Capsule, SDI) comparing with a light-cured bulk-fill composite after 6 months. METHODS: Fifty-five participants with at least three posterior teeth needing restoration were recruited. A total of 165 restorations were performed on Class I or Class II cavities. After the application of Stela primer, the chemically-cured composite (Stela Automix or Stela Capsule) was inserted. For the light-cured composite group, a universal adhesive (Scotchbond Universal) was applied with a bulk-fill composite (Filtek One). Participants were evaluated for spontaneous and stimulated POS in the baseline, after 48 h, 7 days, and 6 months. Additionally, each restoration was assessed using the updated version of FDI criteria after 6 months. The differences in the proportions of the groups were compared by Cochran test statistics (α = 0.05). RESULTS: Both chemically-cured composites showed a lower risk of POS compared to the light-cured composite at baseline and up to 48 h (p < 0.04). A significantly lower surface luster and texture was observed for the Stela Capsule composite compared to the light-cured bulk-fill composite (baseline and 6 months; p = 0.03). A significant color mismatch was observed for the light-cured bulk-fill composite compared to the chemically-cured composites (baseline and 6 months; p = 0.03). No significant differences were observed in any other item evaluations (p > 0.05). CONCLUSION: Chemically-cured composites exhibit lower postoperative sensitivity and less color mismatch compared to a light-cured bulk-fill composite after 6 months of clinical service. CLINICAL SIGNIFICANCE: The chemically-cured composites appear to be an appealing option for restoring posterior teeth, as they exhibit lower postoperative sensitivity compared to a light-cured bulk-fill composite, both at baseline and up to 48 h, and less color mismatch.
Asunto(s)
Resinas Compuestas , Restauración Dental Permanente , Sensibilidad de la Dentina , Humanos , Resinas Compuestas/química , Resinas Compuestas/uso terapéutico , Restauración Dental Permanente/métodos , Femenino , Masculino , Método Doble Ciego , Adulto , Persona de Mediana Edad , Curación por Luz de Adhesivos Dentales , Materiales Dentales/química , Cementos de Resina/química , Adulto Joven , Diente MolarRESUMEN
OBJECTIVE: This descriptive observational study aimed to determine clinically relevant and applicable data of enamel thickness (ETH), considering the mesio-distal differences of anterior and posterior permanent teeth and their relationships. MATERIAL AND METHODS: The sample consisted of right-sided standardized radiographs of 34 individuals (21 females and 13 males), aged between 13 and 24 (average 16) years, with all permanent teeth intact and without crowding. Four periapical and four interproximal radiographs were obtained and digitized. ETH measurements (mesial to distal contact points at the dentin-enamel junction) were performed after correction for radiographic image magnification. The Students' t-test was applied to the differences between paired means, with the Pearson correlation to evaluate the correlation between them. RESULTS: The mesial and distal ETH increased from the anterior to the posterior teeth. Incisor ETH ranged between 0.60 and 0.84 mm. Canines, premolars, and molars were more than 1.0 mm thick, and molar enamel reached values between 1.26 and 1.44 mm. CONCLUSION: Distal ETH was significantly greater than the mesial ETH, and progressively thicker from the anterior to posterior teeth. Interproximal reduction (IPR) of the lower central and upper lateral incisors should be avoided, reduced, or performed on their distal surfaces. There is a positive and significant correlation between ETH and the mesial and distal surfaces of the teeth. Periapical radiographs and evaluation of the remaining ETH are necessary in cases of retreatment. The location and number of tooth size discrepancies should be considered in treatment planning and appropriately compensated with IPR.
Asunto(s)
Esmalte Dental , Dentición Permanente , Humanos , Femenino , Esmalte Dental/diagnóstico por imagen , Esmalte Dental/anatomía & histología , Masculino , Adolescente , Adulto Joven , Diente Premolar/diagnóstico por imagen , Diente Premolar/anatomía & histología , Diente Molar/diagnóstico por imagen , Diente Molar/anatomía & histología , Incisivo/diagnóstico por imagen , Incisivo/anatomía & histología , Diente Canino/diagnóstico por imagen , Diente Canino/anatomía & histologíaRESUMEN
DESIGN: Double-blind (participant and outcome assessor), randomised, non-inferiority, two-arm (1:1 allocation) clinical trial. CASE SELECTION: The study included children aged 4-8 years old from public schools in Tietê, Brazil, who had mesio-occlusal carious lesions, into dentine, in primary molars. The carious teeth had to be asymptomatic of pulpal involvement. The children had to be medically fit and cooperative for dental treatment within their classroom environment. Consent was gained from a parent/guardian prior to entering the study. Children with carious lesions in multiple teeth, only one tooth was included, which was selected by a random draw. Treatment on other teeth would be carried out in the nearest health centre. DATA ANALYSIS: The primary outcome was the 2-year survival of the restorations, analysed using Kaplan-Meier survival curves and Cox regression (α = 5%). Costs for materials and professional services were recorded in Brazilian Reais (R$), converted to US dollars (US$), and analysed using Monte Carlo simulation. RESULTS: Of the 152 children enrolled (76 per group), 121 (79%) were evaluated at the 2-year mark. Overall, the 2-year survival rate of the restorations was 39% (EF: 45%; RSC: 32%), with no significant difference between the two groups. The total cost of restorations with RSC was lower than with EF, resulting in a cost saving of US$6.18 per restoration. CONCLUSION: After 2 years, Riva Self Cure demonstrated comparable survival rates to Equia Forte for mesio-occlusal restorations in primary molars, while being more cost-effective from a Brazilian perspective.