RESUMEN
INTRODUCTION: More data are needed before affirming that single-visit approaches are effective and safe for regenerative endodontic procedures (REPs). This study compared clinical and radiographic outcomes of REPs between interappointment dressing or single-visit protocols. METHODS: Twenty young patients presenting traumatized immature teeth with pulp necrosis were divided into 2 groups. Teeth were submitted to 6% sodium hypochlorite and 2% chlorhexidine irrigation and to 17% EDTA use before blood clot induction. In the interappointment dressing group (n = 11), calcium hydroxide was used with 2% chlorhexidine gel for 21 days before scaffold induction. In the single-visit group (n = 9), the scaffold was induced during the only appointment. Patients were followed up for 24 months. Primary, secondary, and tertiary outcomes were assessed by 3 independent evaluators. Preoperative and follow-up radiographs were assessed for quantitative measurements of the apical diameter, root width, root length, and cervical barrier placement and compared between groups using the t test or Mann-Whitney U test. Categoric variables were assessed with the G test and the Fisher exact test and continuous variables with the Mann-Whitney U test. Statistical significance was set at 5%. RESULTS: One tooth showed persistence of infection. No difference was observed in cervical barrier placement (P > .05); between groups regarding primary, secondary, and tertiary outcomes (P > .05); and in parameters of quantitative radiographic outcomes (P > .05). CONCLUSIONS: Completing REPs with an interappointment dressing or a single-visit protocol presented similar clinical and radiographic outcomes. A single-visit protocol of REPs using 6% sodium hypochlorite, 2% chlorhexidine, and 17% EDTA permitted satisfactory outcomes in necrotic immature permanent teeth.
Asunto(s)
Endodoncia Regenerativa , Vendajes , Hidróxido de Calcio/uso terapéutico , Clorhexidina/uso terapéutico , Necrosis de la Pulpa Dental/diagnóstico por imagen , Necrosis de la Pulpa Dental/terapia , Humanos , Tratamiento del Conducto RadicularRESUMEN
Abstract Objective: To evaluate the Antimicrobial Photodynamic Therapy (aPDT) in infected deciduous teeth by quantifying the viable bacteria in root canal treatment. Material and Methods: Radicular canal cultures were collected (n= 10). Four intra-canal samples were collected at four different times in each of the sampled teeth, as follows: Time 1 (T1), baseline: After opening the pulp-chamber; Time 2 (T2): After application of aPDT; Time 3 (T3): After mechanical, chemical manipulation; Time 4 (T4): After a second application of aPDT. The aPDT was performed with a 4J/cm energy low-intensity diode, together with 0.005% methylene blue as a photosensitizer. The clinical specimens were taken to the laboratory for a bacteria count (colony forming units) and the results were statistically analyzed using the Friedman and Wilcoxon tests, with a significance level of α=0.05. Results: Statistical differences were seen between the numbers of bacteria at times T1-T2, T1-T3 and T1-T4 on the cultivated plates. However, no significant statistical differences were observed between the number of bacteria in samples T2-T3, T2-T4 and T3-T4. Conclusion: Antimicrobial photodynamic therapy can be a good co-adjuvant in root canal decontamination of necrotic primary teeth.
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Humanos , Masculino , Femenino , Preescolar , Fotoquimioterapia/instrumentación , Diente Primario , Necrosis de la Pulpa Dental/diagnóstico por imagen , Terapia por Luz de Baja Intensidad/instrumentación , Brasil/epidemiología , Proyectos Piloto , Estadísticas no Paramétricas , Diente no Vital/diagnósticoRESUMEN
Pulpectomies in primary molars are often hindered by several factors, including anatomical and physiological characteristics of posterior primary teeth and young patients' lack of cooperation with laborious treatments. This study was undertaken in search of easier but equally effective therapies that could eliminate infection, preserve the teeth and avoid extractions. The aim of the study was to estimate and compare clinical and radiographic success between pulp treatment with 3Mix-MP and pulpectomy with Maisto-Capurro paste in primary necrotic molars. A longitudinal prospective study was conducted at the Department of Comprehensive Pediatric Dentistry of the Faculty of Dentistry of the University of Buenos Aires (20152017). The study included 46 primary molars with necrotic pulp of children without immune or metabolic compromise. Children and their legal guardians provided assent and informed consent. Selected molars were randomly divided into 2 groups: G1: Pulpectomy treatment with Maisto-Capurro paste; and G2: Treatment with 3Mix-MP paste. Treatments were evaluated at 1, 3, 6,12 and 18 months (intra and inter-rater agreement 0.92 and 0.84). Clinical success was considered to be the absence of any of the following: pain, sensitivity to percussion or palpation, swelling, fistula and non-physiological mobility, while radiographic success was considered to be: absence of internal or external non-physiological resorption, no progression or reduction of radiolucent periapical/interradicular lesion and evidence of bone regeneration. Percentages, 95% C.I., and CHI2 were calculated for the comparison between groups. Overall clinical success was 91.5% and 87.5% (p=0.48) and overall radiographic success was 88.3% and 82.3% (p=0.31) for G1 and G2 respectively. No significant clinical or radiographic difference was found between groups. Both treatments showed similar clinical and radiographic behavior during the study periods.
Las pulpectomías en molares primarios se ven dificultadas frecuentemente por las características anatómicas y fisiológicas de éstos y por la escasa colaboración que brindan los pacientes de corta edad ante tratamientos tan laboriosos. En búsqueda de terapéuticas más sencillas, pero igualmente eficaces, que consigan eliminar la infección para conservar las piezas y evitar las exodoncias, se ha planteado como objetivo de este estudio: estimar y comparar la proporción de éxito clínico y radiográfico entre el tratamiento pulpar con 3Mix-MP y la pulpectomía con pasta de Maisto-Capurro en molares primarios con necrosis. Se realizó un estudio longitudinal y prospectivo en la Cátedra de Odontología Integral Niños de la Facultad de Odontología de la Universidad de Buenos Aires (2015 - 2017). Formaron parte del estudio 46 molares primarios con diagnóstico de necrosis pulpar, de niños sin compromiso inmunológico ni metabólico y que junto con sus responsables legales brindaron el asentimiento y el consentimiento informado. Los molares seleccionados fueron divididos aleatoriamente en 2 grupos: G1: Tratamiento de pulpectomía con pasta de Maisto-Capurro y G2: Tratamiento con pasta 3Mix-MP. Los tratamientos fueron evaluados al mes, 3, 6, 12y 18 meses (concordancia intra-examinador 0,92 e interexaminador 0,84), considerando como éxito clínico la ausencia de dolor, sensibilidad a la percusión y palpación, edema, fístula y movilidad no fisiológica; y como éxito radiográfico, ausencia de reabsorción interna o externa no fisiológica, no progresión o reducción de la lesión radiolúcida interradicular/periapical y evidencia de regeneración ósea. Se calcularon porcentajes, I.C 95% y CHI2para la comparación. El éxito clínico global fue de 91,5%y 87,5% (p=0.48) y el éxito radiográfico global de 88,3% y 82,3% (p=0.31)para G1 y G2 respectivamente, sin diferencias significativas entre ambos grupos. En los periodos estudiados ambos tratamientos mostraron comportamientos clínico y radiográfico semejantes.
Asunto(s)
Antibacterianos/uso terapéutico , Necrosis de la Pulpa Dental/diagnóstico por imagen , Necrosis de la Pulpa Dental/terapia , Diente Molar/diagnóstico por imagen , Pulpectomía , Materiales de Obturación del Conducto Radicular/uso terapéutico , Diente Primario , Niño , Endodoncia , Femenino , Humanos , Masculino , Estudios Prospectivos , Pulpectomía/efectos adversos , Resultado del TratamientoRESUMEN
Resumen Se presenta el caso clínico de una paciente femenina de 7 años de edad, la cual sufrió traumatismo dental en el central superior derecho permanente, al impactarse de manera directa en el pavimento al caer de una bicicleta. Se presenta necrosis pulpar como complicación postraumática a un mes de ocurrido el evento. El objetivo de este caso es mostrar que el diagnóstico adecuado y el conocimiento sobre un protocolo para el manejo del paciente con trauma dental son indispensables para el éxito del tratamiento y pronóstico del diente.
Abstract The clinical case of a 7-year-old female patient who suffered dental trauma in the permanent upper right central incisor presented by directly impacting the pavement after falling from a bicycle. Pulpar necrosis is presented as a postraumatic complication one month after the event. The objective of this case is to show that the adequate diagnosis and knowledge about the protocol for the management of the patient with dental trauma is essential for the success of the treatment and prognosis of the tooth.
Asunto(s)
Humanos , Femenino , Niño , Férulas (Fijadores) , Traumatismos de los Dientes/complicaciones , Necrosis de la Pulpa Dental/diagnóstico por imagen , Luxaciones Articulares , MéxicoRESUMEN
OBJECTIVE: This study aimed to analyze the correlation between crestal alveolar bone loss with the presence of some bacterial species in root canals and the apical lesion area of necrotic teeth. DESIGN: Data from 20 patients with diagnosis of pulp necrosis and acute apical abscesses, without active periodontal diseases, were evaluated. Patients with history of antibiotic usage three months prior to the study, with exposed pulp cavity, and with probing depth >3â¯mm were not included. The root size, the distance between the bone crest to the tooth apex in the mesial and distal surfaces, and the apical lesion area were measured from standard periapical radiographies by a calibrated examiner. Root canal samples were collected using sterilized paper points. In multirooted teeth, the largest root canal was sampled. Culture, microbial isolation and identification by phenotypic methods were performed. Spearman correlation and exact Fischer test were calculated between higher/lower existing bone crests, according to the median and the presence of specific bacteria. RESULTS: No statistically significant differences were found between occurrence of pathogenic bacteria, such as Porphyromonas gingivalis, Porphyromonas endodontalis, and Prevotella intermedia, and groups with higher/lower degree of bone loss (pâ¯>â¯0.05). A negative significant correlation was found between Parvimonas micra and periodontal bone loss (pâ¯=â¯0.02). Additionally, no statistically significant association was found between crestal bone loss and the apical lesion area. CONCLUSIONS: It was concluded that, in patients without active periodontitis, the presence of pathogenic bacteria in the root canal was not correlated with periodontal bone loss.
Asunto(s)
Pérdida de Hueso Alveolar/microbiología , Cavidad Pulpar/microbiología , Necrosis de la Pulpa Dental/microbiología , Absceso Periapical/microbiología , Adulto , Pérdida de Hueso Alveolar/diagnóstico por imagen , Brasil , Cavidad Pulpar/diagnóstico por imagen , Necrosis de la Pulpa Dental/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Absceso Periapical/diagnóstico por imagen , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND: Dental trauma and deep caries are frequent findings in children and adolescents that may lead to pulp necrosis in young permanent teeth. As a consequence, the root stops its development, and managing these immature teeth becomes challenging due to the presence of open apexes and fragile dentinal walls. AIM: We aimed to carry out a systematic review including a meta-analysis to compare the endodontic treatments available in the management of immature necrotic permanent teeth and determine which one provides the best clinical and radiographic outcomes. DESIGN: The literature was screened via PubMed/MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials databases until August 2015 to select randomized clinical trials that compared at least two different treatments regarding immature necrotic permanent teeth comprising clinical and radiographic success as outcome. Two reviewers independently performed the screening and evaluation of the articles. A total of 648 studies were retrieved from the databases, in which only 14 were selected to full-text analysis by the appliance of inclusion criteria. After the exclusion criteria, the remaining seven studies had their data extracted and assessed for bias risk. Pooled-effect estimates were obtained comparing clinical and radiographic success rates among MTA Versus other treatments. RESULTS: Evaluation of clinical (Z = 2.32, P = 0.02, OR = 5.37, 95% CI: 1.29-22.23, I = 0%) and radiographic (Z = 2.45, P = 0.01, OR = 4.31, 95% CI: 1.34-13.82, I = 0%) outcomes favored the MTA (control group) when compared to other endodontic treatments (P < 0.05). No evidence of heterogeneity was detected among the studies (I < 50%), whereas a moderate risk of bias was identified in five of them. CONCLUSIONS: Although almost all of the identified studies presented moderate risk of bias, MTA apexification seems to produce overall better clinical and radiographic success rates among the endodontic treatment available in immature necrotic permanent teeth.
Asunto(s)
Necrosis de la Pulpa Dental/diagnóstico por imagen , Necrosis de la Pulpa Dental/terapia , Dentición Permanente , Radiografía Dental , Diente no Vital , Adolescente , Niño , Humanos , Evaluación de Procesos y Resultados en Atención de SaludRESUMEN
PURPOSE: The purposes of this study were (1) to assess the endotoxin levels in root canals of primary teeth with necrotic pulps and periapical lesions; and (2) to evaluate the correlation of endotoxin levels with the periapical lesion size. METHODS: Twenty primary molars with necrotic pulps and periapical lesions were selected. Standardized radiographs were obtained and the lesions were measured. Material from each root canal was collected to quantify the bacterial endotoxin. The results were analyzed using Pearson's correlation, student's t test, and Fisher's exact test (α equals five percent). RESULTS: The initial amount of bacterial endotoxin in the root canals ranged from 0.089 to greater than 50.00 endotoxin units (EU)/mL and was detected in 100 percent of the samples. A positive but not significant correlation was observed between the amount of endotoxin and periapical lesion size in primary molars. CONCLUSION: Endotoxin was observed in 100 percent of root canals of primary teeth with a periapical lesion. However, there was no statistical significance between bacterial endotoxin levels and the periapical lesion area.
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Cavidad Pulpar/microbiología , Necrosis de la Pulpa Dental/microbiología , Endotoxinas/análisis , Diente Molar/microbiología , Periodontitis Periapical/microbiología , Diente Primario/microbiología , Niño , Cavidad Pulpar/diagnóstico por imagen , Necrosis de la Pulpa Dental/diagnóstico por imagen , Femenino , Humanos , Masculino , Diente Molar/diagnóstico por imagen , Periodontitis Periapical/diagnóstico por imagen , Diente Primario/diagnóstico por imagenRESUMEN
The aim of this study was to assess, in vivo, the accuracy of the NovApex® electronic foramen locator in determining working length (WL) in vital and necrotic posterior teeth. The NovApex®was used in 144 canals: 35 teeth with vital pulps (68 canals) and 42 teeth with necrotic pulps (76 canals). WL was measured with the NovApex® locator and confirmed using the radiographic method. Differences between electronic and radiographic measurements ranging between 0.0 and 0.4 millimeters were classified as acceptable; differences equal to or greater than 0.5 millimeter were considered unacceptable. Pearson's chi-square test was used to assess the influence of pulp condition on the accuracy of NovApex®(a = 0.05). Regardless of pulp condition, differences between electronic and radiographic WL measurements were acceptable in 73.61% of the canals. No statistically significant differences in accuracy were observed when comparing vital and necrotic canals (p > 0.05). There were 38 unacceptable measurements. In none of these cases was the file tip located beyond the radiographic apex; in 32, it was located short of the NovApex® measurement. Pulp condition had no significant effect on the accuracy of NovApex®.
Asunto(s)
Cavidad Pulpar/anatomía & histología , Pulpa Dental/patología , Preparación del Conducto Radicular/instrumentación , Ápice del Diente/anatomía & histología , Adolescente , Adulto , Anciano , Distribución de Chi-Cuadrado , Instrumentos Dentales , Pulpa Dental/diagnóstico por imagen , Cavidad Pulpar/diagnóstico por imagen , Necrosis de la Pulpa Dental/diagnóstico por imagen , Necrosis de la Pulpa Dental/patología , Electrónica Médica/instrumentación , Humanos , Persona de Mediana Edad , Odontometría/instrumentación , Tamaño de los Órganos , Radiografía , Reproducibilidad de los Resultados , Ápice del Diente/diagnóstico por imagen , Adulto JovenRESUMEN
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
OBJECTIVE: This study evaluated experimentally-induced periapical bone loss sites using digital radiographic and histopathologic parameters. MATERIAL AND METHODS: Twenty-seven Wistar rats were submitted to coronal opening of their mandibular right first molars. They were radiographed at 2, 15 and 30 days after the operative procedure by two digital radiographic storage phosphor plates (Digora®). The images were analyzed by creating a region of interest at the periapical region of each tooth (ImageJ) and registering the corresponding pixel values. After the sacrifice, the specimens were submitted to microscopic analysis in order to confirm the pulpal and periapical status of the tooth. RESULTS: There was significant statistically difference between the control and test sides in all the experimental periods regarding the pixel values (two-way ANOVA; p<0.05). CONCLUSIONS: The microscopic analysis proved that a periapical disease development occurred during the experimental periods with an evolution from pulpal necrosis to periapical bone resorption.
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Resorción Ósea , Necrosis de la Pulpa Dental , Enfermedades Periapicales , Animales , Resorción Ósea/diagnóstico por imagen , Resorción Ósea/patología , Necrosis de la Pulpa Dental/diagnóstico por imagen , Necrosis de la Pulpa Dental/patología , Enfermedades Periapicales/diagnóstico por imagen , Enfermedades Periapicales/patología , Intensificación de Imagen Radiográfica , Radiografía Dental Digital/métodos , Ratas , Ratas Wistar , Factores de TiempoRESUMEN
AIM: To monitor radiographically the progress of bone repair within chronic periapical lesions after root canal treatment using digital subtraction radiography (DSR). METHODOLOGY: Twelve patients with 17 single-rooted teeth with chronic apical periodontitis associated with an infected necrotic pulp were selected for root canal treatment. Periapical radiographs were taken before treatment (baseline) and immediately post-treatment, 45, 90, 135 and 180 days after treatment. The radiographic protocol included the use of individualized film holders with silicone bite blocks. The six radiographic images were digitized and submitted to digital subtraction using DSR software, resulting in five subtracted images (SI). Quantitative analysis of these SI was performed using Image Tool software to assess pixel value changes, considering a step-wedge as the gold standard and a cut-off value of 128 pixels. The aim was to identify any increase or decrease in mineral density in the region of the periapical lesion. RESULTS: A minor decrease in mineral density at the canal filling session and a significant progressive mineral gain in the following evaluations (P < 0.001) occurred. Pairwise comparison of pixel grey values revealed that only the 180-day follow-up differed significantly from the previous SI. CONCLUSION: Digital subtraction radiography is a useful method for evaluating the progress of bone repair after root canal treatment. Noticeable mineral gain was observed approximately 90 days after root canal filling and definite bone repair after 180 days.
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Pérdida de Hueso Alveolar/fisiopatología , Regeneración Ósea/fisiología , Periodontitis Periapical/fisiopatología , Radiografía Dental Digital/métodos , Técnica de Sustracción , Adolescente , Adulto , Pérdida de Hueso Alveolar/diagnóstico por imagen , Periodontitis Crónica/diagnóstico por imagen , Periodontitis Crónica/fisiopatología , Necrosis de la Pulpa Dental/diagnóstico por imagen , Necrosis de la Pulpa Dental/fisiopatología , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Masculino , Persona de Mediana Edad , Periodontitis Periapical/diagnóstico por imagen , Tratamiento del Conducto Radicular , Adulto JovenRESUMEN
OBJECTIVES: The aim of this study was to compare two methods for the evaluation of periapical lesion changes following endodontic therapy (digital subtraction technique and morphometric analysis) by outlining the radiolucent area. METHODS: 13 human anterior teeth with pulp necrosis and chronic periapical lesions were used. Periapical radiographs were taken immediately after endodontic therapy (0) and then 2 months, 4 months and 6 months post treatment, using an intraoral radiographic film holder stabilized with impression material. The films were processed in a standard manner and the digitized images were submitted to digital subtraction using Adobe Photoshop 6.0. New bone formation or bone resorption areas were then measured. In the morphometric analysis, the periapical lesions were outlined using VixWin 2000 and the area (in square millimetres) was recorded. The obtained data were submitted to agreement analysis for comparison of the two techniques. RESULTS: There was no correlation between the areas of radiographic changes detected by digital subtraction and periapical lesion outline (r = 0.02-0.45). The new bone formation areas observed by digital subtraction presented higher values, with bone changes being especially evident in the 2 month follow-up radiographs, which suggests a higher sensitivity for this method. CONCLUSIONS: Both methods are suitable for the evaluation of periapical lesion changes, but the digital subtraction technique is more sensitive for detecting radiographic periapical changes.
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Necrosis de la Pulpa Dental/diagnóstico por imagen , Enfermedades Periapicales/diagnóstico por imagen , Intensificación de Imagen Radiográfica/métodos , Programas Informáticos , Técnica de Sustracción , Enfermedad Crónica , Estudios de Seguimiento , Humanos , Tratamiento del Conducto Radicular , Interfaz Usuario-ComputadorRESUMEN
OBJECTIVE: To evaluate 2 techniques for the treatment of human primary molars with necrotic pulp and bifurcation bone loss by means of radiographic examination for 48 months. METHOD AND MATERIALS: Fifty-one mandibular primary molars were evaluated in children ranging from 4.5 to 6.5 years of age. The teeth with necrotic pulp and bifurcation bone loss were diagnosed by radiographic examination. The teeth were divided into 2 groups: group 1 (28 teeth) -- pulpotomy technique using formocresol as a temporary dressing between sessions and coronal chamber obturation with zinc oxide-eugenol cement; and group 2 (23 teeth) -- pulpectomy technique with calcium hydroxide paste as a temporary dressing between sessions and root canal obturation with a dense calcium hydroxide paste. Standardized radiographs were taken immediately after the fillings were completed and after 12, 24, 36, and 48 months. The radiographs were digitized and analyzed with software that outlined and measured the bifurcation radiolucency. RESULTS: Bifurcation radiolucency reduced significantly or repaired completely for both treatments in the first 12 months. Minor radiographic reduction of the lesion was observed from 12 to 24 months, and no significant reduction of the remaining radiolucent area was observed from 24 to 48 months after treatment. CONCLUSION: The 2 endodontic techniques evaluated showed similar results. The main effect of treatment on the lesion repair was obtained in the first year after treatment.
Asunto(s)
Necrosis de la Pulpa Dental/terapia , Defectos de Furcación/terapia , Pulpectomía/métodos , Pulpotomía/métodos , Hidróxido de Calcio , Niño , Preescolar , Necrosis de la Pulpa Dental/complicaciones , Necrosis de la Pulpa Dental/diagnóstico por imagen , Restauración Dental Permanente , Estudios de Seguimiento , Formocresoles , Defectos de Furcación/complicaciones , Defectos de Furcación/diagnóstico por imagen , Humanos , Diente Molar , Radiografía , Materiales de Obturación del Conducto Radicular , Diente Primario , Cemento de Óxido de Zinc-EugenolRESUMEN
The aim of this retrospective study was to evaluate clinical and radiographic results related to avulsed and replanted teeth in patients who sought treatment at the Dental Trauma Center of the Dental School of Piracicaba, State University of Campinas, Piracicaba, SP, Brazil. One hundred replanted teeth were studied from 48 individuals (18 females and 30 males, with a mean age of 15 years and 9 months). Post-replantation factors (clinical and radiographic) were observed. The clinical aspects evaluated were crown discoloration, pulp necrosis, mobility changes, presence of fistulae and tooth infra-position. Radiographic examination aimed to identify replacement and inflammatory root resorptions, pulp canal obliteration and the presence of radiolucent areas. Depending on clinical and radiographic findings, results were classified as: complete success, acceptable success, uncertain success or failure. During anamnesis, other factors such as stage of root formation, period extra-alveolar, storage medium, type of splintation, and period after replantation time were recorded. The data obtained were statistically analyzed in order to determine the relationship between the post-replantation factors and outcome of teeth replantation. Linear logistic regression revealed that the majority of replanted teeth were associated with root resorptions and its occurrence duplicated proportionally as the time after replantation increased. Based on these findings, replantation procedures must be submitted to an accurate follow-up, as the success of replanted teeth, which already tends to be limited, may be even more jeopardized if cases are not controlled.
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Avulsión de Diente/cirugía , Reimplante Dental/efectos adversos , Adolescente , Adulto , Niño , Necrosis de la Pulpa Dental/diagnóstico por imagen , Necrosis de la Pulpa Dental/etiología , Femenino , Humanos , Modelos Logísticos , Masculino , Fístula Oral/etiología , Enfermedades Periapicales/diagnóstico por imagen , Enfermedades Periapicales/etiología , Radiografía , Estudios Retrospectivos , Resorción Radicular/diagnóstico por imagen , Resorción Radicular/etiología , Anquilosis del Diente/etiología , Movilidad Dentaria , Resultado del TratamientoRESUMEN
The purpose of the present study was to determine the influence of the type of trauma on the pulp vitality and the time elapsed until seeking dental care in children aged 0-3 years seen at the Baby Clinic of the Araçatuba Dental School, UNESP. A total of 1813 records were analyzed. Two hundred and three patients, corresponding to 302 traumatized teeth, were assessed clinically and radiographically. Hard-tissue injuries were the most frequent (52%), with a predominance of enamel crown fractures (41.4%), followed by concussions (12.6%) and intrusions (11.6%). Clinical and radiographic examination revealed that 72% of the traumatized teeth maintained pulp vitality. In the case of supporting-tissue lesions, 51.1% of the patients sought care within 1-15 days after injury, while in the case of hard-tissue injuries, 52.7% sought care only after 16 days. The results showed that supporting-tissue injuries had a significant influence on the faster seeking of dental care.
Asunto(s)
Enfermedades de la Pulpa Dental/etiología , Pulpa Dental/fisiopatología , Traumatismos de los Dientes/clasificación , Preescolar , Esmalte Dental/lesiones , Pulpa Dental/diagnóstico por imagen , Necrosis de la Pulpa Dental/diagnóstico por imagen , Femenino , Humanos , Lactante , Masculino , Aceptación de la Atención de Salud , Enfermedades Periapicales/diagnóstico por imagen , Periodoncio/lesiones , Radiografía , Estudios Retrospectivos , Resorción Radicular/diagnóstico por imagen , Factores de Tiempo , Avulsión de Diente/terapia , Corona del Diente/lesiones , Decoloración de Dientes/clasificación , Traumatismos de los Dientes/terapia , Movilidad Dentaria/clasificaciónRESUMEN
The aim of this study was to evaluate the presence of bacterial biofilm on the external surface of the root apex in teeth with pulp necrosis, with and without radiographically visible periapical lesions, and in teeth with a vital pulp. Twenty-one teeth were extracted, eight with pulp necrosis and periapical lesions, eight with pulp necrosis without radiographically visible periapical lesions, and five with a vital pulp. The roots were sectioned, and the root apexes (+/- 3 mm) were processed for scanning electron microscope evaluation. The surface of the apical root was evaluated for the presence of microorganisms, root resorption, and biofilm. There were no microorganisms on the apical root surface of either teeth with pulp vitality or with pulp necrosis with no radiographically visible periapical lesions. Microorganisms were always present in teeth with pulp necrosis and radiographically visible periapical lesions. These included cocci, bacilli, and filaments and the presence of an apical biofilm. Apical biofilm is clinically important because microbial biofilms are inherently resistant to antimicrobial agents and cannot be removed by biomechanical preparation alone. This may cause failure of endodontic treatment as a consequence of persistent infection.
Asunto(s)
Necrosis de la Pulpa Dental/microbiología , Ápice del Diente/microbiología , Biopelículas , Cemento Dental/diagnóstico por imagen , Cemento Dental/microbiología , Necrosis de la Pulpa Dental/diagnóstico por imagen , Humanos , Microscopía Electrónica de Rastreo , Periodontitis Periapical/microbiología , Radiografía , Resorción Radicular/diagnóstico por imagen , Resorción Radicular/microbiología , Ápice del Diente/diagnóstico por imagenRESUMEN
The determination of whether a symptom-free tooth has pulpal and periapical disease relies heavily on radiographic findings and pulp tests. A case of a symptom-free upper left first molar is presented. The radiographic evidence of pathological changes associated with the endo-antral syndrome coupled with diffuse pulpal calcifications facilitated the diagnosis of chronic pulpal periapical disease. Non-surgical root canal therapy resulted in periapical healing as shown on a follow-up radiograph.
Asunto(s)
Sinusitis Maxilar/diagnóstico por imagen , Sinusitis Maxilar/etiología , Enfermedades Periapicales/complicaciones , Enfermedades Periapicales/diagnóstico por imagen , Adulto , Necrosis de la Pulpa Dental/complicaciones , Necrosis de la Pulpa Dental/diagnóstico por imagen , Femenino , Humanos , Radiografía , Tratamiento del Conducto Radicular , SíndromeRESUMEN
A correlation between clinical and X-ray findings with histopathology in teeth diagnosed as necrotic 30 permanent human teeth with a deep carious lesion associated with a periapical radiolucency were studied. Results were based on the histopathologic findings, correlated with clinical and radiographic data, analyzed underlight microscope. The clinically diagnosed necrotic teeth with a periapical radiolucency were 19 (63.33%), showed remnants of vital pulp tissue under histologic observation, mainly in the medium and apical root thirds, in multi-rooted teeth. Presence of infiltrated bacteria was also observed at dentinal tubules coronally. 11 teeth (36.66%) remnants did not show any evidence of vital pulp tissue, only total necrosis was observed. This group showed the presence of bacteria infiltrated at the dentinal tubules coronally and into the root canals.