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Introduction: Foraminal Enlargement (FE) is a cleaning performed in the apical-most region of the tooth, in order to optimize root disinfection. This systematic review evaluated the influence of FE during root canal treatment on bacterial reduction and repair of the periapical lesion. Materials and Methods: Searches in PubMed/MEDLINE, Scopus, Cochrane Library, Web of Science, Embase, Scielo, Lilacs and OpenGrey were performed until January-2024. Ex vivo and in vivo studies evaluating the effects of FE in the bacterial reduction and repair of the periapical lesion were included, respectively, followed by risk of bias assessment (modified version of Joanna Briggs Institute's for ex vivo studies and Systematic Review Centre for Laboratory animal Experimentation's risk of bias tools for in vivo studies). The meta-analysis was not feasible and a qualitative summary for each outcome was provided. Results: Of 950 studies, 2 in vivo studies were eligible, using animal models with infected teeth. Of these two, periapical repair was evaluated with hematoxylin-eosin stain, and FE improved periapical healing. Regarding ex vivo studies, 3 were eligible, using extracted human teeth. The inoculations in ex vivo models were performed with Enterococcus (E.) faecalis, and FE reduced E. faecalis in the ex vivo models. Conclusions: Foraminal enlargement seems to increase bacterial reduction within the root canal, and provide major periapical tissue repair on the histological analysis in animal studies. However, caution is necessary when translating these results to the clinical environment.
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Introduction: The presented study aimed to characterise periapical disease in teeth with primary non-surgical root canal treatment in persistent or emergent categories and their risk association. Methods: A retrospective observational study that evaluated permanent teeth with primary non-surgical root canal treatment, was conducted clinically and radiographically for over one year. The following variables were analysed: gender, age, type and location of tooth, previous diagnosis, treatment conditions, and type of coronal restoration. The supplementary variables included the perspectives of the treatment outcome, such as Remains normal, Improvement, and Failure. Statistical analysis was performed using a univariate analysis that estimated the average and proportion for each factor according to the result of the primary non-surgical root canal treatment. The multiple correspondence analysis identified the hierarchy between active variables and their association with the results. Results: A total of 232 teeth in 155 participants were analysed. A χ2 value, (P=0.023) showed that the emergent disease is associated with patients around the age of 50. The multiple correspondence analysis identified a tendency of grouping between the emergent disease and the short filling category, followed by symptomatic pulpitis as a previous diagnosis. The persistent disease was associated with errors and overfillings. An inadequate root filling and taper density adversely impacted the treatment outcome. Conclusions: The length of obturation influenced the presence of failure. Short fillings were associated with emerging periapical disease. Errors and overfillings contributed to the persistent disease in the populations studied.
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Este estudo busca avaliar quantitativamente a expressão do RNA mensageiro (mRNA) das integrinas alfa1, alfa4, alfa 5, alfa L, citocinas e quimiocinas, a partir de células presentes no líquido intersticial periapical adjacente a dentes com infecção do canal radicular. Foram selecionados 22 indivíduos com necessidade de tratamento endodôntico e encaminhados à Faculdade de Odontologia da Universidade Federal de Minas Gerais (Belo Horizonte, MG, Brasil). As amostras foram coletadas em 11 dentes necróticos e portadores de infecções endodônticas e 11 dentes hígidos que necessitavam de tratamento endodôntico por motivos protéticos. Após a cirurgia de acesso e antes dos procedimentos de limpeza e modelagem do sistema de canais radiculares (T0), imediatamente após a limpeza e formatação do sistema de canais radiculares(T1), em 7 (T2) e 14 dias (T3), um cone de papel esterilizado endodôntico # 20 foi inserido no SCR, mantido por 2 min, e posteriormente armazenado a -70°C. Real-Time PCR analisou microbiologicamente essas amostras para ler a expressão gênica do rRNA microbiano 16S e fragmentos da região ITS do gDNA fúngico da espécie Candida. Após os procedimentos de limpeza e formatação do SCR, três cones de papel absorvente esterilizados foram inseridos. Passivamente, a ponta do papel ultrapassou o ápice radicular em 2 mm e permaneceu por 2 minutos. As amostras foram coletadas imediatamente após a limpeza e modelagem do RCS, 7 e 14 dias após a primeira sessão. As pontas de papel tiveram os 4 mm finais cortados, inseridos em Eppendorf e armazenados a - 70°C. Com este procedimento, o RNA foi extraído do líquido intersticial periapical para caracterizar as expressões dos genes ITGA1, ITGA4, ITGA5, ITGAL, IL-1ß, TNF-α, IL-17A, IL-10, IFN-γ, CCL2/MCP-1, CCL5, CXCR4, e 16S usando PCR em tempo real. O DNA genômico (gDNA) foi extraído para se avaliar a abundância de Candida utilizando-se sequências ITS, por PCR em tempo real. Os resultados demonstraram que os níveis de expressão de mRNA do 16S diminuíram após os procedimentos de limpeza e modelagem e que a abundância de Candida foi insipiente na amostra analisada. As citocinas pro- inflamatórias IL-1ß e IL-17 apresentaram níveis de expressão elevados frente a infecção, reduzindo significativamente após os procedimentos de limpeza e formatação. Os níveis de expressão gênica de TNF-α significantemente aumentaram, em ambos os grupos. Não se observou diferença significativa quanto a expressão gênica das citocinas IFN-γ, IL-10, CCL-2 e CCL-5 e das integrinas ITGAL e ITGA5 nos tempos avaliados. A expressão gênica de CXCR4 reduziu significativamente do tempo T1 para o T2, no grupo experimental. As expressões gênicas de ITGA1 e ITGA4, no grupo experimental, reduziram significativamente de maneira tempo dependente. Finalmente, não houve alteração significativa na expressão de marcadores de macrófagos (CD64), enquanto expressão de marcadores de fibroblastos (S100A4) aumentou significativamente no grupo controle. Concluiu-se que a carga microbiana e a abundância de leveduras correlacionam-se positivamente com a expressão de mediadores pró-inflamatórios e que a que terapia endodôntica negativamente impacta a expressão dos mediadores pró-inflamatórios e das integrinas nos tecidos perirradiculares.
This study seeks to quantitatively evaluate the expression of messenger RNA (mRNA) of integrins alpha1, alfa4, alpha 5, alpha L, cytokines, and chemokines, from cells present in the periapical interstitial fluid adjacent to teeth with root canal infection. Twenty-two individuals needing endodontic treatment and referred to the School of Dentistry of the Federal University of Minas Gerais (Belo Horizonte, MG, Brazil) were selected. The samples were collected in 11 necrotic teeth and carriers of endodontic infections and 11 healthy teeth needing endodontic treatment for prosthetic reasons. After access surgery and before root canal system (RCS) cleaning and shaping procedures (T0), immediately after cleaning and shaping the root canal system (T1), in 7 (T2) and 14 days (T3) an endodontic sterilized paper point #20 was inserted into the RCS, maintained for 2 min, and subsequently stored at -70°C. Real-Time PCR microbiologically analyzed these samples to read the gene expression of microbial rRNA 16S and fragments of the ITS region of the Fungus Candida species gDNA. After RCS cleaning and shaping procedures, three sterilized absorbent paper cones were inserted. Passively, the paper point exceeded the root apex by 2 mm and remained for 2 minutes. Samples were collected immediately after RCS cleaning and shaping, 7 and 14 days after the first session. The paper points have the 4 mm of their tip cut, inserted in Eppendorf, and stored at - 70°C. This procedure extracted RNA from the periapical interstitial fluid to characterize the expressions of the genes ITGA1, ITGA4, ITGA5, ITGAL, IL-1ß, TNF- α, IL-17A, IL-10, IFN-γ, CCL2/MCP-1, CCL5, CXCR4, ITS using Real-Time PCR. The results showed that 16S mRNA expression levels decreased after cleaning and modeling procedures and that Candida abundance was incipient in the analyzed sample. Pro-inflammatory cytokines IL-1ß and IL-17 showed high expression levels against infection, significantly reduced after cleaning and formatting procedures. TNF-α gene expression levels significantly increased in both experimental and control groups. No significant difference was observed regarding the gene expression of the cytokines IFN-γ, IL-10, CCL-2, and CCL-5 and the integrins ITGAL and ITGA5. The gene expressions of ITGA1 and ITGA4 in the experimental group were significantly reduced time-dependent. Finally, there was no significant change in their macrophage markers (CD64) expression, while fibroblast markers (S100A4) expression significantly increased in the control group. It was concluded that microbial load and yeast abundance are positively correlated with the expression of pro-inflammatory mediators and that endodontic therapy negatively impacts the expression of pro-inflammatory mediators and integrins in periradicular tissues.
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Periodontite Periapical , Contagem de Colônia Microbiana , Integrinas , Citocinas , QuimiocinasRESUMO
Introducción: el empleo de software educativo es una alternativa motivadora en los diferentes escenarios docentes. Objetivo: mostrar la validación del software educativo sobre diagnóstico y tratamiento de enfermedades pulpares y periapicales para su generalización en estudiantes de Estomatología. Material y Métodos: se realizó un estudio de innovación tecnológica o producto terminado digital en la etapa comprendida desde marzo de 2018 a marzo de 2019. Se utilizó la herramienta Mediator v9.0. Se utilizaron métodos teóricos: histórico-lógico, analítico-sintético y el sistémico-estructural; y empíricos: la revisión documental y una encuesta a estudiantes y expertos en función de evaluadores externos del producto. Para evaluar la factibilidad del software se utilizó el método de Criterio de Experto y el Criterio de usuario. Las principales variables evaluadas fueron el diseño de las secciones del software, su funcionalidad, cientificidad del contenido, relación de las imágenes con el objetivo del software, así como su uso en la docencia. Resultados: el producto obtenido consta de un texto básico con hipervínculos para acceder a los demás componentes, así como galerías de imágenes y ejercicios de autoevaluación. Según Criterio de Experto la calidad técnica del producto y la calidad del contenido quedaron evaluadas en la categoría Muy Adecuado. Según Criterio de Usuario, la funcionalidad, la motivación individual y los aspectos de diseño fueron evaluados de Bien. Conclusiones: se desarrolló un software educativo que cuenta con recursos variados para el aprendizaje sobre el tema abordado(AU)
Introduction: The use of the educational software is a motivating alternative in different teaching scenarios. Objective: To validate the educational software related to the diagnosis and treatment of pulp and periapical diseases for its generalization in dental students. Material and Methods: A study linked with technological innovation or digital finished product was conducted during the period between March 2018 and March 2019. The tool used was Mediator v9.0. Theoretical methods such as historical-logical, analytical-synthetic, inductive-deductive, and systemic-structural were used; empirical methods, which included the documentary review and a survey, were applied to students and experts as external evaluators of the product. The methods of Expert Judgment and Customer Judgment were used to evaluate the feasibility of the software. The main variables evaluated were the design of software sections, its functionality, scientific content, relationship between the images and the objective of the software and its use in the teaching-learning process. Results: The product obtained is a basic text with hyperlinks to access the rest of the components, image galleries and self-evaluation exercises. According to Expert Judgment, the technical quality of the software and the quality of its content were evaluated as good. According to Customer Judgment, the functionality, self-motivation and design aspects were evaluated as optimal. Conclusions: An educational software with various resources for learning about the topic approached was developed(AU)
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Doenças Periapicais/diagnóstico , Doenças Periapicais/terapia , Software , Doenças da Polpa Dentária/diagnóstico , Doenças da Polpa Dentária/terapia , Educação em Odontologia/métodosRESUMO
AIM: To characterize the proteome of 20 root canals in teeth with post-treatment endodontic disease using mass spectrometry and to correlate the identified proteins with clinical features. METHODOLOGY: Twenty patients with radiographic evidence of apical periodontitis and need for root canal re-treatment were selected. Samples from the root canal contents were collected and processed using two-dimensional capillary nano-flow liquid chromatography and electrospray ionization tandem mass spectrometry. The acquired spectra were separately searched against specific protein database. The results obtained were analysed using descriptive statistics. Additionally, Pearson's chi-square test or one-sided Fisher's exact test, as appropriate, was chosen to examine the null hypothesis that there is no relationship between each clinical feature and the presence of specific microbial or human proteins. Significance levels were set at 5% (P < 0.05). RESULTS: A total of 1153 human and 720 microbial UniProt accession numbers corresponding to proteins were recovered. The greater prevalence of proteins was related to biological functions, such as cellular and metabolic processes. A considerable number of microbial proteins with clinical relevance functions, such as pathogenesis/virulence, proteolysis, cell adhesion and drug resistance, were detected. Common endodontic pathogens related to post-treatment endodontic disease such as Enterococcus spp., Propionibacterium spp. and Streptococcus spp. were associated with 23, 40 and 94 distinct proteins, respectively. As for human proteins, many factors related to the immune system process were detected. No significant correlations were found between microbial and human proteins and the clinical features investigated (P > 0.05). CONCLUSIONS: A considerable number of microbial and human proteins were identified using proteomic analyses, being mainly related to processes indicating cell viability. No significant correlation was found between proteins and clinical features. These findings suggest a network of important microbial pathogenic functions that may be responsible for the host immune system response.
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Doenças da Polpa Dentária , Periodontite Periapical , Cavidade Pulpar , Humanos , Proteômica , Tratamento do Canal RadicularRESUMO
AIM: To evaluate the mRNA expression levels of the cytokines interferon-γ, tumour necrosis factor-α, interleukin (IL)-1ß, IL-10, IL-6, VEGF, and AGT and the chemokine CCL2/MCP-1 in periapical interstitial fluid associated with root canal infections before and after the reduction of the bacterial load using a cleaning procedure. METHODOLOGY: The case group included 11 patients with chronic liver disease, and the control group included 11 healthy patients. Clinical samples were taken from teeth with pulp necrosis. After cleaning and drying the canal, three paper points were introduced into the root canal and passed through the root apex (2 mm) into the periapical tissues for 1 min. The samples were collected immediately after root canal cleaning and 7 days later to characterize those gene expression levels using real-time PCR. The data were subjected to the Shapiro-Wilk and the Wilcoxon tests. RESULTS: In the control group, significantly increased expression of the pro-inflammatory cytokines IFN-γ and TNF-α was observed in teeth with restrained bacterial loads (day 7) (P < 0.05). Similarly, increased TNF-α expression was found on day 7 in the liver group (P < 0.05). No differences were observed in the expression levels of the IL-1ß, IL-10 and, IL-6, MCP-1/CCL-2 and VEGF between the first collection (day 0) and second collection (day 7), over time in either group. CONCLUSION: Chronic liver disease patients exhibited sufficient immunologic ability showing relatively similar expression levels of cytokines, chemokines and angiogenic factors in periapical samples compared with the responses from no-chronic liver disease patients. The outcomes of this study suggest that liver impairment did not compromise the periapical immune response.
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Quimiocinas/metabolismo , Citocinas/metabolismo , Hepatopatias/complicações , Hepatopatias/imunologia , Doenças Periapicais/imunologia , Tratamento do Canal Radicular , Dente/imunologia , Adulto , Idoso , Carga Bacteriana , Quimiocina CCL2/metabolismo , Cavidade Pulpar/microbiologia , Necrose da Polpa Dentária/imunologia , Feminino , Humanos , Interferon gama/metabolismo , Interleucina-10/metabolismo , Interleucina-1beta/metabolismo , Interleucina-6/metabolismo , Masculino , Pessoa de Meia-Idade , Tecido Periapical/imunologia , Tecido Periapical/microbiologia , RNA Mensageiro/metabolismo , Ápice Dentário , Fator de Necrose Tumoral alfa/metabolismo , Fator A de Crescimento do Endotélio Vascular/metabolismoRESUMO
A odontologia equina é uma especialidade crescente no Brasil, porém sua importância ainda é negligenciada pelos proprietários e alguns veterinários. O objetivo deste estudo foi analisar um caso de sinusite unilateral por doença periapical de 1º molar eqüino. Neste relato, uma descarga nasal unilateral esquerda eqüina foi analisada há 30 dias, durante o exame radiográfico, foi possível observar a presença de pus no seio maxilar rostral, acima do dente comprometido 209, e a extração do dente comprometida e o dente contralateral também comprometido. O tratamento pós-operatório baseou-se na lavagem da boca do cavalo com água corrente, na aplicação de mel de abelha com extrato de própolis, na administração de anti-inflamatórios e antibióticos, proporcionando excelente recuperação e remissão cirúrgica e pós-operatória. sinais clínicos totais observados.
Equine dentistry is a growing specialty in Brazil, however its importance is still often overlooked by owners and some veterinarians. The objective of this study was to analyze a case of unilateral sinusitis due to equine 1st molar periapical disease. In this report, an equine left unilateral nasal discharge was analyzed 30 days ago, during the radiographic examination, it was possible to observe the presence of pus within the rostral maxillary sinus, above the compromised tooth 209, and the extraction of the tooth compromised and the contralateral tooth also compromised. The postoperative treatment was based on washing the horse's mouth with running water, applying bee honey with propolis extract, as well as administering anti-inflammatory and antibiotics, providing excellent surgical and postoperative recovery and remission. total clinical signs observed.
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Animais , Doenças Periapicais/veterinária , Própole , Sinusite/veterinária , Odontologia/veterinária , Cavalos/anormalidadesRESUMO
A odontologia equina é uma especialidade crescente no Brasil, porém sua importância ainda é negligenciada pelos proprietários e alguns veterinários. O objetivo deste estudo foi analisar um caso de sinusite unilateral por doença periapical de 1º molar eqüino. Nester elato, uma descarga nasal unilateral esquerda eqüina foi analisada há 30 dias, durante o exame radiográfico, foi possível observar a presença de pus no seio maxilar rostral, acimado dente comprometido 209, e a extração do dente comprometida e o dente contralateral também comprometido. O tratamento pós-operatório baseou-se na lavagem da boca do cavalo com água corrente, na aplicação de mel de abelha com extrato de própolis, na administração de anti-inflamatórios e antibióticos, proporcionando excelente recuperação e remissão cirúrgica e pós-operatória. sinais clínicos totais observados.(AU)
Equine dentistry is a growing specialty in Brazil, however its importance is still of ten overlooked by owners and some veterinarians. The objective of this study was to analyze a case of unilateral sinusitis due to equine 1st molar periapical disease. In this report, an equine left unilateral nasal discharge was analyzed 30 days ago, during the radiographic examination, it was possible to observe the presence of pus within the rostral maxillary sinus, above the compromised tooth 209, and the extraction of the tooth compromised and the contralateral tooth also compromised. The postoperative treatment was based on washing the horse's mouth with running water, applying bee honey with propolis extract,as well as administering anti-inflammatory and antibiotics, providing excellent surgical and postoperative recovery and remission. total clinical signs observed.(AU)
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Animais , Cirurgia Bucal , Doenças dos Cavalos , Doenças Periapicais/veterinária , Cárie Dentária/veterinária , Sinusite/veterináriaRESUMO
La periodontitis apical es una patología inflamatoria que afecta los tejidos periapicales de un diente desvitalizado. El objetivo de este estudio fue caracterizar histológica y morfométricamente las lesiones de quistes y granulomas utilizando microscopía óptica. Se analizaron seis biopsias obtenidas de dientes con indicación de exodoncia. El análisis histológico se realizó mediante microscopía óptica y microfotografías, con análisis de contraste de imágenes y conteo celular mediante ImageJ. Descripción de las características histológicas: en los quistes se observaron cavidades rodeadas de epitelio escamoso estratificado no queratinizado y una cápsula fibrosa compuesta de fibrocitos, fibroblastos e infiltrado inflamatorio crónico; en los granulomas se observaron capilares, una capsula fibrosa de fibrocitos/fibroblastos y un infiltrado inflamatorio de predominio linfocitario. Cuantificación del número celular de infiltrado inflamatorio: para quistes fue de 9,2 cel/10000 µm2, mientras que para granulomas fue de 20,8 cel/10000 µm2, sin diferencias estadísticas significativas entre ambos (p=0,654). Cuantificación del número celular de fibrocitos/fibroblastos: para quistes fue de 15,4 cel/10000 µm2, mientras que para granulomas fue de 18,5 cel/10000 µm2, sin diferencia estadística significativa (p=0,499). Porcentaje de colágeno tipo I: para los quistes fue de 37,8±19,2 %, mientras que para granulomas fue de 33,8±23,3 %, sin diferencias estadísticas significativas (p=0,704). Se observó una correlación negativa moderada para el infiltrado inflamatorio (R=0,637) y una correlación positiva baja para fibrocitos/fibroblastos (R=0,121), en relación a la cantidad de colágeno tipo I. Medición del área de las lesiones periapicales: el promedio total de las lesiones fue de 10,7±5,0 mm2, siendo el mayor tamaño un quiste de 18,1 mm2 y el menor un granuloma de 5,2 mm2. El análisis histológico permite realizar un diagnóstico diferencial de lesiones con características similares y así definir el tratamiento más adecuado.
Apical periodontitis is an inflammatory pathology that affects the periapical tissues of a devitalized tooth. The aim of this study was to histologically and morphometrically characterize lesions of cysts and granulomas using light microscopy. Six biopsies obtained from teeth with indication of exodontia were analyzed. The histological analysis was carried out by means of optical microscopy and microphotographs, with contrast analysis of images and cell count by ImageJ. A description of the histological characteristics was made, observing the cavities surrounded by stratified squamous non-keratinized epithelium and a fibrous capsule composed of fibrocytes, fibroblasts and chronic inflammatory infiltrate; in the granulomas, capillaries, a fibrous capsule of fibrocytes/fibroblasts and a predominantly lymphocytic inflammatory infiltrate were observed. In relation to quantification of the cellular number of inflammatory infiltrate, for cysts itwas of 9.2 cel / 10000 mm2, while for granulomas it was 20.8 cel / 10000 mm2, without significant statistical differences between both (p = 0.654). The quantification of the fibrocyte / fibroblast cell number was, for cysts, 15.4 cells / 10000 mm2, while for granulomas it was 18.5 cells / 10000 mm2, without significant statistical difference (p = 0.499). With respect to the percentage of collagen type I, for the cysts was 37.8 ± 19.2%, while for granulomas it was 33.8 ± 23.3%, without significant statistical differences (p = 0.704). A moderate negative correlation was observed for the inflammatory infiltrate (R = 0.667) and a low positive correlation for fibrocytes / fibroblasts (R = 0.121), in relation to the amount of type I collagen. Measurement of the area of the periapical lesions: the total average of lesions were 10.7 ± 5.0 mm2, the largest being a cyst of 18.1 mm2 and the smallest a granuloma of 5.2 mm2. The histological analysis allows to make a differential diagnosis of lesions with similar characteristics and thus define the most appropriate treatment.
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Humanos , Pessoa de Meia-Idade , Granuloma Periapical/patologia , Periodontite Periapical/patologia , Cisto Radicular/patologia , Biópsia , Dente não Vital , MicroscopiaRESUMO
Objetivo: O objetivo deste trabalho foi revisar a literatura científica pertinente, dando enfoque ao tratamento endodôntico e dentes portadores de necrose pulpar associados à periodontite apical como fator de risco às manifestações sistêmicas, desde a teoria da infecção focal até os dias atuais. Metodologia: Empregou-se fontes de catalogação bibliográfica identificadas eletronicamente pelo MEDLINE, até setembro de 2018. Os artigos relacionados pela busca eletrônica foram selecionados, por três revisores independentes, avaliando os critérios de inclusão e exclusão. Resultados: A busca apresentou 107 artigos, sendo que destes, 17 estudos satisfizeram os critérios de inclusão, o que possibilitou a análise dos dados. Conclusão: Muitos dos preceitos da teoria da infecção focal estão sendo reerguidos por pesquisas que mostram cada vez mais a existência de associações entre patologias endodônticas e sistêmicas.
Objective: The aim of this work was to review the pertinent scientific literature, focusing on endodontic treatment and teeth with pulp necrosis associated with apical periodontitis as a risk factor for systemic manifestations, from the focal infection theory to the present day. Methodology: The sources of bibliographic cataloging electronically identified by MEDLINE were used until September 2018. Articles related to the electronic search were selected by three independent reviewers, evaluating the inclusion and exclusion criteria. Results: The search presented 107 articles, of which, 17 studies met the inclusion criteria, which made it possible to analyze the data. Conclusion: Many of the precepts of the focal infection theory are being reinstated by research that increasingly shows the existence of associations between endodontic and systemic pathologies.
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Doenças Periapicais , Pulpite , Cavidade Pulpar , Infecção Focal DentáriaRESUMO
Resumen: Introducción: Las lesiones periapicales crónicas producen defectos óseos en la zona apical del diente comprometido. La terapia estándar requiere de una osteotomía, remoción del ápice, un profuso curetaje para remover el tejido infectado y granulomatoso, dejando un defecto óseo. Reporte de casos: Dos pacientes con lesiones periapicales fueron sometidos a una apicectomía donde se les colocó como relleno óseo plasma rico en fibrina. El tratamiento fue efectivo, ya que en 30 días se observó radiográficamente una zona radiopaca sugiriendo una formación ósea. Conclusión: La utilización de plasma rico en fibrina para rellenos óseos después de cirugías paraendodónticas podría ser una buena alternativa a los rellenos óseos comerciales por tener propiedades óseo-inductoras.
Abstract Introduction: Chronic periapical lesions cause bone defects in the apical area of compromised teeth. Standard therapy requires osteotomy, apex removal and profuse curettage to remove granulomatous and infected tissue, thus leaving a bone defect in its wake. Report of two cases: Two patients with periapical lesions were subjected to apicoectomy procedure where fibrin-rich plasma was placed as bone filling. Treatment was effective, since after 30 days a radio opaque area was radiographically observed, suggesting bone formation. Conclusion: Use of fibrin-rich plasma as bone filling after paraendodontic surgeries could represent a suitable alternative to commercial bone fillings, due to its bone induction properties.
RESUMO
OBJECTIVES: To describe the use of open-source software for the post-processing of CBCT imaging for the assessment of periapical lesions development after endodontic treatment. METHODS: CBCT scans were retrieved from endodontic records of two patients. Three-dimensional virtual models, voxel counting, volumetric measurement (mm3) and mean intensity of the periapical lesion were performed with ITK-SNAP v. 3.0 software. Three-dimensional models of the lesions were aligned and overlapped through the MeshLab software, which performed an automatic recording of the anatomical structures, based on the best fit. Qualitative and quantitative analyses of the changes in lesions size after treatment were performed with the 3DMeshMetric software. RESULTS: The ITK-SNAP v. 3.0 showed the smaller value corresponding to the voxel count and the volume of the lesion segmented in yellow, indicating reduction in volume of the lesion after the treatment. A higher value of the mean intensity of the segmented image in yellow was also observed, which suggested new bone formation. Colour mapping and "point value" tool allowed the visualization of the reduction of periapical lesions in several regions. CONCLUSIONS: Researchers and clinicians in the monitoring of endodontic periapical lesions have the opportunity to use open-source software.
Assuntos
Tomografia Computadorizada de Feixe Cônico , Doenças Periapicais/diagnóstico por imagem , Doenças Periapicais/terapia , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Tratamento do Canal Radicular , Feminino , Humanos , Imageamento Tridimensional , Masculino , Pessoa de Meia-Idade , Software , Adulto JovemRESUMO
A doença periapical inflamatória é uma sequela da infecção e necrose pulpar. Ela representa a resposta de defesa do hospedeiro à agressão proveniente do canal radicular. Assim, lesões periapicais crônicas se desenvolvem como resposta à manutenção da inflamação e à reabsorção óssea. As células T reguladoras (Treg) e células T helper (Th) 17 (Th17) têm papel fundamental na regulação da resposta imunológica. Forkhead box P3 (FoxP3) é o fator de transcrição para as células Treg, mas a diferenciação e maturação das células T naive em Treg ou Th17 depende também de citocinas específicas como o fator transformador de crescimento ß (TGF-ß), interleucina 10 (IL-10), interleucina 17 (IL-17), interleucina 6 (IL-6) e interleucina 21 (IL-21). Outras citocinas participam na modulação da atividade de Treg e Th17 como as quimiocinas CCL4 e CCL20 com função de recrutamento destas células para atuação no processo inflamatório. O papel de Treg e Th17 tem sido muito estudado em doenças autoimunes, mas ainda pouco avaliado na patogenia das lesões inflamatórias periapicais crônicas. Para este estudo foram utilizadas oitenta e sete amostras de tecido periapical humano para realização de análises morfológicas e dosagem de citocinas por meio de ensaio imunoenzimático (ELISA) (TGF-ß, IL10, IL-17, CCL4, CCL20). As amostras de tecido periapical foram coletadas de três grupos: grupo controle (dentes hígidos), grupo de dentes com necrose pulpar e lesão periapical e grupo de dentes com necrose pulpar sem lesão periapical. Observamos alta expressão de CCL4 e TGF-ß no grupo com lesão periapical quando comparado com os grupos sem lesão e uma correlação positiva entre CCL20 e IL-17, além de um aumento na expressão de CCL20 no grupo com lesão periapical quando comparado ao controle. Nossas observações implicam que essas duas características, tanto pró-inflamatórias quanto imunossupressoras, estão presentes na lesão periapical crônica, ocorrendo de maneira simultânea e com características de co-estimulação, como resultado do intenso trabalho da resposta imunológica do hospedeiro contra o processo inflamatório proveniente das bactérias intracanais e seus subprodutos.(AU)
Inflammatory periapical disease is a sequel of the infection and pulp necrosis. It represents the host defense response to aggression from the root canal. Chronic periapical lesions are developed in response to the maintenance of inflammation and bone resorption. Regulatory T cells (Tregs) and Th17 cells play a key role in regulating the immune response with opposite functions. Forkhead box P3 (FoxP3) is the master transcription factor for Treg cells, but differentiation and maturation of naive T cells in Treg or Th17 also depend on specific cytokines such as transforming growth factor ß (TGFß), interleukin 10 (IL -10), interleukin17 (IL-17), interleukin-6 (IL-6) and interleukin-21 (IL-21). Other cytokines participate in the modulation of the Treg and Th17 activity, as the chemokines CCL4 and CCL20 with function of recruitment of these cells to act in the inflammatory process. The role of Treg and Th17 has been better studied in autoimmune diseases, but sparsely evaluated in the pathogenesis of chronic periapical inflammatory lesions. Eighty-six human samples were used to perform histologic analysis and the cytokine dosage by enzyme-linked immunosorbent assay (ELISA) (TGF-ß, IL-10, IL-17, CCL4, CCL20) in the periapical tissue of three groups: control group, group of teeth with pulp necrosis and periapical lesion and group of teeth with necrosis without periapical lesion. We observed high expression of CCL4 and TGF-ß in the group with periapical lesion in comparison with the groups without lesion and demonstrated increased expression of CCL20 in the group with periapical lesion when compared to control. Our findings imply that these two characteristics, pro-inflammatory and immunosuppressive, are present in the chronic periapical lesion, occurring simultaneously and with co-stimulation characteristics, as a result of the intense actionof the host's immune response against the inflammatory process coming from intracanal bacteria and their by-products.(AU)
Assuntos
Quimiocinas , Citocinas , Doenças Periapicais , Periodontite Periapical , Tecido Periapical , Células Th17 , Necrose da Polpa DentáriaRESUMO
Introducción: la oclusión traumática se define como una alteración en las relaciones oclusales del sistema masticatorio, lo cual podría ser un factor conducente a un proceso inflamatorio en el ligamento periodontal, en la pulpa dental, y en tejidos blandos sensitivos. Objetivo: identificar las afecciones pulpares de origen no infeccioso en órganos dentarios con oclusión traumática en pacientes de un hospital del sector público de Mérida, Yucatán, México. Métodos: se realizó un estudio observacional y analítico, en un hospital del sector público de Mérida, Yucatán, México (2014). La muestra estuvo constituida con un total de 156 órganos dentarios de 82 pacientes, de 20 y más años de edad, que presentaron oclusión traumática en dientes permanentes y que mostraron alguna afección en tejido pulpar de origen no infeccioso, de acuerdo con la clasificación de la Academia Americana de Endodoncia. También se incluyó a los pacientes que presentaban caries, fracturas, fisuras, obturaciones, endodoncia, ortodoncia o trauma dentoalveolar. Se empleó un muestreo No probabilístico, por conveniencia. Se obtuvo el consentimiento informado y voluntario, historia médica y dental, y se realizó la evaluación de los signos y síntomas de dolor, pruebas pulpares (térmicas y eléctricas), palpación y percusión y abordaje diagnóstico con tinción/transiluminación, así como pruebas oclusales con papel de articular y examinación e interpretación de radiografías periapicales. Se utilizó estadística descriptiva. Resultado: hubo ausencia de dolor en 53 por ciento de los 156 órganos dentarios estudiados. Las alteraciones radiográficas se presentaron en 63 por ciento: entre ellas los nódulos pulpares tuvieron el mayor porcentaje (25 por ciento). La pulpitis fue reversible en 37 por ciento (n= 58); la oclusión traumática más frecuente fue la maloclusión (n= 49). En los 156 órganos dentarios estudiados, el signo clínico que mostró mayor frecuencia fue el desgaste en esmalte (n= 56). Conclusiones: las afecciones pulpares de origen no infeccioso se presentaron en alto porcentaje de dientes permanentes de pacientes con oclusión traumática(AU)
Introduction: Occlusal trauma is defined as an alteration in the occlusal relationships of the masticatory system, which may lead to inflammation of the periodontal ligament, the dental pulp and sensitive soft tissues. Objective: Iidentify non-infectious pulpal disorders in dental organs with occlusal trauma of patients from a public hospital in Mérida, Yucatán. Methods: An observational analytical study was conducted at a public hospital in Mérida, Yucatán, Mexico (2014). The study universe was 156 dental organs of 82 patients aged 20 years and over with occlusal trauma in permanent teeth and some degree of non-infectious pulp tissue disorder, based on the classification of the American Academy of Endodontics. Patients were also included who presented caries, fractures, fissures, fillings, endodontic treatment, orthodontic treatment or dentoalveolar trauma. Convenience non-probability sampling was applied. Voluntary informed consent was obtained. Medical and dental records were examined. An evaluation was carried out of pain signs and symptoms. Thermal and electric pulp tests were performed, as well as palpation, percussion and diagnostic staining/transillumination. Occlusal testing was conducted using articulating paper. Periapical radiographs were examined and interpreted. Descriptive statistics were used. Result: There was no pain in 53 percent of the dental organs studied. Radiographic alterations were present in 63 percent; the most common were pulp nodes (25 percent). Pulpitis was reversible in 37 percent (n= 58), and the most frequent occlusal trauma was malocclusion (n= 49). In the 156 teeth studied, the most common clinical sign was enamel wear (n= 56). Conclusions: Non-infectious pulpal disorders were present in a large number of permanent teeth of patients with occlusal trauma(AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Oclusão Dentária Traumática/diagnóstico , Má Oclusão , Doenças Periapicais/diagnóstico , Pulpite , México , Modelos Teóricos , Estudo ObservacionalRESUMO
Objetivo Evaluar la prevalencia de enfermedades pulpares y periapicales como factores de riesgo de la uveítis secundaria de pacientes del ISSSTE, Mérida, Yucatán, 2013. Introducción Las enfermedades pulpares y periapicales pueden producir una reacción inflamatoria que afecta el órgano de la visión. Material y métodos Estudio descriptivo, transversal y observacional. Se efectuó: consentimiento informado, cédula de investigación con: datos demográficos, resultados del examen clínico intraoral de 12 pacientes con diagnóstico a priori de uveítis secundaria confirmado por un oftalmólogo, con presencia de enfermedad pulpar o periapical acompañada con la historia de dolor (duración, frecuencia, tipo y calidad), exámenes pulpares (palpación, percusión, térmicos y de vitalidad). Se tomaron radiografías periapicales y panorámicas. Se realizó estadística descriptiva y se utilizó la prueba chi cuadrado (χ2) de bondad de ajuste para dos categorías con la corrección de Yates. Resultados De 34 pacientes diagnosticados con diferentes tipos de uveítis, el 35.29% fue establecido como uveítis secundaria. El 33.33% de los pacientes con ésta estuvieron entre los 48-57 años de edad. Se estudiaron 19 órganos dentarios de los 12 pacientes, el 26.32% presentó enfermedad pulpar, y 73.68% periapical. Conclusión Las enfermedades que involucran a la pulpa dental y periápice, pueden producir reacción inflamatoria en el ojo.
Aim Assessment of periapical and pulp disease prevalence as a risk factor for secondary uveitis in patients attending ISSSTE (Social Security Institute for Government Workers) in 2013 in the city of Merida, Yucatan, Mexico. Introduction Periapical and pulp diseases can elicit inflammatory reactions which might affect vision. Material and methods The present study was of a descriptive, cross-sectioned and observational nature. Patients' Informed consent was secured. System identification card included demographic data, intraoral clinical examination results of 12 patients with an a priori diagnosis of secondary uveitis confirmed by a dentist, with presence of pulp or periapical disease along with history of pain (duration, frequency, type and quality), pulp examinations (palpation, percussion, thermal and vitality tests). Panoramic and periapical X-rays were taken, descriptive statistics were conducted as well as chi-square (χ 2) test of goodness of fit for two categories with Yates correction. Results Out of the 34 patients diagnosed with different types of uveitis, 35.29% was established as secondary uveitis. Of the aforementioned patients, 33.33% were in the 48-57 years age range. The examination encompassed 19 teeth of the 12 patients; out of these, 26.32% exhibited pulp disease and 73.68 periapical disease. Conclusion Diseases involving dental periapex and pulp may cause inflammatory reaction in the eyes.
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AIM: To present a case report of a metastasis from cervical cancer to the maxilla, which was misdiagnosed as periapical disease and to caution clinicians that metastases could have a disguised clinical presentation that must be taken into account in the differential diagnosis of periapical disease in oncologic patients. SUMMARY: Although metastatic tumours of the jaws are uncommon, they may mimic benign inflammatory processes and reactive lesions. The ability of metastatic lesions to mimic periapical disease is discussed and a brief review of the literature is presented, emphasizing the importance of correct diagnosis to prevent delay in diagnosing cancer. Attention should therefore be given to the patient's medical history, especially of those with a previous history of cancer, and all dental practitioners should be aware of the possibility of metastases that may be confused with periapical disease. Finally, endodontists are well placed to recognize malignant and metastatic oral lesions during the initial clinical stages, given that their treatments are usually based on frequent dental appointments and long-term follow-ups.
Assuntos
Carcinoma de Células Escamosas/secundário , Carcinoma de Células Escamosas/terapia , Neoplasias Maxilares/secundário , Neoplasias Maxilares/terapia , Neoplasias do Colo do Útero/patologia , Adulto , Diagnóstico Diferencial , Erros de Diagnóstico , Feminino , Humanos , Doenças Periapicais/diagnósticoRESUMO
Entre as consequências da forma de ação do MTA e seus produtos encontra-se a participação na indução da mineralização nos tecidos onde é aplicado e a redução da inflamação ali presente. Sendo a hipertensão arterial uma desordem crônica de cunho inflamatório que parece agir negativamente na mobilização do cálcio e nas estruturas ósseas do organismo, pode-se inferir que o desenvolvimento da lesão periapical e o seu tratamento por meio do uso do MTA podem ser alterados pela presença do estado hipertensivo. Dessa forma, o objetivo do presente trabalho foi de estudar a influência da hipertensão arterial no padrão fenotípico da lesão periapical, na diferenciação dos osteoclastos, na resposta inflamatória tecidual e na capacidade de mineralização dos cimentos reparadores à base de MTA. Para isso o trabalho foi dividido em três artigos. O artigo 1 comparou aspectos potenciais da formação da lesão periapical nas condições de hipertensão e normotensão, tendo como hipóteses nulas que a hipertensão não altera a quantidade de osteoclastos diferenciados, o tamanho da lesão periapical e a expressão das citocinas inflamatórias IL1α, IL1β e TNFα da lesão periapical. Esse artigo teve como resposta que, apesar de não haver diferenças estatisticamente significantes entre o tamanho da lesão periapical e a expressão de citocinas inflamatórias, ratos hipertensos apresentaram um elevado número de osteoclastos diferenciados. Já o artigo 2 investigou se a hipertensão afeta a resposta tecidual do MTA branco e cinza implantados subcutaneamente em ratos, bem como a capacidade dessas substâncias para induzir a mineralização, sendo a hipótese nula testada que a hipertensão não altera a resposta tecidual e capacidade de mineralização do MTA. Por meio dos resultados para as análises histológicas com as colorações Hematoxilina e Eosina e Von Kossa e sob luz polarizada, observou-se que a hipertensão exacerba a resposta inflamatória e diminui a capacidade de mineralização, prejudicando, dessa...
Among MTA and its products consequences, it is found the participation in mineralization induction in tissue where it is applied and reduction of inflammation maybe present. High blood pressure is a chronic inflammatory disorder that seems acting negatively on calcium mobilization and bone structures of the body. So it can be inferred that periapical lesion development and its treatment using MTA can be altered by the presence of a hypertensive state. Thus, the objective of this research was to study the influence of hypertension in periapical lesion phenotypic, in osteoclast differentiation, in tissue inflammatory response and mineralization ability of MTA repair cements. For this, work was divided into three articles. Article 1 compared potentials aspects of periapical lesion formation in hypertensive and normotensive conditions. Null hypothesis was high blood pressure does not change the number of differentiated osteoclasts, periapical lesion size and expression of IL1α, IL1β and TNFα inflammatory cytokines in apical periodontitis. Among results, although there was no statistically significant difference between periapical lesion size and inflammatory cytokines expression, hypertensive mice showed a large number of differentiated osteoclasts. Article 2 investigated whether hypertension affect tissue response and mineralization ability of white and grey MTA implanted subcutaneously in rats. Null hypotheses were that high blood pressure did not alter tissue response and mineralization capacity against MTA. Through histological analyzes with Hematoxylin and Eosin and Von Kossa stains and under Polarized Light was observed hypertension exacerbates inflammatory response and decrease mineralization capacity, damaging both tissue repair and mineralization. In turn, article 3 investigated whether hypertension affects white and gray MTA mineralization response when they were implanted subcutaneously in rats through osteoblast biomarkers RUNX-2, OPN and OCN. Null...
Assuntos
Animais , Ratos , Hipertensão , Inflamação , Osteoclastos , Doenças PeriapicaisRESUMO
Entre as consequências da forma de ação do MTA e seus produtos encontra-se a participação na indução da mineralização nos tecidos onde é aplicado e a redução da inflamação ali presente. Sendo a hipertensão arterial uma desordem crônica de cunho inflamatório que parece agir negativamente na mobilização do cálcio e nas estruturas ósseas do organismo, pode-se inferir que o desenvolvimento da lesão periapical e o seu tratamento por meio do uso do MTA podem ser alterados pela presença do estado hipertensivo. Dessa forma, o objetivo do presente trabalho foi de estudar a influência da hipertensão arterial no padrão fenotípico da lesão periapical, na diferenciação dos osteoclastos, na resposta inflamatória tecidual e na capacidade de mineralização dos cimentos reparadores à base de MTA. Para isso o trabalho foi dividido em três artigos. O artigo 1 comparou aspectos potenciais da formação da lesão periapical nas condições de hipertensão e normotensão, tendo como hipóteses nulas que a hipertensão não altera a quantidade de osteoclastos diferenciados, o tamanho da lesão periapical e a expressão das citocinas inflamatórias IL1α, IL1β e TNFα da lesão periapical. Esse artigo teve como resposta que, apesar de não haver diferenças estatisticamente significantes entre o tamanho da lesão periapical e a expressão de citocinas inflamatórias, ratos hipertensos apresentaram um elevado número de osteoclastos diferenciados. Já o artigo 2 investigou se a hipertensão afeta a resposta tecidual do MTA branco e cinza implantados subcutaneamente em ratos, bem como a capacidade dessas substâncias para induzir a mineralização, sendo a hipótese nula testada que a hipertensão não altera a resposta tecidual e capacidade de mineralização do MTA. Por meio dos resultados para as análises histológicas com as colorações Hematoxilina e Eosina e Von Kossa e sob luz polarizada, observou-se que a hipertensão exacerba a resposta inflamatória e diminui a capacidade de mineralização, prejudicando, dessa...
Among MTA and its products consequences, it is found the participation in mineralization induction in tissue where it is applied and reduction of inflammation maybe present. High blood pressure is a chronic inflammatory disorder that seems acting negatively on calcium mobilization and bone structures of the body. So it can be inferred that periapical lesion development and its treatment using MTA can be altered by the presence of a hypertensive state. Thus, the objective of this research was to study the influence of hypertension in periapical lesion phenotypic, in osteoclast differentiation, in tissue inflammatory response and mineralization ability of MTA repair cements. For this, work was divided into three articles. Article 1 compared potentials aspects of periapical lesion formation in hypertensive and normotensive conditions. Null hypothesis was high blood pressure does not change the number of differentiated osteoclasts, periapical lesion size and expression of IL1α, IL1β and TNFα inflammatory cytokines in apical periodontitis. Among results, although there was no statistically significant difference between periapical lesion size and inflammatory cytokines expression, hypertensive mice showed a large number of differentiated osteoclasts. Article 2 investigated whether hypertension affect tissue response and mineralization ability of white and grey MTA implanted subcutaneously in rats. Null hypotheses were that high blood pressure did not alter tissue response and mineralization capacity against MTA. Through histological analyzes with Hematoxylin and Eosin and Von Kossa stains and under Polarized Light was observed hypertension exacerbates inflammatory response and decrease mineralization capacity, damaging both tissue repair and mineralization. In turn, article 3 investigated whether hypertension affects white and gray MTA mineralization response when they were implanted subcutaneously in rats through osteoblast biomarkers RUNX-2, OPN and OCN. Null...