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INTRODUCTION: Pulp stones (PS) are calcifications commonly found in the pulp tissue that may be associated with systemic diseases. OBJECTIVE: To evaluate the association between PS and systemic diseases. METHODS: A case-control study with the inclusion of individuals from 18 to 65 years of age, of both sexes. Analysis was made of 1047 digital panoramic radiographs. The controls could not have any teeth with PS; the cases were the contrary. A questionnaire comprising demographic, habit, and general health (diabetes, problems with blood vessels, altered cholesterol level, heart attack, kidney or gallbladder stone, arthritis, or autoimmune disease, and for women, endometriosis, and ovarian cyst). Data were submitted to the Student's t-test to identify differences between groups about sex and age. The Chi-square test was applied to the cross-tabulation. The analyses were performed using SPSS®, version 25.0, with a 5% significance level. RESULTS: 490 patients participated (242 cases and 248 controls). There was no difference between groups for the sex (p=0.966) and age (p=0.186). Only "kidney stone" was associated with the case group (p=0.001), being almost three times higher when compared to the control group. No significant differences were found in females about the presence or absence of PS (p>0.05). CONCLUSÃO: In this research, it is suggested the existence of an association between kidney stones and the presence of pulp stones.
INTRODUÇÃO: Nódulos pulpares (NP) são calcificações comumente encontradas no tecido pulpar que podem estar associadas a doenças sistêmicas. OBJETIVO: Avaliar a associação entre NP e doenças sistêmicas. MÉTODOS: Estudo caso-controle com inclusão de indivíduos de 18 a 65 anos de idade, de ambos os sexos. Foram analisadas 1047 radiografias panorâmicas digitais. Os controles não poderiam ter dentes com NP; os casos foram o contrário. Foi aplicado um questionário aos participantes, contendo variáveis demográficas, de hábitos e de saúde geral (diabetes, problemas com vasos sanguíneos, nível de colesterol alterado, ataque cardíaco, cálculo renal ou biliar, artrite ou doença autoimune, e para as mulheres, endometrioses e cisto no ovário). Os dados foram submetidos ao teste t de Student para identificar diferenças entre os grupos em relação ao sexo e à idade. O teste Qui-quadrado foi aplicado para a tabulação cruzada. As análises foram realizadas no SPSS®, versão 25.0, com nível de significância de 5%. RESULTADOS: Participaram 490 pacientes (242 casos e 248 controles). Não houve diferença entre os grupos para sexo (p=0,966) e idade (p=0,186). Apenas "cálculo renal" associou-se ao grupo caso (p=0,001), sendo quase três vezes maior quando comparado ao grupo controle. Não foram encontradas diferenças significativas no sexo feminino em relação à presença ou ausência de PS (p>0,05). CONCLUSÃO: Nesta pesquisa, sugere-se a existência de uma associação entre cálculos renais e presença de Nódulos pulpares.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Calcificações da Polpa Dentária , Cistos Ovarianos , Artrite , Tabagismo , Veias , Consumo de Bebidas Alcoólicas , Cálculos Biliares , Cálculos Renais , Diabetes Mellitus , Endometriose , Hipercolesterolemia , Infarto do MiocárdioRESUMO
This study aimed to assess the association between genetic polymorphisms in BMP2 (rs1005464 and rs235768), BMP4 (rs17563), SMAD6 (rs2119261 and rs3934908) and RUNX2 (rs59983488 and rs1200425) and pulp stones (PS). A total of 117 participants, consisting of 63 individuals with PS and 54 without PS, were included. Digital radiographs and a demographic/clinical questionnaire were used. Genomic DNA from salivary cells was genotyped via real-time polymerase chain reaction. Statistical analyses, including Chi-Square, Fisher's exact tests, Poisson regression and dimensionality reduction, were conducted. The rs2119261 polymorphism in the SMAD6 gene showed an association with genotype distribution in the recessive model (p = 0.049). The T-T haplotype in the SMAD6 gene (rs2119261 and rs3934908) was more prevalent in the control group and significantly linked with PS (p = 0.029). No associations were found between PS risk and genetic polymorphisms in BMP2, BMP4 and RUNX2. Polymorphisms in the SMAD6 gene were associated with PS.
Assuntos
Proteína Morfogenética Óssea 2 , Proteína Morfogenética Óssea 4 , Subunidade alfa 1 de Fator de Ligação ao Core , Proteína Smad6 , Humanos , Proteína Smad6/genética , Proteína Morfogenética Óssea 4/genética , Subunidade alfa 1 de Fator de Ligação ao Core/genética , Masculino , Feminino , Proteína Morfogenética Óssea 2/genética , Adulto , Polimorfismo de Nucleotídeo Único , Genótipo , Polimorfismo Genético/genética , Adulto Jovem , Estudos de Casos e ControlesRESUMO
As calcificações pulpares provocam alterações morfológicas no interior dos canais radiculares que dificultam o tratamento endodôntico. Para solucionar essa dificuldade, a ferramenta Endoguide ou Endodontia Guiada foi desenvolvida para a resolução de casos complexos. Esta pesquisa objetivou descrever as aplicações da ferramenta Endoguide no tratamento de canais calcificados na endodontia. Todas as buscas foram realizadas por um único pesquisador na base de dados PubMed/MEDLINE e busca manual utilizando os descritores "Endodontics", "Digital", "Cone beam", "Guided". Foram considerados elegíveis os artigos publicados entre 2010 e 2022 e excluídos os estudos cuja publicação não foi obtida na íntegra e ainda aqueles em que os resultados não apresentaram embasamento teórico e prático suficientes para que pudessem ser incluídos no trabalho. Após as buscas, foram encontrados 47 artigos, selecionados inicialmente pelo título e resumos, excluindo as duplicatas. Ao final, a leitura completa e coleta de dados foi realizada em 6 artigos. As informações relevantes dos artigos selecionados foram transcritas em forma de quadro para sumarizar os achados. A endodontia guiada pode ser uma excelente alternativa para tratamentos de casos complexos, necessitando um investimento financeiro mínimo no consultório, pois os equipamentos de captura de imagem, planejamento virtual e de guias podem ser realizados em laboratórios capacitados. Assim, concluímos que o emprego da Endoguide como ferramenta no tratamento de canais calcificados se mostrou bem-sucedido e sua utilização não requer um conhecimento amplo, podendo ser usada por profissionais menos experientes.
Pulp calcifications cause morphological changes inside the root canals that make endodontic treatment difficult. To solve this difficulty, the tool Endoguide or Guided Endodontics was developed to solve complex cases. This research aimed to describe the applications of the Endoguide tool in the treatment of calcified root canals in endodontics. All searches were performed by a single researcher in the PubMed/MEDLINE database and manual search using the descriptors "Endodontics", "Digital", "Cone beam", "Guided". Articles published between 2010 and 2022 were considered eligible, and studies whose publication was not obtained in full text were excluded, as well as those in which the results did not have sufficient theoretical and practical basis for them to be included in the study. After the searches, 47 articles were found, initially selected by title and abstract, excluding duplicates. In the end, the complete reading and data collection was performed with 6 articles. Relevant information from the selected articles was transcribed for a table to summarize the findings. Guided endodontics can be an excellent alternative for treating complex cases, requiring minimal financial investment in the office, as image capture equipment, virtual planning and guides can be performed in trained laboratories. Thus, we conclude that the use of Endoguide as a tool in the treatment of calcified canals proved to be successful and its use does not require extensive knowledge and can be used by less experienced professionals.
Las calcificaciones pulpares provocan cambios morfológicos en el interior de los conductos radiculares que dificultan el tratamiento endodóntico. Para solventar esta dificultad se desarrolló la herramienta Endoguide o Endodoncia Guiada para resolver casos complejos. El objetivo de esta investigación fue describir las aplicaciones de la herramienta Endoguide en el tratamiento de conductos radiculares calcificados en endodoncia. Todas las búsquedas fueron realizadas por un único investigador en la base de datos PubMed/MEDLINE y búsqueda manual utilizando los descriptores "Endodontics", "Digital", "Cone beam", "Guided". Se consideraron elegibles los artículos publicados entre 2010 y 2022, y se excluyeron los estudios cuya publicación no se obtuvo a texto completo, así como aquellos en los que los resultados no tenían suficiente base teórica y práctica para ser incluidos en el estudio. Tras las búsquedas, se encontraron 47 artículos, seleccionados inicialmente por título y resumen, excluyendo los duplicados. Al final, se realizó la lectura completa y la recogida de datos con 6 artículos. La información relevante de los artículos seleccionados se transcribió para elaborar una tabla que resumiera los hallazgos. La endodoncia guiada puede ser una excelente alternativa para el tratamiento de casos complejos, requiriendo una mínima inversión financiera en el consultorio, ya que los equipos de captura de imágenes, la planificación virtual y las guías pueden realizarse en laboratorios capacitados. Así, concluimos que el uso de la Endoguía como herramienta en el tratamiento de conductos calcificados demostró ser exitoso y su uso no requiere de grandes conocimientos y puede ser utilizado por profesionales menos experimentados.
Assuntos
Tecnologia/instrumentação , Calcificações da Polpa Dentária , Endodontia , Tecnologia , Software/tendências , Equipamentos e Provisões , Tomografia Computadorizada de Feixe CônicoRESUMO
This study evaluated the drilling path (mm) and the dentin wear (mm3 ) of two instruments used during guided endodontic access. Twenty mandibular incisors with calcified canals were selected using cone-beam computed tomography (CBCT) and fixed in articulated models. Preoperative CBCT scans were performed in combination with intraoral scanning, and the images were reconstructed in the Blue Sky Bio software for access planning and printing the guides. The access cavity was drilled with 1.0-mm-diameter bur (DSP) and 0.8-mm-diameter bur (Munce). Postoperative CBCT was performed, and the images obtained preoperative and postoperative were superimposed for the analyses. Data were analysed by a t-test and linear regression (α = 0.05). No difference was found in the drilling path (p = 0.422). However, the Munce bur had higher dentin wear than the DSP bur (p = 0.011). A positive linear correlation (R2 = 0.859) was found between the factors.
Assuntos
Cárie Dentária , Endodontia , Humanos , Cavidade Pulpar/diagnóstico por imagem , Cavidade Pulpar/cirurgia , Tomografia Computadorizada de Feixe Cônico/métodos , Dentina/diagnóstico por imagemRESUMO
A calcificação do canal radicular é um processo que pode ocorrer posteriormente a um traumatismo dentário ou que pode se desenvolver lentamente em decorrência do envelhecimento dentário fisiológico. É caracterizada pela deposição de tecido duro tanto na câmara pulpar como no canal radicular. Essa condição pode ser diagnosticada através de radiografias periapicais e tomografia computadorizada. Em alguns casos, pode estar associada à necrose pulpar e presença de lesão periapical, e o tratamento pode ser considerado bastante complexo. Este relato de caso clínico aborda o tratamento endodôntico do elemento 21, sintomático, com obliteração do canal radicular e necrose pulpar como sequela de um traumatismo dentário. Após a realização de todos os exames, foi dado o diagnóstico de periodontite apical crônica, sendo proposto o tratamento endodôntico convencional. A maior dificuldade encontrada foi a localização da entrada do canal radicular. Inúmeras radiografias foram realizadas a fim de evitar desvios. Somente ao final do terço médio foi possível localizar a entrada do canal radicular e dar prosseguimento ao tratamento, utilizando a técnica coroa-ápice e medicação intracanal à base de hidróxido de cálcio durante as sessões. Foi possível realizar a obturação do canal radicular quando a paciente se mostrou assintomática. Obteve-se sucesso na realização da técnica, e, após a conclusão do caso, foi possível observar remissão dos sintomas. Após um período de acompanhamento de 6 meses e, posteriormente, de 3 anos, foi possível observar cicatrização dos tecidos periapicais
The calcification of the root canal is a process that may occur after a dental trauma or slowly develop due to physiological dental aging. It is characterized by hard tissue deposition on both the pulp chamber and the root canal. Periapical radiography and computed tomography can be used to diagnose this condition. In some cases, it may be associated with pulp necrosis and the presence of periapical injury, and the treatment may be considered to be quite complex. This case report addresses the endodontic treatment of the central incisor, symptomatic, with root canal obliteration and pulp necrosis as a sequela of dental trauma. After all the tests, chronic apical periodontitis was diagnosed, and conventional endodontic treatment was proposed. The most significant difficulty faced was when locating the root canal's entrance. Numerous radiographs were carried out to avoid deviations. The opening of the root canal could only be found at the end of the middle third, so treatment could proceed by using the crown- down technique and intracanal medication based on calcium hydroxide during the sessions. When the patient was asymptomatic, the root canal has been filled. The accomplishment of the technique was successful, and after finishing the case, there was remission of symptoms. After a six-month follow-up period and three years, the healing of the periapical tissues was observed.
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Root canal treatment and non-vital bleaching of teeth with pulp canal obliteration may represent a complex challenge to the clinician. This report describes the usefulness of the computer-assisted dynamic navigation system for the root canal treatment of two cases of teeth with a history of traumatic injury, extensively obliterated root canals and crown discoloration. Clinical and cone-beam computed tomographic evaluations were completed prior to procedures and 12 months after treatment. Both cases were treated using a computer-assisted dynamic navigation system coupled to a high-speed handpiece in order to establish the location and orientation of the partially obliterated canal and endodontic access route planning. The system allowed an accurate localisation of the root canal with a conservative access cavity. At the 12-month recall examination, the patients continue to be symptom-free, with a normal appearance of the mucogingival complex, adequate restoration of the tooth colour and intact periapical structures.
Assuntos
Cavidade Pulpar , Dente , Computadores , Tomografia Computadorizada de Feixe Cônico/métodos , Cavidade Pulpar/diagnóstico por imagem , Humanos , Tratamento do Canal Radicular/métodosRESUMO
The aim of this study was to describe a new strategy, consisting of the use of cone-beam computed tomography (CBCT) in the planning and intraoperative stages of root canal treatment (RCT), associated with the use of radiopaque gutta-percha markers, as an auxiliary tool in the location of severely calcified root canals. Three cases involving anterior and posterior teeth with severe calcification of the root canal were submitted to initial periapical radiographic and CBCT evaluations for diagnosis and planning of the operative steps. In a first intervention, when the location of the canal orifice was not successful, radiopaque markers were inserted in the suggested position of canal orifice with the aid of magnification and the use of ultrasonic devices, in order to perform an intraoperative CBCT analysis that allowed dynamic navigation through the static position of markers. The association of intraoperative CBCT with radiopaque markers allowed the location of the canal orifice and the following RCT execution. The use of CBCT in two different moments of RCT allowed the diagnosis of three-dimensional anatomical variations of root canal. Add, when associated with the use of radiopaque gutta-percha markers, acted as an auxiliary tool in the location of the canal orifice of calcified canals. Therefore, the presented strategy provides the clinician the precision that cases with calcification require and give an important contribution to treatment predictability.
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Pulp canal obliteration (PCO) presents itself as a frequent pulp complication in traumatized primary teeth, characterized as a progressive deposition of hard tissue in the root canal. In this context, this study aimed to evaluate the association between PCO due to the occurrence of traumatic dental injuries (TDI) in deciduous teeth and specific factors. For this, a retrospective study was carried out through 210 medical records selected from the Dental Trauma Care Program from 2012 to 2019. After applying the eligibility criteria, 371 deciduous teeth were included. Statistical analysis was performed using chi-square and Fischer's exact test. The occurrence of PCO was observed in 4.9%. Associated factors such as age (P=0.63), sex (P=0.47) and search for care (P=0.87) did not influence the occurrence of PCO. Concerning the type of TDI and development of PCO, the injury of subluxation showed a statistically significant association (P=0.01). There was an association of PCO with other TDI complications such as crown discoloration (P<0.01) and acceleration of physiological root resorption (P=0.01). No statistically significant association was found regarding the development of sequelae in permanent successors and PCO (P>0.05). Based on this study, PCO was not a frequent complication of TDI in deciduous teeth in the population evaluated. PCO was associated with subluxation, crown discoloration, and acceleration of physiological root resorption. However, it did not show association with any related factor (age, sex, and seeking care) and the development of clinical or radio graphical sequelae in permanent successors.
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Resumen: El objetivo de este estudio fue evaluar la prevalencia y distribución de cálculos pulpares en un grupo de adultos peruanos mediante tomografía de haz cónico (CBCT). Materiales y métodos: Se analizaron 67 tomografías de haz cónico seleccionadas aleatoriamente de un centro tomográfico en Lima, Perú. Fueron evaluadas 1263 imágenes de piezas dentarias mediante el tomógrafo Point 3D Combi 500 S. El análisis de las imágenes se realizó con el software Real Scan y todas las piezas dentarias fueron evaluadas en las vistas sagital, axial y coronal. Todas las medidas fueron sometidas a prueba de chi cuadrado. (p<0.05). Resultados: De un total de 67 pacientes, un 83,58% presentaron calcificaciones y de 1263 piezas dentarias, un 30.8% a través de la CBCT. La prevalencia de calcificaciones fue mayor en el sexo femenino que masculino. Los molares maxilares y mandibulares fueron los grupos de dientes con mayor frecuencia de cálculos pulpares. Se encontró significancia entre los cálculos pulpares y el género, rango de edad, tipo y estado de pieza dentaria. Conclusiones: La primera molar maxilar tuvo mayor prevalencia de calcificaciones pulpares que la mandibular. La presencia de caries aumentó la posibilidad de aparición de estas calcificaciones, específicamente en maxilar. La CBCT podría ser una herramienta sensible para detectar cálculos pulpares. El conocimiento de la distribución de cálculos pulpares puede ayudar a los dentistas en el tratamiento clínico de endodoncia.
Abstract: The aim of this study was to evaluate the prevalence and distribution of pulp stones in a group of Peruvian adults using cone beam tomography (CBCT). Materials and methods: 60 randomly selected CBCT from a tomographic center in Lima, Peru were analyzed. A total of 1263 images of teeth using the Point 3D Combi 500 S tomograph were evaluated. Images analysis was performed with Real Scan software and all teeth were evaluated in sagittal, axial and coronal views. All measurements were subjected to a chi square test. (p<0.05). Results: Of the 1263 teeth, 30.8% presented pulp calcifications through the CBCT. The prevalence of calcifications was higher in women than in men. The maxillary and mandibular molars were the groups of teeth with the highest frequency of pulp stones. There was significance between the pulp stones and the gender, age range, type and state of the tooth. Conclusions: The maxillary first molars had a higher prevalence of pulp calcifications than the mandibular ones. The presence of caries increased the possibility of the appearance of these calcifications, specifically in the maxillary teeth. CBCT could be a sensitive tool to detect pulp stones. Knowledge of the distribution of pulp stones can help dentists in the clinical treatment of endodontics.
Assuntos
Humanos , Masculino , Feminino , Idoso , Calcificações da Polpa Dentária/diagnóstico , Tomografia Computadorizada de Feixe Cônico/instrumentação , PeruRESUMO
Guided endodontic access is a promising method to treat teeth with pulp calcification. This report aimed to describe a case of root canal treatment performed through guided endodontic access in a calcified anterior tooth with apical periodontitis. A 23-year-old female with a history of trauma 10 years ago in the anterior maxilla was referred to the dental office. Her chief complaint was discolouration of the left central incisor crown. The tooth was sensitive to percussion and responded negatively to pulp sensitivity tests. The periapical radiography showed pulp calcification and periapical radiolucency. Cone-beam computed tomography (CBCT) was obtained to allow a more detailed view of the pulp canal and the periapical area. An intraoral scan was performed and the standard tessellation language (STL) archive was combined with digital imaging and communications on medicine (DICOM) images from CBCT in the Implant Viewer software. Subsequently, a 3D model was designed and printed to guide the endodontic access in position and appropriate angulation for dental instrumentation. The mold was positioned on the patient's tooth and the root canal treatment was performed. After two years, complete healing of periapical tissues was observed. This method facilitates the drill targeting during access, reducing the risk of deviations and perforations.
RESUMO
Objetivo: El objetivo de este informe es presentar tres casos clínicos de piezas dentarias anterosuperiores calcificadas y con decoloración, resueltos según tres protocolos clínicos de blanqueamiento diferentes, con un mismo fin: devolver la estética al sector anterior. Casos clínicos: Cada una de las tres situaciones clínicas de decoloración dentaria se trató siguiendo un protocolo diferente. A partir del análisis clínico y radiográfico, se estableció un diagnóstico y un plan de tratamiento acorde. Todos los casos evolucionaron de manera favorable y siguen siendo controlados periódicamente. Conclusiones: En casos clínicos como los que se muestran en este trabajo, en los que el conducto y la cámara pulpar están calcificados u obliterados totalmente, sería posible realizar blanqueamiento interno y externo para recuperar la armonía óptica de forma conservadora. Este tipo de tratamientos permitiría responder a la alta prevalencia de demanda estética debido a traumatismos y cambios de coloración (AU)
Aim: To present three clinical cases of discoloration in calcified upper anterior teeth, that were resolved following different clinical protocols for teeth whitening to return the aesthetics of the anterior teeth. Clinical cases: Each clinical case of discoloration was treated following a different treatment protocol based on a correct clinical and radiographic diagnosis. All cases had a favourable outcome and have no regular review. Conclusion: In clinical cases as those presented in this article where the canal and pulp chamber are totally calcified or obliterated, it was possible to perform internal and or external whitening to restore optical harmony in a conservative way. This type of treatment would allow responding to the high prevalence of aesthetic demand due to trauma and colour changes (AU)
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Clareamento Dental , Calcificações da Polpa Dentária/terapia , Estética Dentária , Protocolos Clínicos , Peróxido de Carbamida , Peróxido de HidrogênioRESUMO
The aim of this study was to analyze the saliva of patients with pulp stones, with sialometric and sialochemical tests. Eighty individuals, aged between18 and 65 years, of both sexes, were investigated. Patients were included in the pulp stone group when radiographic examination was suggestive of pulp stones in at least one permanent tooth, whereas those without this alteration were considered controls. Saliva was collected by stimulation, followed by salivary flowrate (SFR) and pH analysis tests. The organic components, such as urea (URE), glucose (GLU), total proteins (TPTs), alkaline phosphatase, creatinine (CRE), salivary amylase (SAM), and uric acid (URA), and the inorganic components, such as calcium, iron, and phosphorus, were evaluated by colorimetric techniques in an ultraviolet-visible (UV-vis) spectrophotometer. Differences among pulp stones and control groups were compared using Student's t-test, with a significance level of p < 0.05. In both groups prevailed the female. Statistically significant differences between groups were observed for pH (p = 0.027), SFR (p = 0.002), alkaline phosphatase (p = 0.008), and URA (p = 0.005). None of the inorganic components showed significant difference (p > 0.05). In the analyses stratified by sex, difference between groups was observed for pH (p = 0.007) and URA (p = 0.003) in women. In conclusion, sialometric and sialochemical alterations occurred in patients with pulp stones, with significantly higher levels of pH, SFR, alkaline phosphatase, and URA.
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This study aimed to report a case series and describe the use of guided endodontics in complex symptomatic cases of mandibular and maxillary molars; presenting calcification of all three root canals. The arches of the referred patients were scanned, and high-resolution cone-beam computed tomography (CBCT) imaging was performed. Then, the taken CBCT and tooth scans were aligned and processed using software. A virtual copy of a drill was superimposed onto the scans and evaluated in 3 dimensions. Subsequently, a 3-dimensional (3D) template was designed and printed. Drilling was performed and a radiograph was taken to confirm its position. The canals were reached and endodontic treatment was performed. At the 12-month follow-up, the teeth were completely asymptomatic. The use of guided endodontics in cases of calcification in molars was demonstrated to be a viable and reliable alternative treatment. The technique was based on 3D planning.
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Introdução: a ciência endodôntica tem como objetivo a manutenção do elemento dentário em função no sistema estomatognático, por meio de procedimentos de sanificação, modelagem e obturação dos condutos radiculares. Porém, o sucesso do tratamento pode estar comprometido devido à presença de obliterações parciais ou totais da cavidade pulpar, que dificultam ou, até mesmo, impedem o procedimento. Recentemente, os avanços tecnológicos possibilitaram a transposição dessas barreiras com a confecção de um guia que permite o acesso retilíneo e direciona ao forame apical do canal obliterado. Métodos: o presente estudo descreve o uso do guia endodôntico em um paciente do sexo masculino, de 54 anos de idade, diagnosticado com necrose pulpar no elemento #14, com obliteração do conduto palatino. Resultados: o sucesso do tratamento pôde ser observado após seis meses de controle radiográfico e ausência de sintomatologia. Conclusões: o tratamento endodôntico de canais calcificados por meio da Endodontia guiada demonstrou ser uma abordagem clinicamente viável para localizar canais radiculares obliterados e prevenir acidentes e complicações nos dentes que não podem ser acessados de forma previsível por meio da terapia endodôntica tradicional (AU).
Introduction: Endodontic science aims to maintain the dental element in function in the stomatognathic system, through procedures of sanification, modeling and obturation of the root conduits. However, the success of the treatment may be compromised due to the presence of partial or total obliterations of the pulp cavity, which hinder and even impede the procedure. Recently, the technological advance made it possible to transpose these barriers with the creation of a guide that allows rectilinear access and directs to the apical foramen of the obliterated canal. Methods: The present study describes the use of the endodontic guide in a 54-year-old male patient, diagnosed with pulp necrosis in element 14, with obliteration of the palatine conduit. Results: The success of the treatment could be observed after six months of radiographic control and absence of symptomatology. Conclusions: Endodontic treatment of calcified canals through guided endodontics demonstrates a clinically viable approach to locate obliterated root canals and prevent accidents and complications in teeth that cannot be predictably accessed through traditional endodontic therapy (AU).
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Sistema Estomatognático , Necrose da Polpa Dentária , Ápice Dentário , Terapêutica , Cavidade Pulpar , EndodontiaRESUMO
Introdução: o tratamento endodôntico em dentes com canais calcificados é extremamente desafiador. Durante o procedimento de localização do canal residual, uma quantidade excessiva de dentina pode ser removida, o que pode implicar em maior risco de fratura do elemento dentário. Somado a isso, a calcificação pulpar é o motivo mais comum de perfuração radicular durante o tratamento endodôntico. Métodos: tendo em vista a importância do desenvolvimento de técnicas seguras e precisas para o tratamento endodôntico de canais parcial ou totalmente calcificados, serão apresentados dois relatos de casos clínicos conduzidos segundo uma estratégia terapêutica recentemente descrita na literatura endodôntica. Resultados: o Endoguide tornou mais segura e eficaz a realização do tratamento endodôntico nos dois casos relatados. Conclusão: o guia endodôntico auxiliou na localização do canal radicular calcificado e ajudou a evitar iatrogenias durante sua localização (AU).
Introduction: Endodontic treatment in teeth with calcified root canals is extremely challenging. During the procedure of locating the root canal, an excessive amount of residual dentin can be removed, which may lead to a greater risk of tooth fracture. In addition, pulp calcification is the most common reason for root perforation during endodontic treatment. Methods: Considering the importance of developing safe and efficient techniques for endodontic treatment of partially or completely calcified root canals, these two clinical cases were conducted in accordance with the therapeutic strategy recently described in the endodontic literature. Results: Endoguide made endodontic treatment safer and more effective in the two reported cases Conclusion: The endodontic guide used in the present cases have helped to locate the calcified root canal and to prevent iatrogenies during location (AU).
Assuntos
Humanos , Masculino , Feminino , Adulto , Calcificação de Dente , Calcificações da Polpa Dentária , Tomografia Computadorizada de Feixe Cônico , Diagnóstico por Imagem , Cavidade PulparRESUMO
Objective: To assess the prevalence of pulp stones using Cone Beam Computed Tomography (CBCT) in a Saudi Arabian adolescent population. Material and Methods: CBCT scans of 237 individuals compromising of 1018 teeth were examined. All teeth were analyzed in three dimensions and the presence of pulp stones were identified as a round or oval shaped dense structures in the pulp space. The location of involved tooth in terms of arch, side involved and the status of the tooth were documented. Statistical analysis was carried out by applying Chi-square test. The level of significance was set at 5%. Results: Pulp stones were observed in 119 out of the 237 participants, and in 118 teeth out of 1018 teeth examined, with the patient prevalence of 50.2% and tooth prevalence 10.6%. Pulp stones were observed in 76 (51.3%) of males and 43 (48.3%) of females, with no significant difference (p>0.05). A nonsignificant difference was also noted when maxillary and mandibular arches and the left and right sides were compared. Pulp stones were observed more frequently observed in molars and in carious (8.8%) and restored teeth (17.1%). Conclusion: The prevalence of pulp stones was high in molars and in carious and restored teeth. No significant difference was noticed between gender, arch and side of tooth involved with pulp stones.
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Arábia Saudita , Prevalência , Adolescente , Calcificações da Polpa Dentária , Tomografia Computadorizada de Feixe Cônico/instrumentação , Distribuição de Qui-QuadradoRESUMO
OBJECTIVES: The aim of this study was to evaluate the occurrence of pulp stones by cone-beam computed tomography (CBCT) and to correlate their prevalence with patient's gender, location of tooth (right or left of maxillary or mandibular arch), group of teeth, and restorations. MATERIALS AND METHODS: CBCT images of 382 patients randomly selected from the database of the University Oral Radiology Department were retrospectively examined. A total of 2833 tooth images obtained using the i-CAT 3D Imaging System were evaluated. Image analysis was performed with the i-CAT software, and all teeth were evaluated in sagittal, axial, and coronal views. All the measurements were subjected to chi square test, odds ratio, and Fisher's exact tests (p < 0.05). RESULTS: The prevalence of pulp stones was similar between patient's genders and tooth locations. Pulp stones were detected in 31.9% of patients and 9.5% of teeth. Maxillary and mandibular molars were the groups of teeth with the highest frequency of pulp stones. The presence of restorations increased the chance of occurrence of pulp stones by 2.1 times in all teeth examined (p < 0.0001) and by 4.7 times in maxillary teeth (p < 0.0001). CONCLUSIONS: Pulp stones had a high prevalence with molar teeth showing the highest prevalence. The presence of restorations increased the chance of occurrence of these calcifications, specifically in maxillary teeth. CLINICAL RELEVANCE: CBCT provides accurate anatomical details in three dimensions, offering the possibility to view an individual tooth in axial, sagittal, and coronal views. This study performed an investigation of the occurrence of pulp stones by CBCT.
Assuntos
Tomografia Computadorizada de Feixe Cônico/métodos , Calcificações da Polpa Dentária/diagnóstico por imagem , Adulto , Idoso , Calcificações da Polpa Dentária/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Interpretação de Imagem Radiográfica Assistida por Computador , Estudos Retrospectivos , Fatores de RiscoRESUMO
Tooth avulsion represents the most complicated dental injury, and the classic treatment is tooth replantation. The most common sequelae are pulp canal calcification (PCC) and pulp necrosis. The presence of pulp necrosis after PCC is reported in up to 30% of the cases and is a challenge due to the difficulty of endodontic treatment. This case report describes the surgical treatment of a replanted tooth presenting PCC and periapical pathology eight years after the trauma. An endodontic surgery was performed to remove the apical granuloma, to prepare the apical root, and to seal the apical region with an endodontic cement. In a three-year follow-up, there was an absence of inflammatory signs and symptoms or apical lesion. This report shows the importance of close follow-up after dentoalveolar injuries. After the initial dental trauma and its consequences to pulpal tissues, the executed procedures allowed a favourable outcome.
RESUMO
FUNDAMENTO: las fuerzas ortodóncicas excesivas pueden producir distrofias pulpares al modificar el sistema neuro-vascular de la pulpa. La necrosis de este tejido es la causa más conocida de alteración de color de los dientes. El tratamiento endodóntico y el blanqueamiento convencionales en estos casos se ven comprometidos cuando se desarrolla, además, una degeneración cálcica pulpar. OBJETIVO: mostrar una alternativa terapéutica a la discromía por necrosis pulpar de un diente con calcificación total de la pulpa. Caso clinico: se presenta una paciente de 18 años de edad con calcificación total de la pulpa posterior a un tratamiento ortodóncico y discromía en tercio cervical de corona del incisivo central superior derecho. CONCLUSIONS: se realizó tratamiento restaurador con carilla vestibular de composite fotocurable, logrando resultados estéticos satisfactorios.
BACKGROUND: excessive orthodontic forces may cause pulp dystrophies since they modify the pulp neuro vascular system. Necrosis of this pulp tissue is the most known cause of teeth color changes. Conventional endodontic treatment and bleaching are compromised in these cases whenever pulp calcification is developed. OBJECTIVE: to show an alternative therapy for dental discoloration due to pulpal necrosis in a tooth with pulp calcification. CLINICAL CASE: a eighteen year-old female is reported with pulp calcification following an orthodontic treatment and tooth discoloration in cervical third of a maxillary central right incisor. CONCLUSIONS: a restorative treatment with visible light cure composite veneer was performed, achieving satisfactory aesthetic results.
Assuntos
Humanos , Feminino , Aparelhos Ortodônticos/efeitos adversos , Descoloração de Dente/terapia , Calcificações da Polpa Dentária/terapiaRESUMO
Due to its anatomical positioning, the central upper incisors are the most affected teeth when related to trauma injuries in the craniofacial region, among with nose traumas. In childhood, traumatic injury is most often caused by bicycle accidents, sports, recreational activities or falls. The aim of this report is to describe a treatment for intrusion of the left maxillary central incisor and the subsequent complications in an 8-year-old boy. Also, the report emphasizes the importance of careful long-term follow-up monitoring intruded permanent teeth. Pulp tissue, as other tissues in the human body, tends to change with traumas. Some of those changes are natural while others occur as result of injuries to the dentin-pulp complex such as caries lesions, periodontal disease, calcifications, as in the present report, or restorative dental procedures. Normally conducted endodontic treatment must take place to obtain maximal results, but only after the re-stabilization of the tooth.
Debido a su localización anatómica, los incisivos centrales superiores son los dientes más afectados cuando se refieren a las lesiones traumáticas de la región craneofacial, entre los traumas nasales. En la infancia, lesión traumática suele ser ocasionado por accidentes de bicicleta, deportes, actividades recreativas o caídas. El objetivo de este artículo es describir un tratamiento para la intrusión del incisivo central superior izquierdo y las complicaciones posteriores en un niño de 8 años de edad. Asimismo, el informe hace hincapié en la importancia de cuidado a largo plazo con un seguimiento intrusión dientes permanentes. Tejido de la pulpa, como otros tejidos en el cuerpo humano, tiende a cambiar con traumas. Algunos de estos cambios son naturales, mientras que otros se producen como consecuencia de las lesiones del complejo dentina-pulpa, como las lesiones de caries, enfermedad periodontal, calcificaciones, como en el presente informe, restauración o intervención dental. Tratamiento endodóntico a cabo normalmente deben tener lugar para obtener los máximos resultados, pero sólo después de la re-estabilización del diente.