RESUMO

El objetivo de la terapia endodóntica consiste en tratar o prevenir la periodontitis apical. La efectiva eliminación o disminución de microbiota es esencial para la reparación periapical. Debido a esto, se utiliza el empleo de medicamentos intraconductos para tratar químicamente el sistema de conductos radiculares, y cobra relevancia la capacidad de penetración y difusión de dicho medicamento para entrar en contacto directo con los microorganismos que penetren dentro de los túbulos dentinales, conductos laterales e itsmos. Se realizó una revisión de la literatura en bases de datos electrónicas con los buscadores "Pubmed, Scielo y Google Académico", utilizando palabras clave para identificar la literatura publicada relevante en inglés. El análisis y los criterios de elegibilidad se documentaron de acuerdo con los elementos de informe para revisiones sistemáticas y meta-análisis (Preferred Reporting Items for Systematic Reviews and Meta-Analysis, PRISMA). No se impusieron restricciones sobre la fecha de publicación. Se recogieron datos sobre capacidad de difusión de medicación intraconductos en túbulos dentinales, conductos laterales e itsmos radiculares y se sometieron a análisis descriptivo de datos. La búsqueda bibliográfica en bases de datos electrónicas según los criterios de inclusión arrojó 45 títulos y resúmenes. Entre ellos, 7 artículos fueron seleccionados. Se determinó un rango de penetración del medicamento muy variable, entre 27,7 - 2350 μm y rango de difusión de 200-500 μm. Hay pocos estudios publicados que reporten la capacidad de penetración y difusión de la medicación intraconductos. El vehículo empleado y diámetro de las partículas en la preparación del medicamento y la eliminación de la capa de desecho aumentaría la capacidad de penetración/difusión del medicamento intraconductos dentro del túbulo dentinal, conductos laterales e itsmo.

The objective of endodontic therapy is to treat or prevent apical periodontitis. The effective elimination or reduction of the microbiota is essential for periapical repair. Due to this, the use of intracanal drugs is used to chemically treat the root canal system, and the penetration and diffusion capacity of said drug becomes relevant to come into direct contact with the microorganisms that penetrate inside the dentinal tubules, lateral canals and isthmus. A literature review was carried out in electronic databases with the search engines "Pubmed, Scielo and Google Academic", using keywords to identify the relevant published literature in English. The analysis and eligibility criteria were documented according to the reporting items for systematic reviews and meta-analyzes (Preferred Reporting Items for Systematic Reviews and Meta-Analysis, PRISMA). No restrictions were placed on the date of publication. Data on intracanal drug diffusion capacity in dentinal tubules, lateral canals and root isthmus were collected and subjected to descriptive data analysis. The bibliographic search in electronic databases according to the inclusion criteria yielded 45 titles and abstracts. Among them, 7 articles were selected. A highly variable drug penetration range was determined, between 27.7 - 2350 μm and a diffusion range of 200-500 μm. There are few published studies that report the penetration and diffusion capacity of intracanal medication. The vehicle used and the diameter of the particles in the preparation of the drug and the elimination of the waste layer would increase the penetration / diffusion capacity of the drug within the dentinal tubule, lateral canals and isthmus.

Assuntos

RESUMO

Introduction Benign Paroxysmal Positional Vertigo (BPPV) is the most common vestibular disorder, resulting from detached otoliths that migrate to one of the semicircular canals - canalolithiasis - or one of the cupulas - cupulolithiasis. The present study is related to lateral canal BPPVs, which may be either geotropic or apogeotropic. The geotropic variant of lateral semicircular canal benign paroxysmal positional vertigo (LC-BPPV) is attributed to free floating particles in the posterior arm of the lateral semicircular canal. Objectives To verify the possibility of employing the Zuma repositioning maneuver, with a brief modification, as an alternative treatment for geotropic LC-BPPV. Methods Seven patients with geotropic LC-BPPV were enrolled and treated with the Zuma modified maneuver. Patients were reevaluated 1 hour after a single maneuver, to confirm the resolution of vertigo and positional nystagmus. Results All seven patients achieved immediate resolution of vertigo and positional nystagmus as measured 1 hour after the application of the maneuver. Conclusion The Zuma modified maneuver was effective for geotropic LC-BPPV after a single application. The use of the Zuma maneuver for both apogeotropic and geotropic LC-BPPV may simplify the treatment of these patients.

RESUMO

Abstract Introduction Benign Paroxysmal Positional Vertigo (BPPV) is the most common vestibular disorder, resulting from detached otoliths that migrate to one of the semicircular canals - canalolithiasis - or one of the cupulas - cupulolithiasis. The present study is related to lateral canal BPPVs, which may be either geotropic or apogeotropic. The geotropic variant of lateral semicircular canal benign paroxysmal positional vertigo (LC-BPPV) is attributed to free floating particles in the posterior arm of the lateral semicircular canal. Objectives To verify the possibility of employing the Zuma repositioning maneuver, with a brief modification, as an alternative treatment for geotropic LC-BPPV. Methods Seven patients with geotropic LC-BPPV were enrolled and treated with the Zuma modified maneuver. Patients were reevaluated 1 hour after a single maneuver, to confirm the resolution of vertigo and positional nystagmus. Results All seven patients achieved immediate resolution of vertigo and positional nystagmus as measured 1 hour after the application of the maneuver. Conclusion The Zuma modified maneuver was effective for geotropic LC-BPPV after a single application. The use of the Zuma maneuver for both apogeotropic and geotropic LC-BPPV may simplify the treatment of these patients.

RESUMO

AIM: (i) To quantify biofilm removal from a simulated isthmus and a lateral canal in an artificial root canal system during syringe irrigation with NaOCl at different concentrations and delivered at various flow rates (ii) to examine whether biofilm removal is further improved by a final high-flow-rate rinse with an inert irrigant following irrigation with NaOCl. (iii) to simulate the irrigant flow in these areas using a computer model (iv) to examine whether the irrigant velocity calculated by the computer model is correlated to biofilm removal. METHODOLOGY: Ninety-six artificial root canals with either a simulated isthmus or lateral canal were used. A dual-species in vitro biofilm was formed in these areas using a Constant Depth Film Fermenter. NaOCl at various concentrations (2, 5 and 10%) or adhesion buffer (control) was delivered for 30 s by a syringe and an open-ended needle at 0.033, 0.083, or 0.166 mL s-1 or passively deposited in the main root canal (phase 1). All specimens were subsequently rinsed for 30 s with adhesion buffer at 0.166 mL s-1 (phase 2). The biofilm was scanned by Optical Coherence Tomography to determine the percentage of the remaining biofilm. Results were analysed by two 3-way mixed-design ANOVAs (α = 0.05). A Computational Fluid Dynamics model was used to simulate the irrigant flow inside the artificial root canal system. RESULTS: The flow rate during phase 1 and additional irrigation during phase 2 had a significant effect on the percentage of the remaining biofilm in the isthmus (P = 0.004 and P < 0.001). Additional irrigation during phase 2 also affected the remaining biofilm in the lateral canal significantly (P ≤ 0.007) but only when preceded by irrigation at medium or high flow rate during phase 1. The effect of NaOCl concentration was not significant (P > 0.05). Irrigant velocity in the isthmus and lateral canal increased with increasing flow rate and it was substantially correlated to biofilm removal from those areas. CONCLUSIONS: The irrigant flow rate affected biofilm removal in vitro more than NaOCl concentration. Irrigant velocity predicted by the computer model corresponded with the pattern of biofilm removal from the simulated isthmus and lateral canal.

Assuntos

RESUMO

Objetivo: Evaluar ex vivo el sellado obtenido a nivel deconductos laterales simulados en piezas dentarias con conductosradiculares amplios, obturadas con ProRoot MTA, DensellMTA y gutapercha más AHPlus con termocompactación.Materiales y métodos: Se seleccionaron 45 incisivoscentrales superiores humanos extraídos con ápices maduros.Se realizaron las aperturas coronarias y se instrumentaron losconductos radiculares hasta la longitud de trabajo con limastipo K (Dentsply/Maillefer) y luego con fresas Largo #1, #2y #3 (Dentsply/Maillefer). Durante la preparación, los conductosradiculares se irrigaron con agua destilada. Luego, en35 de los 45 dientes se talló un conducto lateral simulado enla cara mesial, a aproximadamente 3 mm del ápice anatómico,empleando un instrumento Engine Reamer #15 (Dentsply/Maillefer). Las raíces de los 35 dientes fueron recubiertaspor una lámina de gomaespuma y envueltas con una cintade teflón, a fin de simular el ligamento periodontal. En estascondiciones, se dividieron los 45 dientes en cuatro grupos de10 especímenes cada uno y un grupo control de 5 especímenes.Grupo control: conducto radicular no obturado. Grupo1: conducto radicular obturado con ProRoot MTA (Dentsply/Maillefer). Grupo 2: conducto radicular obturado con MTACemento Reparador (Densell). Grupo 3: conducto radicularobturado con AHPlus (Dentsply De Trey) y conos de gutaperchacon la técnica híbrida empleando un Guttacondensor#45 (Dentsply/Maillefer). Grupo 4: comprende los 10 especímenesen los que no se habían tallado los conductos lateralessimulados. Se obturaron los conductos radiculares conel mismo procedimiento que el grupo 3, y posteriormente setallaron los conductos laterales simulados...

Aim: Ex vivo evaluation of the sealing obtained at thelevel of simulated lateral canals in teeth with wide root canals,filled with ProRoot MTA, Densell MTA and AHPlus withthermo-compacted gutta-percha.Materials and methods: Forty-five extracted maxillaryhuman central incisors with mature apices were selected.The canals were instrumented at the working length with Kfiles (Dentsply/Maillefer) and then using Largo burs #1, #2,and #3 (Dentsply/Maillefer). During the preparation, the rootcanals were irrigated with distilled water. Later, in 35 of the45 teeth, a simulated lateral canal was drilled in the mesialsurface of each sample at approximately 3 mm coronally tothe anatomic apex using an Engine Reamer #15 (Dentsply/Maillefer). The surfaces of these 35 teeth were wrapped upwith a thin layer of foam and covered with teflon tape to simulatethe periodontal ligament. The 45 teeth were divided intofour groups of 10 specimens each, and a control group of 5specimens. Control group: unfilled root canal. Group 1: rootcanal filled with ProRoot MTA (Dentsply/Maillefer). Group2: root canal filled with MTA Cemento Reparador (Densell).Group 3: root canal filled with AHPlus (Dentsply) and thehybrid technique using gutta-percha and Guttacondensor#45 (Dentsply/Maillefer). Group 4: this group includes the10 specimens in which the simulated lateral canals were notdrilled. The root canals were filled with the same procedureas group 3 and then the simulated lateral canals were drilled...

Assuntos

RESUMO

AIM: To evaluate the ability of a calcium silicate-based sealer (iRoot SP) and an epoxy resin-based sealer (Topseal) using two gutta-percha filling techniques to fill artificial lateral canals (ALCs). METHODOLOGY: Seventy single-rooted human teeth were selected. Ten of these were used to obtain pilot data. Three ALCs were produced on mesial and distal surfaces of each root, one in each third, using size 10 engine reamers. The roots were randomly assigned to four experimental groups according to the filling technique and sealer used: 1, cold gutta-percha (single-point technique) with iRoot SP (SP-iR); 2, cold gutta-percha (single-point technique) with Topseal (SP-T); 3, continuous wave of condensation technique with iRoot SP (CWC-iR); and 4, continuous wave of condensation technique with Topseal (CWC-T). Digital periapical radiographs were taken. After the sealer had set, the roots were demineralized, cleared in methyl-salicylate and examined under a stereomicroscope. The depth of penetration of sealer and/or gutta-percha into the ALC was scored using a 5-point system, conducting an analysis on four surfaces. Filling scores of 0-1 were considered not acceptable, whilst scores of 2-4 were considered acceptable. Pearson's chi-square test was used to compare the experimental groups (P < 0.05). RESULTS: CWC-T was associated with the highest acceptable filling (57.8%), followed by CWC-iR (53.3%), SP-T (48.9%) and SP-iR (36.7%). Only when SP-iR was compared to the other groups, was the difference significant (P < 0.05). The apical third was associated with the lowest acceptable filling (37.5%). It was followed, in ascending order, by the middle (51.6%) and coronal thirds (58.3%). These differences were significant only when the apical thirds were compared to the other root thirds (P < 0.05). CONCLUSION: The calcium silicate-based sealer with continuous wave of condensation was more effective in artificial filling lateral canals than the single-point technique. The epoxy resin-based sealer with both filling techniques was effective in artificial filling lateral canals.

Assuntos

RESUMO

Muitas técnicas de obturação têm sido desenvolvidas, especificamente com o objetivo de aumentar a qualidade do selamento apical com a associação guta-percha/cimento obturador. O objetivo desta pesquisa foi avaliar, por mei do exame radiográfico, a qualidade do preenchimento de canais laterais de 60 dentes extraídos, utilizando cimento de Grossman conjuntamente com a aplicação de quatro diferentes técnicas obturadoras: McSpadden, híbrida de Tagger, Thermafil e condensação lateral. Os resultados foram obtidos com a análise das radiografias finais, em que se observou a superioridade do sistema Thermafil em relação às demais técnicas testadas para o preenchimento dos canais laterais

Many obturation techniques have been developed, specifically with the purpose of increasing the quality of the apical sealing with theassociation gutta-percha/sealer. The aim of this study was to evaluate,by means of radiographic exam, the sealing quality of 60 extracted teeth lateral canals, using Grossman sealing and four types of obturation techniques: McSpadden, Tagger hybrid technique, Thermafil andlateral condensation. The results were obtained with the analysis ofthe final radiographs, in which could be observed that Thermafil had superiority in relation to the other techniques when testing the sealing of lateral canals.

Assuntos