Celso Neiva Campos

Autotransplantation of a Mandibular Third Molar: A Case Report with 5 Years of Follow-up

This paper describes the autologous transplantation of a mandibular right third molar to replace the residual roots of the second molar in the same quadrant, preserving function and aesthetics. A 5-year clinical and radiographic follow-up was undertaken. After transplantation, the donor tooth received endodontic treatment and placement of calcium hydroxide, which was periodically replaced every 3 months until the filling of the root canals, totalizing a period of 1-year, when apical closure was confirmed. The tooth was in perfect functional and aesthetic conditions 5 years after beginning of treatment. Autotransplantation is a feasible option for replacing missing teeth when a donor tooth is available. The autotransplantation of a right mandibular third molar with compromised function and aesthetics to replace the residual roots resulting from coronal destruction due to extensive carious lesion of the second molar in the same quadrant was a viable treatment alternative.

Revascularization of an Immature Tooth with Apical Periodontitis UsingCalcium Hydroxide: A 3-year Follow-up

Root canal treatment of teeth presenting immature development is a great challenge for both the patient and the professional. The thinness of the root canal walls of immature teeth may lead to root fracture and thus the outcomes of such treatments are uncertain. Revascularization is based on root canal decontamination followed by the induction of blood migration from the periapical tissues and the development of new vascular tissue in the canal space. The principle of disinfection in regenerative endodontics is that it should be achieved with minimum root canal instrumentation; an intracanal medication is used to inhibit bacterial growth and appropriate sealing of the coronal portion is performed. The American Association of Endodontists (AAE) considerations for regenerative endodontics include calcium hydroxide as an alternative intracanal dressing. This material has also been claimed to diminish the possibility of dental staining during revascularization procedures. The relatively new treatment protocol has been widely reported in the last few years; however it should be performed only when other alternatives are not reasonable. This case report presents a 3-year follow-up of a case of revascularization of a maxillary central incisor using calcium hydroxide as a root canal disinfection dressing.

Correlation between Endodontic Infection and Periodontal Disease and Their Association with Chronic Sinusitis: A Clinical-tomographic Study

Introduction The proximity of the roots of maxillary posterior teeth to the maxillary sinus floor can be associated with the development of chronic maxillary sinusitis (CMS). Therefore, this study evaluated the correlation between the presence of endodontic infection and periodontal disease in maxillary posterior teeth and the presence of CMS. Methods A total of 83 patients (159 maxillary sinuses) were selected and underwent clinical dental examination to assess tooth mobility and pulp condition. In addition, cone‐beam computed tomography was performed to evaluate the presence of periapical lesion and periodontal bone loss, and measure the distance from the root apex to the cortical of the maxillary sinus. The maxillary sinuses were divided into 2 groups: CMS and no maxillary sinusitis. Data were analyzed using χ2 test and binary logistic regression analysis (P < .05). Results Periodontal disease was positively associated with CMS, leading to a 3.45‐fold higher association between these disorders (P < .05). CMS was significantly more common in patients with periodontal disease or endodontic infection in close proximity with the maxillary sinus. Periodontal disease or endodontic infection that was more distant from the maxillary sinus was more common in patients with no maxillary sinusitis (P < .05). To the extent that the tooth is more distant from the maxillary sinus floor, the chance of presenting CMS is reduced up to 2.5‐fold (P < .05). Conclusion Periodontal disease and proximity to the maxillary sinus are more common in cases of CMS, requiring a dental assessment and cone‐beam computed tomography evaluation in patients with CMS with ineffective treatment.

Evaluation of root canal morphology of maxillary premolars: a cone-beam computed tomography study

The aim of this study was to evaluate the root canal configuration of maxillary premolars using cone-beam computed tomography (CBCT). CBCT images of 999 maxillary premolars from a database were analysed to determine the frequency of the number of roots, root canals and Vertuccis classification. The associations among these variables were evaluated by Chi-square test (P < 0.05). In the first premolars, 42.2% of single-rooted teeth had a type II configuration, whereas 98.7% of 2-rooted teeth showed type IV. In the second premolars, type I was the most prevalent (49.9%). The presence of two roots was more prevalent in first premolars, and the presence of one root was more prevalent in second premolars (P < 0.05). Male patients had a higher percentage of two roots compared with female patients (P < 0.05). Type IV and I was more prevalent in first and second premolars respectively (P < 0.05). There was a high frequency of 2-rooted and single-rooted teeth among maxillary first and second premolars respectively.

Antimicrobial activity and biocompatibility of a calcium hydroxide - and aloe vera-based intracanal medication

Objective: to investigate the antimicrobial activity and biocompatibility of the calcium hydroxide [Ca(OH)2] + propylene glycol (PG) + aloe vera (AV) paste in comparison with other pastes used as intracanal medication. Material and Methods: there was evaluated 3 intracanal medication based on calcium hydroxide and propylene glycol, varying only the third component. In group 1, the third component was camphorated paramonochlorophenol (CPMC); in group II, chlorhexidine (CHX); and in group III, aloe vera. The antimicrobial activity was analyzed through the direct contact of the intracanal medication pastes with strains of Enterococcus faecalis; Kocuria rhizophila; Pseudomonas aeruginosa and Candida albicans. The biocompatibility was evaluated in subcutaneous tissue of rats during experimental 7, 21 and 63 days. Results: it was observed that the Group II showed the best results regarding antimicrobial activity, followed by group III and I. The Ca(OH)2 + PG + AV paste was considered biocompatible since it presented discrete fibrosis and suggestive histological characteristics of normal healing after 63 days, approaching the control group. Conclusion: the association of Ca (OH)2 + PG + AV showed antibacterial activity and adequate biocompatibility when compared with commonly pastes used as intracanal medication.

Diagnosis of Mesiodistal Vertical Root Fractures in Teeth with Metal Posts: Influence of Applying Filters in Cone-beam Computed Tomography Images at Different Resolutions

Introduction: The aim of this article was to evaluate the influence of applying filters in cone‐beam computed tomography (CBCT) images at different resolutions. These CBCT images were obtained for diagnosing mesiodistal vertical root fractures (VRFs) in teeth with metal posts. Methods: Forty teeth were treated endodontically, and 20 received metal posts. Ten teeth without posts and 10 teeth with posts were subjected to VRF in the mesiodistal direction. The sample was submitted to periapical radiographs and CBCT exams with a voxel of 0.25 and 0.30 mm. To reduce the influence of the metal artifact in the CT images, the teeth were evaluated with and without the application of filters (“Sharpen” and “Hard”). The images were evaluated by 2 radiologists who identified the presence of VRF. Accuracy values (receiver operating characteristic curves) for the different variables were compared by using analysis of variance and t test. Results: No difference was observed between images with and without filter application (P > .05). Images obtained with a 0.25‐mm voxel were more accurate (P < .05). The presence of the metal post reduced the accuracy of the diagnosis of VRF (P < .05), and the CBCT images showed superior results compared with periapical radiographs (P < .05). Conclusions: The presence of a metal post and the voxel size significantly interfere with the diagnosis of VRF. Despite the formation of metal artifacts associated with metallic cores, applying filters did not improve the diagnosis. For mesiodistal VRF, the CBCT images are superior to the periapical radiographs.

Evaluation of the dentin changes in teeth subjected to endodontic treatment and photodynamic therapy

Introducao A PDT antimicrobiana e um eficiente metodo coadjuvante na desinfeccao do sistema de canais radiculares, o que torna importante o estudo sobre a possibilidade de alteracoes morfologicas e permeabilidade provocadas pelo laser de diodo na estrutura dentinaria radicular. Objetivo A proposta deste estudo foi investigar as alteracoes morfologicas e percentual de infiltracao apical radicular apos o uso do laser diodo. Material e metodo Quarenta dentes monorradiculares foram instrumentados pelo sistema rotatorio Protaper e irrigados com NaOCl 5,25% e EDTA 17%. Depois, foram divididos aleatoriamente em: G1: nao receberam PDT (controle); G2: receberam pre-irradiacao com fotossensibilizador azul de toluidina e irradiacao com laser diodo de AsGaAl. Em seguida, 10 dentes de cada grupo foram analisados por MEV quanto as alteracoes morfologicas. Os outros 10 dentes foram obturados e corados por Rodamina B para avaliar o percentual de infiltracao apical. Resultado Os resultados mostraram diferenca significativa entre G1 e G2 (p 0,001). O percentual de infiltracao apical foi significativamente maior em G2 que em G1 (p<0,001 – t student). Conclusao Concluiu-se que a utilizacao do laser diodo promoveu a reducao de smear layer e abertura dos tubulos dentinarios, nao influenciando na ocorrencia de erosao, cracks e carbonizacao. O laser aumentou a permeabilidade da dentina apical.

The Use of an Alternative Extraoral Periapical Technique for Patients with Severe Gag Reflex.

Gag reflex is a physiologic mechanism that promotes contraction of the muscles of the tongue and pharyngeal walls. Different factors, including intraoral radiographic films and sensors, may trigger this reflex. Patients with severe gag reflex may not be able to tolerate the presence of intraoral radiographic films or sensors during root canal therapy (RCT). This factor may prevent an appropriate intraoral radiograph, which is important in RCT. Different approaches have been used to facilitate dental procedures in patients suffering from severe gag reflex. The use of an extraoral radiographic technique is an alternative method to obtain working length confirmation in patients with severe gag reflex. In this report of 2 cases, the use of an extraoral radiographic technique as an alternative approach during RCT in patients with severe gag reflex associated with phobic behavior and trismus was successfully demonstrated.