Evaldo Rodrigues

Maxillary first molar with 7 root canals diagnosed using cone-beam computed tomography

Root canal anatomy is complex, and the recognition of anatomic variations could be a challenge for clinicians. This case report describes the importance of cone beam computed tomographyic (CBCT) imaging during endodontic treatment. A 23 year old woman was referred by her general dental practitioner with the chief complaint of spontaneous pain in her right posterior maxilla. From the clinical and radiographic findings, a diagnosis of symptomatic irreversible pulpitis was made and endodontic treatment was suggested to the patient. The patient underwent CBCT examination, and CBCT scan slices revealed seven canals: three mesiobuccal (MB1, MB2, and MB3), two distobuccal (DB1 and DB2), and two palatal (P1 and P2). Canals were successfully treated with reciprocating files and filled using single-cone filling technique. Precise knowledge of root canal morphology and its variation is important during root canal treatment. CBCT examination is an excellent tool for identifying and managing these complex root canal systems.

Effectiveness of different formulations of Endo-PTC to promote root canal cleaning.

CONTEXT Endo-PTC are used during endodontic treatment; however, until now no study evaluated the cleaning of dentin walls after use of different Endo-PTC formulations. AIMS The aim of this study was to assess qualitatively, by means of scanning electron microscopy (SEM) images, the cleaning of dentin walls of root canals after chemomechanical preparation (CMP) using Endo-PTC cream and Endo-PTC light associated to 2.5% sodium hypochlorite and 17% ethylenediamine tetraacetate (EDTA). MATERIALS AND METHODS Forty single-rooted human maxillary central incisors with straight canals and fully formed apex were selected. The specimens were randomly divided into four groups depending on the type of Endo-PTC and the final rinse with 17% EDTA. After CMP, all specimens were sectioned and processed for observation of the apical thirds by using SEM. Three calibrated evaluators attributed scores to each specimen. STATISTICAL ANALYSIS USED The differences between irrigation protocols were analyzed with Kruskal-Wallis test followed by Bonferroni adjustment for multiple comparisons. The significance level was set at α = 0.05. RESULTS The use of Endo-PTC cream or Endo-PTC light did not influence the smear-layer (SL) removal (P > 0.05). When EDTA were used, it was obtained the best cleaning results with no significant difference between the substances (P < 0.05). CONCLUSIONS It can be concluded that EDTA is essential to promote SL removal which was not affected by the type of Endo-PTC formulation.

Single-session endodontic treatment of six teeth with extensive periapical lesion

This paper aims to report a single-session endodontic treatment of a periapical lesion, while highlighting the effectiveness and safety of the technique. The patient presented with no painful symptoms at the clinic to have his maxillary anterior teeth examined due to trauma suffered two years earlier. Radiographic examination revealed a lesion in the apical periodontium, extending from the region of tooth #13 to tooth #23. The teeth were isolated, and access surgery was performed in all crowns. Cleaning and shaping (6% NaOCl) were carried out with Gattes-Glidden drills with step-back instrumentation from #2 to #4. Catheterization was performed with manual files #25 up to the working length (6% NaOCl), and confirmed with foramen locator. Cleaning and shaping of all root canals were performed with the aid of ProTapers F4 and F5 instruments (Dentisply/Maillefer) (6% NaOCl). Passive ultrasonic irrigation was performed for 3 minutes in each tooth with continuous irrigation of 17% EDTA and Irrisonic ultrasonic insert (Helse). Final irrigation with 6% NaOCl and drying with paper points were performed. There was placement of methylene blue at 0.05% for 5 minutes on each tooth, followed by laser application (photodynamic therapy) for 80 seconds on each tooth. New irrigation with 6% NaOCl was carried out to remove the remaining methylene blue. Drying with paper points was performed for a second time, followed by filling with gutta-percha ProTapers F5 cones thermoplasticized with gutta-percha condenser #60 and AHPlus paste. In checking the conditions two years later, it was found that the procedure had been performed with integrity, thereby confirming the success of single-session endodontic treatment of infected root canals.