Flávia Sens Fagundes Tomazinho

The challenges of treating a fused tooth

This paper describes and discusses the multidisciplinary treatment involving a permanent maxillary lateral incisor fused to a supernumerary tooth, both presenting pulp necrosis and periapical lesion. A 15-year-old male patient sought treatment complaining of pain, swelling and mobility on the maxillary right lateral incisor. After clinical and radiographic examination, root canal preparation was performed according to the crown-down technique and a calcium hydroxide dressing was placed for 15 days. The patient returned and the definitive endodontic filling was done with thermomechanical compaction of gutta-percha and sealer. After 18 months, clinical and radiographic examinations were carried out and no pain or swelling was reported. Two years after endodontic treatment, the patient returned for periodontal and cosmetic treatments. Nine months later, a cone-beam computed tomography (CBCT) revealed that the previously detected periodontal defect and periapical lesion were persistent. Apical endodontic surgery was indicated. The supernumerary tooth was removed, the communicating distal surface was filled and the surgical site received bioactive glass and demineralized bovine organic bone. The pathological tissue was submitted to histopathological examination and the diagnosis was periapical cyst. One year after the apical endodontic surgery, CBCT showed bone formation at maxillary lateral incisor apical area. Two years after the surgery, the restoration was replaced due to aesthetic reasons and periapical radiograph showed success after 5 years of treatment. A correct diagnosis and establishment of an adequate treatment plan resulted in a successful management of the case.

Efficacy of Different Cone-beam Computed Tomographic Protocols in the Identification of Mesiobuccal Canals of Maxillary First Molars: A Tomographic and Ex Vivo Study

Introduction: Complementary methods of anatomic diagnosis, including cone‐beam computed tomographic (CBCT) imaging, may be useful in the diagnosis of mesiobuccal (MB) canals of maxillary molars. Methods: Thirty‐five maxillary first molars were subjected to ex vivo analysis and 4 CBCT protocols: i‐CAT Classic (Imaging Sciences International, Hatfield, PA) (ICC group), i‐CAT Next Generation (Imaging Sciences International) (ICN group), PreXion 3D (PreXion, San Mateo, CA) (16.8‐second acquisition time; PX1 group), and PreXion 3D (33.5‐second acquisition time; PX2 group). The images were evaluated by 2 calibrated endodontists who kept records following protocols previously published in the literature. Micro–computed tomographic imaging was used as the control. Results: The correct identification of anatomic variations of MB roots was 54.3% (n = 19) in the ICC group, 65.7% (n = 23) in the ICN group, and 80.0% (n = 28) in the PX1 and PX2 groups. The probability of agreement between the ICC and the control groups was significantly different from the probability of agreement with the PX1 (P < .05) and PX2 (P < .05) groups. The other groups showed no significant differences compared with the control group. There was no difference in the probability of agreement between the tomographic protocols and the ex vivo results. Conclusions: The PX1 and PX2 groups were more effective for the diagnosis of MB canals. PX1 is the most suitable because it results in a shorter radiation time and diagnostic imaging similar to PX2. The single‐canal anatomy was the most prevalent in the study. HIGHLIGHTSThe i‐CAT Classic protocol resulted in fewer diagnoses of mesiobuccal (MB) canals of maxillary molars.The PreXion 3‐dimensional protocols were more effective for the diagnosis of MB canals of maxillary molars.There was no difference in the probability of agreement between the tomographic protocols and the ex vivo result.Type I anatomy was the most prevalent in this study.

Influence of Prior Cervical Enlargement on Apical Cleaning Using Single File

The goal of this study was to compare the apical cleaning capabilities of single files from 3 different rotary systems in the presence or absence of prior cervical preparation based on a histological analysis. A total of 84 human single-rooted mandibular permanent incisors were divided into 6 groups (14 canals each). Cleaning and shaping was performed under the following protocols: Group I, F2 ProTaper at working length; Group II, SX ProTaper and F2 ProTaper; Group III, size 25, .06 taper Mtwo at working length; Group IV, SX ProTaper and size 25, .06 taper Mtwo; Group V, size 25, .06 taper BR3 BioRace at working length; and Group VI, SX ProTaper and size 25, .06 taper BR3 BioRace. After cleaning and shaping, the root canals were evaluated by histological analysis. The percentage of remaining debris was evaluated using a cross-hatched grid superimposed over each image. Data were assessed using the Shapiro-Wilk and ANOVA tests. Statistically significant differences were observed between groups (p =0.0001) with respect to amount of remaining debris; use of SX in conjunction with F2 ProTaper yielded a significantly lower mean percentage of debris. It was concluded that cleaning ability improves when root canal preparation with F2 ProTaper is complemented by prior cervical enlargement.

Root Preparation of Deciduous Teeth: Efficacy of WaveOne and ProTaper Systems with and without Passive Ultrasonic Irrigation

Introduction: The aim of this study was to compare root preparation of deciduous teeth with WaveOne Large (WO) and ProTaper F4 (PT) instruments with or without passive ultrasonic irrigation (PUI). Methods and Materials: Forty-eight deciduous teeth were scanned before and after root preparation and divided in four groups (n=12): WO+EDTA (WO); WO+EDTA with PUI (WOPUI); PTF+EDTA (PT); and PT+EDTA with PUI (PTPUI). Root canal enlargement by micro-computed tomography and root canal cleaning by scanning electron microscopy (SEM) were analyzed. Data were submitted to two-way ANOVA and Tukey’s tests to analyze the root canal volume variation, and Kruskal-Wallis followed by Friedman and Wilcoxon tests were used to evaluate the cleaning efficacy. The level of significance was set at 0.05. Results: No significant difference occurred in total volume between groups (P>0.05). On analysis by thirds of the root canal, there was a difference in volume between WO (cervical) compared to WO and PT (apical), and PTPUI (middle and apical) (P<0.05). When cleaning of the thirds within the same group was compared, there was a significant difference in all groups (P<0.05). Among the groups, in the thirds, in the cervical a difference occurred (P=0.028), and the pairwise comparisons indicated statistically difference between WO and PT, and WO and PTPUI (P<0.05). In the pairwise comparisons among thirds, in the groups, difrences occured in all of them when compared the cervical and apical thirds (P<0.05). Conclusion: Passive ultrasonic irrigation has not improved the smear layer removal in deciduous teeth. Despite the differences in performance between WO and PT instruments, both were suitable for preparation of deciduous teeth.

In vitro evaluation of gutta-percha dissolution ability of different solvents

Introduction: The removal of the filling material during the Endodontic retreatment is essential, so a better action of solvents on the gutta-percha is desired. Objective: To evaluate in vitro the gutta-percha dissolution ability of different solvents. Material and methods: Four solvents (xylol, eucalyptol, citrol, and orange oil) were applied on gutta-percha points, which had been later submitted to the weight loss analysis at 2, 5, and 10 minutes. For each solvent, 30 size #60 main cones were used, divided into three groups. Distilled water was used as control group. The statistical test applied was Kruskal-Wallis. Results: No statistically significant difference occurred among the solvents at 2 minutes (p > 0.05); however, during this period, citrol had the best performance. In longer time intervals, the xylol showed differences compared to eucalyptol at 5 minutes and to eucalyptol and citrol at 10 minutes (p < 0.05). The worst results were found for eucalyptol. Conclusion: This xylol was the solvent with improved ability to dissolve the gutta-percha points, with better results at longer time periods.

Thermoplastic endodontic obturation – TC system: case report

The TC system, developed in 2002, allows the endodontic filling by means of a non-conventional technique that uses gutta-percha at alpha phase,thermoplasticized in its own oven, placed into canal through a McSpadden compactor, without using a main cone. Objective: The aim of this case report was to show the TC system used for root canal filling. Case report: Three teeth of a patient was indicated for endodontic treatment, so TC system was used for the root filling. Conclusion: This technique showed to be effective for the root canal filling.