Josué Martos

Morphologic Analysis of the Root Apex in Human Teeth

INTRODUCTION To determine the morphologic shape and position of the root apex and the major foramen in maxillary and mandibular teeth. METHODS A total of 845 maxillary and mandibular human teeth root specimens were evaluated. Each root specimen was measured at each root apex by using a calibrated microscope at a magnification of 20x. The anatomic parameters evaluated included the position of the root apex and the major foramen (in the center, buccal, lingual, mesial, or distal) and shapes of peripheral contours of the major foramen (rounded, oval, asymmetric, and semilunar) and root apex (rounded, flat, beveled, and elliptical). All data were summarized, and means, frequencies, and percentages were calculated for each group of specimens (incisors, canines, premolars, and molars). RESULTS The most frequent root apex morphology in maxillary and mandibular teeth was the round shape (35.1%). The most frequent shape of the apical foramen was round (52.9%) or oval (25.2%). The major location of both the root apex (39.7%) and the major foramen (58.4%) was in the center of the root. CONCLUSION The most frequent root apex morphology and apical foramen in the maxillary and mandibular teeth was the round followed by the oval shape. The most prevalent location of the root apex and the major foramen was in the center followed by the distal position.

Dissolving efficacy of some organic solvents on gutta-percha

The aim of this study was to evaluate the solubility of gutta-percha in four organic solvents used in endodontics. The solubility of gutta-percha (Dentsply) was assessed in xylol, orange oil, eucalyptol, chloroform and distilled water. A hundred and fifty samples of gutta-percha were prepared using a standardized stainless steel mould and divided into five groups for immersion in the different solvents tested and in distilled water (control group) for 2, 5 and 10 minutes. The means of gutta-percha dissolution in the solvents were obtained by the difference between the pre-immersion original weight and the post-immersion weight in a digital analytical scale (Gehaka-AG2000). Data were statistically analyzed by Analysis of Variance (ANOVA) and multiple comparisons with Scheffes test (p<0.05). The best solvency capacity was obtained with xylol. Chloroform, orange oil and eucalyptol presented similar results, and distilled water did not promote alterations in the gutta-percha.

Early flaring and crown-down shaping influences the first file bind to the canal apical third.

The determination of the apical constriction, its diameter and correct cleaning are significant for the biological response in the critical apical zone. Kerekes and Tronstad evaluated morphometrically molars and reported a wide variation of constriction sizes. Additionally, the continuous cement deposition on the constriction throughout life alters its shape and size. There is a wide variation in the canal apical diameter in all tooth groups what hinders the decision making of how much to enlarge the canals. Frequently, the first file to bind does not reflect the apical canal diameter. Clinically, the estimative of the apical diameter is not precise even with the adjunct use of radiographs or electronic apex locators. Stabholz et al. demonstrated that early flaring is critical to tactile determination of the apical diameter. Without early flaring the apical diameter was determined in only 32.3% of the cases, while after this procedure the determination increased to 75%. Therefore, the tactile sensitivity determines more accurately the number of instruments required for the enlargement of the apical region. In spite of this, the tactile sensitivity does not determine whether the instrument is bound just at the constriction zone or if interferences along the root canal are negatively influencing the apical binding. Leeb and Philippas reported that the normal dentin deposition promotes the root canal constriction and narrows the cervical region in molars. Irregularities of the walls and/or curvatures of the root canal can exert a pressure against the file and interfere with the practitioner’s ability to determine whether the binding occurred at the apical region. The

In vivo comparison of the accuracy of two electronic apex locators.

The aim of this study was to analyse in vivo the accuracy of two apex locators, Root ZX and Novapex, to determine the position of the apical constriction. Twenty-three human single-rooted teeth to be extracted for periodontal reasons constituted the experiment. Endodontic access was obtained and the apical constriction was determined by one of the apex locators after initial crown-down preparation. When the electronic marker indicated that the tip of the endodontic file was at the apical constriction, the teeth were filled with composite and then surgically removed. The presence of the endodontic file tip at the apical constriction was evaluated stereomicroscopically (30×) and confirming radiographs were exposed. The accuracy of Root ZX and Novapex was 91.7% and 81.8% respectively. Within the limits of this study, the evaluated apex locators have a similar clinical performance for the apical constriction location.

Granuloma gravidarum (pyogenic granuloma) treated with periodontal plastic surgery.

outcome included stillbirth, early neonatal death, and morbidity such as neonatal admission and birth asphyxia. Adversematernal outcomeswere mortality and morbidity, such as prolonged hospital stay of more than 7 days, anemia requiring blood transfusion, sepsis, and hysterectomy. Statistical analysis was performed using SPSS software, version 15.0 (SPSS, Chicago, IL, USA). Odds ratios (OR) and 95% confidence intervals (CI)were used to analyze the risk of developing obstetric complications. The total number of obstetric admissions during the study period was 6714. Of these, 664 women were admitted in a moribund state and a total of 140 women were enrolled in the study. Eclampsia and hemorrhage were the leading complications, affecting 34.3% and 20% of women respectively; antepartum hemorrhage affected 15% and postpartum hemorrhage affected 5% of women. Severe anemia (17%) and sepsis (11.5%), including septic induced abortion and puerperal sepsis, were the other primary causes of referral.When the occurrence of adverse maternal and perinatal outcomes was compared with the educational status of the couple there was a direct relationship between the level of literacy and health outcome (Table 1). Women who reached hospital within 4 hours of recognizing a problemhad a greater chance of a good outcome (OR 1.49; 95%CI, –0.27 to 1.07). For women reaching the hospital within 8 hours the odds ratio was9.43 (95%CI, 0.71–3.77). All 7womenwho tookmore than 12 hours to reach hospital died following admission. Regarding perinatal outcome, if a woman reached hospital within 2 hours the odds ratio was 1.86 (95% CI, –0.22 to 1.45), within 4 hours the odds ratio was 2.47 (95% CI, 0.13–1.68), within 8 hours it was 1.23 (95% CI, –1.05 to 1.45), and within 12 hours the odds ratio was 4.24 (95% CI, –0.78 to 3.67). Failure to arrange money was cited as the most common reason for thedelay in reachinghospital for 71(50.7%)women followedbydifficulty in arranging transport for 62 (44.3%) women. Only 3 women had used an ambulance. Owing to financial difficulties or lack of availability of transport, 15 (10.7%)womenhad resorted to nonmotorized vehicles (e.g. rickshaw, cart). Women who had received some prenatal care had a better chance of a goodmaternal outcome (OR1.28; 95%CI, –0.54 to 1.03) and a good perinatal outcome (OR 3.38; 95% CI, 0.29–2.15). Increasing access to health facilities at community level and prenatal care are vital for the improvement of health services for women in lowincome countries [2]. The present study highlights that the cost of travel and health services, coupled with the difficulty in arranging motorized transport and poor road infrastructure, were themain reasons for delay in reaching health facilities and consequently the increased maternal mortality rate. Poor literacy standards among the women and their partners also had a direct impact on health outcomes. Ensuring that pregnant women receive regular prenatal care and birth preparedness will help achieve the Millennium Development Goals [3].

Antimicrobial activity of essential oils and chloroform alone and combinated with cetrimide against Enterococcus faecalis biofilm

The Enterococcus faecalis bacteria have been identified as the most commonly recovered species from teeth with persistent endodontic infections. The antimicrobial activity of essential oils and chloroform (CHL), alone and in association with various concentrations of cetrimide (CTR), against biofilm of Enterococcus faecalis was investigated. Solutions of CHL, eucalyptus oil (EO) and orange oil (OO) associated with CTR at 0.3%, 0.2%, 0.1%, and 0.05% were used to determine antimicrobial activity by exposing treated bovine dentine blocks to E. faecalis. Biofilms grown in the dentine blocks for 7 days were exposed to solutions for 2 and 5 min. Biofilm reduction between OO and EO at 2 min did not show any significant differences; however, OO had a higher kill percentage of biofilms than did the eucalyptus oil at 5 min (p < 0.01). Combinations with CTR at all concentrations achieved a 100% kill rate at 2 and 5 min. The association of CTR with solvent agents achieved the maximum antimicrobial activity against E. faecalis biofilms in dentine.

Restoration of posterior teeth using occlusal matrix technique

This article describes a technique for duplicating occlusal surface anatomy using the Biteperf device. Duplication requires an intact occlusal enamel surface and is only indicated when caries lesions are hidden. The occlusal matrix technique allows for preservation of all anatomic details. When the last layer of composite has been placed, the occlusal matrix is forced into the uncured composite to replicate the original occlusal surface, instead of performing manual curing and shaping as in the standard approach. It is technically possible to achieve this effect with any material that is able to copy anatomic details. The main benefits of the occlusal matrix technique, more precisely the Biteperf, are the technical ease of use due to its simplicity and its high accuracy in reconstructing occlusal morphology.

Crown fragment reattachment in anterior-fractured tooth: A five-year follow-up

Treatment of anterior dental fractures often requires an immediate procedure. Reattachment of the fragment to its original position is an optimal approach to aesthetic and functional rehabilitation. This paper reports the case of a permanent maxillary lateral incisor with crown fracture treated by adhesive fragment reattachment. Follow-up radiographs over 5 years demonstrated the satisfactory resolution of the clinical case.

Clinical technique for invasive cervical root resorption

This clinical case report describes the diagnosis and treatment of an external invasive cervical resorption. A 17-year-old female patient had a confirmed diagnosis of invasive cervical resorption class 4 by cone beam computerized tomography. Although, there was no communication with the root canal, the invasive resorption process was extending into the cervical and middle third of the root. The treatment of the cervical resorption of the lateral incisor interrupted the resorptive process and restored the damaged root surface and the dental functions without any esthetic sequelae. Both the radiographic examination and computed tomography are imperative to reveal the extent of the defect in the differential diagnosis.

Analysis of the periodontal status of patients with mandibular-bonded retainers

Purpose: This clinical study evaluated the periodontal status of patients with bonded retainers as compared to a non-treated control group. Methods: Forty dental students were included in the sample and divided into the following two groups: 1) a test group of 20 subjects that, after orthodontic treatment, have been bonded retainer users for at least 2 years and 2) a control group of 20 patients that never experienced orthodontic treatment nor used any bonded retainer. The region associated with the retainer in the test group and the lower canine-to-canine region in the control group were examined according to the following clinical parameters: plaque index (PI), bleeding on probing (BOP), gingival recession (GR), clinical attachment level (CAL) and probing depth (PD). Results: No differences were observed for GR or BOP (P>0.05). In contrast, the test group showed higher values of CAL and PD at proximal sites when compared to controls (P<0.05). In addition, IP was significantly increased at buccal and lingual sites (P<0.05). Conclusion: The placement of orthodontic bonded retainers negatively affected periodontal health, resulting in increased PI, PD and CAL.