Pablo Castelo-Baz

In vitro comparison of passive and continuous ultrasonic irrigation in simulated lateral canals of extracted teeth

INTRODUCTION Complete endodontic system disinfection requires the removal of vital and necrotic pulp tissue, microorganisms, and toxins. The purpose of this study was to compare the effects of 2 ultrasonic irrigation techniques on the penetration of sodium hypochlorite into the main canal and simulated lateral canals of extracted teeth. METHODS Two simulated lateral canals each were created 2, 4, and 6 mm from the working length in 60 single-rooted teeth (6 canals/tooth, n = 360). To resemble the clinical situation, a closed system was created in each tooth. The teeth were randomly assigned to 3 experimental irrigation groups: group 1 (n = 20), positive pressure irrigation (PPI); group 2 (n = 20), passive ultrasonic irrigation (PUI); and group 3 (n = 20), continuous ultrasonic irrigation (CUI). Samples were evaluated by direct observation of still images recorded under a dental operating microscope. To examine irrigating solution penetration, 20% Chinese ink (Sanford Rotring GmbH, Hamburg, Germany) was added to a 5% sodium hypochlorite solution and delivered into the root canals. RESULTS The results showed a significantly higher (P < .05) penetration of irrigant into the lateral canals in the CUI group. PUI and CUI did not differ significantly in solution penetration into the apical thirds of the main canals. The PPI group showed a significantly lower penetration of sodium hypochlorite into the main and lateral canals compared with the CUI and PUI groups. CONCLUSIONS CUI as a final rinse significantly increased the penetration of irrigating solution into simulated lateral canals.

Combined Endodontic-Periodontal Treatment of a Palatogingival Groove.

A palatogingival groove is a developmental anomaly that predisposes the involved tooth to develop a severe periodontal lesion. These grooves often present a clinical challenge because diagnosis and treatment planning require an interdisciplinary approach. This case report describes the successful management of a right maxillary lateral incisor with a deep palatogingival groove in combination with an extensive periodontal pocket and pulp necrosis of the involved tooth. Collaborative management used a combination of endodontic treatment, periodontal therapy, odontoplasty, and a periodontal regenerative procedure using protein complex derived from enamel matrix (Emdogain; Straumann, Basel, Switzerland). Despite a predicted poor prognosis, the tooth lesion healed. This report also discusses the rationale behind the treatment modalities.

Cone-beam Computed Tomographic Study of Root Anatomy and Canal Configuration of Molars in a Spanish Population

Introduction The aim of this study was to identify morphologic peculiarities of roots and analyze the root canal configuration in maxillary and mandibular first and second molars by means using cone‐beam computed tomographic (CBCT) imaging in a Spanish population. Methods A total of 284 maxillary molars and 242 mandibular molars from 112 patients were examined in vivo by CBCT imaging; only untreated molars with healthy and fully matured apices were included in this study. Details regarding the number of roots, number of canals, and root canal configuration were recorded. Results Maxillary first and second molars had 3 roots in 97.2% and 79%, respectively. In mandibular molars, the frequency of 2 roots was 94% in first molars and 83% in second molars. The canal configuration of the palatal root was 100% Vertucci type I (1‐1) in first and second molars. The distobuccal root showed a Vertucci type I configuration in 97% of first and 100% of maxillary second molars. The mesiobuccal root for first molars showed a Vertucci type II configuration (2‐1) in 56.5% cases and Vertucci type IV (2‐2) in 23.2%. For maxillary second molars, the Vertucci type I configuration reached 52.7%. In mandibular molars, the mesial root showed higher variability. Most frequent was the presence of 2 canals, Vertucci type II for first and second molars. In the distal root, the most common configuration was Vertucci type I in both molars. Conclusions The greater percentage of fused roots was observed in maxillary molars. Vertucci type II configuration was more frequent than type IV in the mesial root of mandibular molars and the mesiobuccal root of maxillary molars. A third canal in the mesial root of first mandibular molars (6.7%) was higher than expected. HighlightsRoot anatomy shows a high frequency of fused roots (17%) in maxillary second molars.Root canal configuration frequency in the mesiobuccal root of maxillary first molars was Vertucci type II (56.3%), type IV (23.2%), and type I (13.8%). In second molars, the frequency was Vertucci type I (52.7%), type II (33%), and type IV (9.8%).The frequency of a third root in the first and second mandibular molars was 2.5% and 1.6%, respectively.Root canal configuration frequency in the mesial root of mandibular first molars was Vertucci type II (51.3%) and type IV (37.8%). In the second molars, it was Vertucci type II (78.2%) and type IV (15%).The presence of a third canal in the mesial root was 6.7% in first molars and 2.5% in second molars.

Ultramicroscopic study of the interface and sealing ability of four root canal obturation methods: Resilon versus gutta‐percha

Recently, filling materials have been introduced based on the dentine adhesion technologies used in conservative dentistry in an attempt to seal the root canal more effectively. The purpose of this study was to investigate the interface between the canal and root-filling material. Sealing ability of four root canal obturation methods was analysed by means of scanning electron microscopy. Extracted single-rooted teeth were endodontically treated and filled with gutta-percha/Pulp Canal Sealer using the Thermafil (TH) technique, gutta-percha/Pulp Canal Sealer using the System B (SB) technique, Resilon points/RealSeal (RS) and RealSeal 1/RealSeal (RS1). Specimen interfaces were analysed using field-emission scanning electron microscopy. The adhesive groups RS and RS1, formed hybrid layers but showed areas of separation (gaps) similar to those in the conventional obturation groups. The RS and RS1 groups showed less separation in the coronal third, but the separation was similar to that in the TH and SB groups in the middle and apical thirds. The sealing ability of Resilon is not superior to that of existing materials.

Management of large class II lesions in molars: how to restore and when to perform surgical crown lengthening?

The restoration of endodontic tooth is always a challenge for the clinician, not only due to excessive loss of tooth structure but also invasion of the biological width due to large decayed lesions. In this paper, the 7 most common clinical scenarios in molars with class II lesions ever deeper were examined. This includes both the type of restoration (direct or indirect) and the management of the cavity margin, such as the need for deep margin elevation (DME) or crown lengthening. It is necessary to have the DME when the healthy tooth remnant is in the sulcus or at the epithelium level. For caries that reaches the connective tissue or the bone crest, crown lengthening is required. Endocrowns are a good treatment option in the endodontically treated tooth when the loss of structure is advanced.

In vitro comparison of passive and continuous ultrasonic irrigation in curved root canals

Background The efficacy of endodontic irrigation procedures can be compromised by the complexity of the root canal system. Delivering irrigants to the apical third of curved canals presents a particular challenge to endodontists. This study compared the effects of two ultrasonic irrigation techniques on the penetration of sodium hypochlorite into the main canal and simulated lateral canals of curved roots in extracted teeth. Material and Methods Two sets of simulated lateral canals were created at 2, 4, and 6 mm from the working length in 60 single-rooted teeth (6 canals/tooth, n = 360 canals). The teeth were randomly divided into three experimental irrigation groups: group 1 (n = 20), positive pressure irrigation (PPI); group 2 (n = 20), passive ultrasonic irrigation (PUI); and group 3 (n = 20), continuous ultrasonic irrigation (CUI). To assess the irrigation solution penetration, 20% Chinese ink (Sanford Rotring GmbH, Hamburg, Germany) was added to a 5% sodium hypochlorite solution and delivered into the curved root canals. The penetration of contrast solution into the simulated lateral canals was scored by counting the number of lateral canals (0-2) penetrated to at least 50% of the total length. Results The CUI group showed significantly higher (P < 0.05) irrigant penetration into the lateral canals and into the apical third of the main canals. The PPI group showed significantly lower sodium hypochlorite penetration (P < 0.001) into the main and lateral canals compared with that in the CUI and PUI groups. Significantly higher irrigant penetration was observed in the PUI group than the PPI group. Conclusions Using CUI as the final rinse significantly increased the penetration of irrigant solution into the simulated lateral canals and apical third of curved roots. Key words:Continuous ultrasonic irrigation, curved root canals, passive ultrasonic irrigation, positive pressure irrigation, root canal irrigation.

Unifocal orofacial granulomatosis in retromolar mucosa: surgical treatment with Er,Cr:YSGG laser.

Orofacial granulomatosis is defined by permanent or recurrent swelling of orofacial tissues with different multiform and multifocal clinical patterns. An 11-year old boy presented with a 2-month history of mucosa enlargement. Intraoral examination revealed an erythematous, polylobulated, exophytic lesion with a smooth surface located in retromolar mucosa, non-tender and non-infiltratated to palpation. The diagnosis was inflammatory lesion compatible with pyogenic granuloma and laser excision was decided. Haematological parameters were within normal range, as well as chest Xrays. These findings lead to a diagnosis of non-symptomatic orofacial granulomatosis, whose early diagnosis can minimize the impact of systemic-related disorders, like Chron’s disease. Key words:Laser, orofacial granulomatosis, childhood, oral lesions, diagnosis.

Management of a crown-root fracture: a novel technique with interdisciplinary approach

Anterior teeth with subgingival fractures require a complex treatment plan that addresses biologic, functional and aesthetic factors. This case report describes the management of a crown-root fractured maxillary left central incisor. An interdisciplinary approach was used to restore the tooth due to the complex nature of the treatment. Orthodontic extrusion was performed to move the fracture line above the alveolar bone and periodontal surgery to recontour the altered gingival margin. Finally, the incisor was restored performing a root canal retreatment with a fiber post and a full ceramic crown. The treatment resulted in secured periodontal health and good aesthetics. Key words:Crown-root fracture, orthodontic extrusion, crown lengthening, root canal retreatment, full ceramic crown.

Available patient-centered Internet information on peri-implantitis. Can our patients understand it?

ObjectivesThe aim of this study was to evaluate the quality, readability, and popularity of patient-oriented online information about peri-implantitis.Materials and methodsThe term “peri-implantitis” was searched in Google® and in Yahoo!®. The first 100 websites of each search engine were considered for further analysis. Quality was measured by DISCERN tool, and JAMA benchmarks. Readability was analyzed by Flesch Reading Ease Score (FRES), Flesch-Kinkaid Reading Grade (FKRG), Gunning Fog index (GFI), and Simple Measure of Gobbledygook (SMOG) index. Popularity was assessed by Alexa Popularity Rank (APR).ResultsOnly 28 websites remained after applying the exclusion criteria. The median overall DISCERN rating was 2.0 [2.0–3.0], which demonstrates the low quality of the information related to peri-implantitis. None of the websites achieved all the four JAMA benchmarks. Legibility indices showed ranges within the scores of difficult to read (FRES, 37.3 [26.9–53.9]; FKRGL, 12.8 [10.5–15.4]; GFI, 15.3 [12.5–18.0]; and SMOG, 11.1 [8.8–13.0]). Median APR was 2,228,599.0 [302,352.0–8,125,885.5].ConclusionsAvailable English-written e-health information on peri-implantitis is poor in terms of quality and the analyzed websites are beyond the reading level recommended for comprehension. The popularity measurement showed great divergences between different Web pages.Clinical relevanceInformation about peri-implantitis on the Internet is difficult to read by patients, which they are not capable of understand.

Alternating versus continuous rotation: Root canal transportation and centering ratio with the ProTaper Next

Background: The technique of alternating rotation has been used with NiTi rotary instruments to increase the resistance to fracture compared with conventional continuous rotation. However, it is still not clear what type of instrumentation could provide better results in the preservation of the original canal anatomy. Aim: The aim of this study is to determine the influence of the type of rotation on canal transportation and centering ability using cone-beam computed tomography (CBCT) imaging. Materials and Methods: In total, 50 mesial canals of mandibular molars with curvatures between 30° and 60° were divided into two experimental groups (n = 25 each) according to the type of movement employed with the ProTaper Next (PTN) instruments: Group A (alternating rotation) and Group B (continuous rotation). Canals were scanned before and after instrumentation using a CBCT scanner to evaluate root canal transportation and the centering ratio at 3, 5, and 7 mm from the apex. Data were analyzed statistically using Students t-test; the significance level was set at P < 0.05. Results: There was no significant difference between the groups in canal transportation or the centering ratio at any of the three studied cross sections (3, 5, and 7 mm). Conclusions: PTN instruments promoted minimal apical transportation and remained relatively centered within the root canal, with no significant difference between alternating and continuous rotation.