Vânia Portela Ditzel Westphalen

Comparative analysis of leakage in root canal fillings performed with gutta-percha and Resilon cones with AH Plus and Epiphany sealers

OBJECTIVE The aim of this study was to compare the leakage of root canal fillings of gutta-percha or Resilon cones in association with AH Plus or Epiphany sealer. STUDY DESIGN Four groups of premolars (n = 64) were instrumented to size 45/.04 ProFile and filled with laterally compacted gutta-percha cones or Resilon cones in association with AH Plus or Epiphany sealer. The specimens were stored for 2 weeks at 37 degrees C and 100% humidity. After that, leakage was measured using the fluid filtration method and determined as microL/min.10 psi. RESULTS Homogeneity of variance and multiple comparisons tests were performed and indicated that root fillings with the combination of gutta-percha cones and AH Plus sealer showed lower leakage values (P < .05) than the other groups. CONCLUSION Considering the experimental conditions and the results obtained, it was concluded that fillings made with gutta-percha cones in combination with AH Plus sealer had the best performance.

Spontaneous eruption of a canine after marsupialization of an infected dentigerous cyst

A dentigerous cyst is the most common developmental odontogenic cyst. It is a benign and asymptomatic intraosseous lesion that affects the bones of the maxillofacial complex, interfering with tooth eruption. This article reports the spontaneous eruption of a canine after marsupialization of an infected dentigerous cyst and extraction of the deciduous teeth. A radiograph showed a large cyst with a radiolucent area involving the mandibular left deciduous canine and first molar, and the permanent canine and first premolar. Although enucleation is the treatment of choice, marsupialization is the best option for large cysts involving an unerupted permanent tooth, as in this case. The patient was followed for 1 year, and eruption of the permanent canine and first premolar and gradual reduction of the radiolucent area were observed.

The Influence of Atopy in the Prognosis of the Replantation of Avulsed Teeth

BACKGROUND Replantation is the most indicated procedure for traumatic dental avulsion, but it invariably results in a greater or lower degree of root resorption. The outcomes of these cases can be affected by some well-known factors. Because studies have shown the importance of the innate and acquired immune response in the mechanisms involved in the resorption of bone tissues, an endeavor was made to verify if such an influence applies to dental resorption. METHODS Fifty-seven avulsed, endodontically treated teeth were assessed in the Endodontics Clinic, Pontifical Catholic University of Paraná. Follow-up of the replanted teeth included periodical clinical examinations and radiographs, in accordance with the control rules of the International Association of Dental Traumatology. The evaluation of atopy was based on the patients personal and family history in conjunction with the skin-prick test for five allergen extracts. RESULTS Of the 46 teeth with a favorable outcome, 33 (71.74%) were in atopic patients, and 13 (28.26%) were in non-atopic patients. Of the 11 teeth with an unfavorable outcome, four (36.36%) were in atopic patients, and seven (63.64%) were in non-atopic patients; a greater prevalence of unfavorable prognoses occurred in non-atopic patients. CONCLUSION The outcome after 1 year for avulsed and replanted teeth is more favorable in atopic patients.

Efficacy of conventional and digital radiographic imaging methods for diagnosis of simulated external root resorption

This in vitro study evaluated and compared the efficacy of conventional (Kodak F-speed (Insight), Kodak) and a digital (DRS Gnatus System, Gnatus) radiographic imaging for diagnosis of simulated external root resorption cavities. Human mandibles containing teeth were covered with bovine muscle slices in order to simulate the soft tissues. Nine teeth out of each group of teeth were investigated. Initially, three periapical radiographs of each tooth were taken using a tube shift technique with mesial and distal angulations in both methods. All teeth were subsequently extracted and had 0.7 and 1.0-mm deep cavities prepared on their buccal, mesial and distal surfaces at the cervical, middle and apical thirds. Steel cylinder burs (DORMER® - HSS) with 0.7 and 1.0-mm diameter were used. Each tooth was replaced on its socket and new radiographs were taken. Three examiners, an endodontist (1), a radiologist (2) and a general dentist (3), evaluated the images. Results were compared by z-test and showed a higher number of cavities detected by the digital method compared to the conventional, regardless of the deepness of the cavity. In decreasing order, examiners 2, 3 and 1 exhibited different potentials of detection of cavities with the conventional method. Examiners 1 and 3 exhibited superior potential than examiner 2 for detection of cavities of different sizes with the digital method.

Relationship between extra-alveolar time and atopy in the prognosis of the replantation of avulsed teeth.

BACKGROUND The aim of this in vivo study was to evaluate the correlation between the occurrence of root resorption in avulsed and replanted teeth, extra-alveolar time, and the possible influence of Th2 immunologic profile, represented by patients atopy and its influence in the prognosis of the tooth. METHODS This study evaluated the presence or absence of root resorption in 57 avulsed and replanted teeth. The replantation technique and endodontic treatments were performed following the International Association of Dental Trauma guidelines. Follow-up of the replanted teeth included monthly clinical and radiographic examinations during 1 year. The patients medical examination, including the personal and family allergic history, in conjunction with the skin prick test based the evaluation of patients atopy. RESULTS Of the 37 teeth of atopic patients, 33 (89.2%) teeth did not present root resorption. Of these, 27 (72.9%) had an extra-alveolar time of <1 hour and 6 (16.2%) had an extra-alveolar time >1 hour. Four (10.8%) teeth presented root resorption and an extra-alveolar period of time >1 hour. CONCLUSION These results showed the importance of the extra-alveolar time and the predominantly Th2 immunologic profile, represented by atopic patients, that suffered replantation after dental avulsion in a 1-year follow-up.

Efficacy of protaper instruments during endodontic retreatment

Introduction: The effectiveness of ProTaper Universal and ProTaper Retreatment rotary instruments was compared to the Hedström files in the removal of filling material from root canals. Materials and Methods: Thirty-six extracted human mandibular premolars with a single straight root canal were shaped and filled with gutta-percha and AH Plus. The specimens were stored for 6 months at 37°C and at 100% relative humidity, and then randomly divided into three groups: PTU - removal of filling material performed with ProTaper Universal instruments; PTR - removal of filling material performed with ProTaper Retreatment instruments; HF – removal of filling material performed with Gates-Glidden burs, Hedström files and solvent. After the filling material removal and diaphanization, the specimens were longitudinally sectioned and images of the canal surfaces were scanned. The remaining areas of filling material were measured (Image Tool 3.0), and data was analyzed statistically (Kruskal-Wallis and Dunn tests). The time required for filling removal in each group was also recorded (one-way ANOVA and Tukeys HSD test). Results: All groups presented remnants of filling material; PTU had the smallest amount and HF group presented the highest mean value (P< 0.05) in all the thirds. The cervical third had the smallest amount of material when compared with the other thirds (P< 0.05). HF group required a longer mean time, presenting significant difference (P< 0.05). Conclusion: Considering the time required and the amount of the filling removal, ProTaper Retreatment were not superior to ProTaper Universal, but both rotary instruments were more effective and less time-consuming than Hedström manual files.

Management of Multiple Dental Trauma: Case Report with Eight-Year Follow-up

This case report documents the clinical approach adopted for two maxillary incisors with intrusion and horizontal root fracture in the middle third after trauma. The proposed procedures involved maintaining pulp vitality and periodontal stability of the fractured teeth with 8 years of follow-up.

The Accuracy of a New Cone-beam Computed Tomographic Software in the Preoperative Working Length Determination Ex Vivo

Introduction: This study investigates the accuracy of 3D Endo software (Dentsply Sirona, Salzburg, Austria) to determine the working length when using preoperative cone‐beam computed tomographic (CBCT) scans of extracted teeth, compared with conventional CBCT software and an electronic apex locator (EAL). Methods: CBCT scans of 30 premolars were obtained. Using OnDemand3D software (Cybermed, Seoul, Korea), the measurement obtained from the coronal reference to the apical foramen (AF) was recorded as the conventional CBCT length. Then, using 3D Endo software (Dentsply Sirona), the suggested length (3D‐SL) and the operator‐adjusted length (3D‐OL) were obtained. Teeth were accessed, and the actual length was measured. Finally, the teeth were embedded in alginate to obtain the electronic length (EL) using the EAL Root ZX (J Morita, Tokyo, Japan). The means of the absolute values and the percentages of distribution of the tested measurement methods were compared to the actual length. Results: No difference was found regarding the mean measurements (analysis of variance, P > .05). All the CBCT measurements presented a high reliability (Dahlbergs formula). The measurements within a ±0.5‐mm range from the AF were 86.6% for the 3D‐SL, 80% for the 3D‐OL and EL, and 73.3% for the CBCT length. The EL presented significantly fewer underestimated measurements (P < .05). The 3D‐OL and 3D‐SL presented significantly fewer measurements beyond the AF (P < .05). Conclusions: The preoperative working length determination using 3D Endo was reliable and similar to conventional CBCT software. However, the combined use of CBCT with an EAL is required to increase the accuracy in the location of the AF. HIGHLIGHTS3D Endo™ is new software dedicated to endodontic treatment planning using cone‐beam computed tomographic (CBCT) data.It presents 2 functions for working length determination: suggested and operator adjusted.The results of both working length functions were reliable and similar to conventional software (OnDemand).Preoperative CBCT working lengths should be confirmed clinically using an electronic apex locator.

Accuracy of Digital Periapical Radiography and Cone-beam Computed Tomography for Diagnosis of Natural and Simulated External Root Resorption

Introduction: The aim of this study was to compare the sensitivity and specificity of digital periapical radiography and cone‐beam computed tomographic (CBCT) imaging in the detection of natural and simulated external root resorptions (ERRs) with micro–computed tomographic (micro‐CT) imaging as the reference standard. Methods: One hundred twenty‐six teeth were scanned using the SkyScan 1172 micro‐CT scanner (Bruker microCT, Kontich, Belgium), and the images were evaluated using NRecon software (Bruker microCT). After micro‐CT imaging, the teeth were divided into 3 groups: control, 42 teeth that did not present any ERR cavities; natural, 42 teeth that presented 1 or more ERR cavities; and artificial, 42 teeth without ERRs but perforations were created to simulate the cavities. Ortho‐, mesio‐, and distoradial digital periapical radiographs and CBCT images were obtained, and the images were evaluated by 2 double‐blinded qualified radiologists. Results: The sensitivities and specificities for the radiographic and tomographic methods were 78.18% and 97.27% and 59.52% and 97.62%, respectively. Within the individual groups, both methods had lower sensitivity and specificity for natural and artificial resorptions, and the differences were statistically significant. Conclusions: CBCT imaging was the best method for the detection of ERRs. Only 74.5% of natural ERR gaps were observed on the digital periapical radiographs and 94.5% on CBCT imaging; in the artificial group, this number increased to 81.8% and 100%, respectively. The configuration of the natural ERR gaps is different from those artificially simulated and is much more difficult to observe. Highlights:This study compared the sensitivity and specificity of digital periapical radiography and cone‐beam computed tomographic (CBCT) imaging in the detection of natural and simulated external root resorptions (ERRs) with micro–computed tomographic imaging as the reference standard.Both methods had lower sensitivity and specificity for natural resorptions compared with artificial resorptions, and the differences were statistically significant.CBCT imaging was the best method for the detection of ERRs.Only 74.5% of natural ERR gaps were observed on digital periapical radiographs and 94.5% on CBCT imaging; in the artificial group, this number increased to 81.8% and 100%, respectively.The configuration of the natural ERR gaps is different from those artificially simulated and is much more difficult to observe.

Maintenance of Pulp after Horizontal Root Fractures in Three Maxillary Incisors: A Thirteen-Year Evaluation

This case report documents the clinical approach adopted for three upper incisors with horizontal root fracture in the middle or cervical third. The proposed procedures involved maintaining pulp vitality and periodontal stability of the fractured teeth with 13 years of follow-up.