Nuevos métodos de desinfección y limpieza del sistema de conductos radiculares

La desinfección y limpieza del sistema de conductos radiculares, es considerada una parte esencial en la preparación químico-mecánica del mismo, cuyo fin es poder conseguir el éxito en endodoncia. El fin de esta tesis doctoral es demostrar la utilidad clínica de dos de estos nuevos mecanismos, la irrigación ultrasónica continua por un lado y el láser de diodo por el otro

Fracture and deformation of ProTaper Next instruments after clinical use

The aim of this study was to evaluate the fracture and defects observed in ProTaper Next files discarded after a normal clinical use. 571 ProTaper Next rotary instruments were collected after clinical use from the clinic of endodontics over 12 months. The length of the files was measured using a digital caliper to determine any fracture, later all the files were evaluated under a stereomicroscope to observe defects such as unwinding, curving or fracture. The data obtained were analyzed using a chi-square and z test. 13.83% of the discarded files showed defects, the most frequent defect was fracture (7.53%). The highest rate of fracture was observed in the X1 (17.04) files (19.87%). The presence of deformations without fracture was also more frequent in the 17.04 file (11.8%). Because of the relatively high incidence of deformation of smaller files, these instruments should be considered as a single use. It is important not to exceed the maximum uses recommended by the manufacturer to reduce the risk of cyclic fatigue, the main cause of fracture of the files (79.07%). It is also important to observe each file after use to discard small defects or fractures

Oral mucosal peeling related to dentifrices and mouthwashes : a systematic review

The aim of this systematic review was to summarise the clinical information available about oral mucosal peeling (OMP) and to explore its aetiopathogenic association with dentifrices and mouthwashes. PICOS outline: Population: subjects diagnosed clinically and/or pathologically. Intervention: exposition to oral hygiene products. Comparisons: patients using products at different concentrations. Outcomes: clinicopathological outcomes (primary) and oral epithelial desquamation (secondary) after use. Study design: any. Exclusion criteria: reports on secondary or unpublished data, in vitro studies. Data were independently extracted by two reviewers. Fifteen reports were selected from 410 identified. Descriptive studies mainly showed low bias risk, experimental studies mostly an ?unclear risk?. Dentifrices or mouthwashes were linked to OMP, with an unknown origin in 5 subjects. Sodium lauryl-sulphate (SLS) was behind this disorder in 21 subjects, tartar-control dentifrices in 2, and flavouring agents in 1 case. Desquamation extension was linked to SLS concentration. Most cases were painless, leaving normal mucosa after desquamation. Tartar-control dentifrices caused ulcerations more frequently. OMP management should consider differential diagnosis with oral desquamative lesions, particularly desquamative gingivitis, with a guided clinical interview together with pathological confirmation while discouraging the use of the product responsible for OMP

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 aesthetic

Vertical preparation: a new technique for analogical and digital impressions

The BOPT technique (Biologically Oriented Preparation Technique) was proposed by Loi et al. (1) and has become a popular form of vertical preparation for complete crowns with promising results. In this procedure, the clinician can operate on the gingival tissue during preparation and modify its structure in thickness and height by adding modifications on the provisional restoration. However, one of the main challenges in this technique is the transference of information about the gingival tissue to the laboratory technician, who will place the margin of the restoration randomly in a space determined by two marks on the working cast.The technique proposed enables the accurate transmission of the exact point where the margin of the restoration needs to be placed. Furthermore, it facilitates the recording of conventional impression materials and intraoral scanners due to the compression of polytetrafluoroethylene (PTFE) tape into the sulcus, which allows to arrest bleeding or intracrevicular liquid and is easily registered irrespective of the method of impression used

Patient-centered web-based information on oral lichen planus : quality and readability

To assess the readability and quality of web-based information available for patients about oral lichen planus (OLP). Three major search engines (Google, Bing and Yahoo!) were used to identify websites of particular interest to the study using the search term ?oral lichen planus?. The first 100 sites of each search engine were considered for the study. The quality of the contents was evaluated using the DISCERN instrument. The Flesch-Kinkaid Reading Grade Level (FKRGL) and the Flesh Reading Ease Score (FRES) were used to assess readability. The presence of the Health on the Net (HON) seal was also evaluated. Following the application of the study?s exclusion criteria, only 28 websites were compiled for further analysis. The median of the DISCERN instrument was 3 [2-3] which means serious or potentially important shortcoming in the quality of the information. Readability indexes pointed to a high reading difficulty (FRES: 48.14±11.22; FKRGL:11.13±2.90). The information provided by the Internet to the general public regarding OLP has major deficits in terms of quality, and at the same time is difficult for a comprehensive reading. Further studies are warranted to test well-produced patient-centered information on OLP

Efficacy of continuous apical negative ultrasonic irrigation (CANUI) in penetration of simulated lateral canals in extracted teeth

The aim of this study was to evaluate the efficacy of continuous apical negative ultrasonic irrigation into simulated lateral canals and the apical third in straight and curved root canals. Two simulated lateral canals were created 2, 4 and 6 mm from the working length in 120 single-rooted teeth (6 canals/tooth, n = 360 straight, n = 360 curved). The teeth were randomly divided into 3 experimental groups: positive pressure irrigation (PPI) (n = 20); passive ultrasonic irrigation (PUI) (n = 20); continuous apical negative ultrasonic irrigation (CANUI) (n = 20). 20% Chinese ink was added to a 5% sodium hypochlorite solution and delivered into the root canals. The results showed a significantly higher (P < 0.05) penetration of irrigant into the lateral canals and up to working length in the CANUI group for straight and curved roots. CANUI improves penetration into the lateral canals and up to the working length of the cleared teeth in straight and curved roots.S

Combined Sodium Hypochlorite and 940 nm Diode Laser Treatment Against Mature E. Faecalis Biofilms in-vitro

INTRODUCTION: Laser irradiation has been introduced in endodontic treatment due to its bactericidal effect. The aim of this study is to evaluate the bactericidal efficacy of a 940 nm diode laser alone or in combination with 5% sodium hypochlorite (NaOCl) against mature biofilms of E. Faecalis.METHODS: Sixty-eight (60 for the three groups, 4 for SEM and 4 as negative controls) single-rooted human central incisors were prepared and contaminated with E. Faecalis. After two weeks of incubation, specimens were randomly divided in three groups; group 1 (n =20), the teeth were irradiated with a 940 nm diode laser; group 2 (n=20), specimens were rinsed with 5% NaOCl; group 3 (n=20), the teeth were rinsed with 5% NaOCl and then were irradiated with 940 nm diode laser. Four teeth were used to observe the biofilms by SEM. Intracanal bacteria sampling was done, and the samples were plated to determinate the CFU count.RESULTS: At 24 hours and 7 days, group 3 showed a significant difference (P=0,02; P=0,00) in disinfection if compared to group 1 but did not show this difference if compared to group 2 (P=1, P=0,66), although group 3 obtaining a more extensive disinfection. Groups 1 and 2 did not show difference after 24 hours (P=0,09) but showed a significant difference 7 days afterwards (P=0,04).CONCLUSION: The combination of sodium hypochlorite and diode laser light (940 nm) has a synergistic effect, intensifying the bactericidal action

Impact of abutment geometry on early implant marginal bone loss. A double-blind, randomized, 6-month clinical trial

Objectives The objective of this study was to analyze the impact of the abutment width on early marginal bone loss (MBL). Material and Methods A balanced, randomized, double-blind clinical trial with two parallel experimental arms was conducted without a control group. The arms were “cylindrical” abutment and “concave” abutment. Eighty hexagonal internal connection implants, each with a diameter of 4 × 10 mm, were placed in healed mature bone. The main variable was the peri-implant tissue stability, which was measured as MBL at 8 weeks and 6 months. Results The final sample consisted of 77 implants that were placed in 25 patients. 38 (49.4%) were placed using the cylindrical abutment, and the other 39 (50.6%) were placed using the concave abutment. The early global MBL of −0.6 ± 0.7 mm in the cylindrical abutment group was significantly higher than it was in the concave abutment group, in which the early global MBL was −0.4 ± 0.6 mm (p = .030). The estimated effect size (ES) was negative for the cylindrical abutment (ES = −1.3730, CI −2.5919 to −0.1327; t-value = −2.4893; p = .0139), therefore implying a loss of mean bone level, and it was positive for the concave abutment (ES = 2.8231; CI: 1.4379 to 4.2083; t-value = 4.0957; p = .0002), therefore implying an increase in the average bone level. Conclusions The concave abutments presented significantly less early MBL at 6 months post-loading than classical cylindrical abutments did

In Vitro Evaluation of the Biological Effects of ACTIVA Kids BioACTIVE Restorative, Ionolux, and Riva Light Cure on Human Dental Pulp Stem Cells

This study aimed to analyze the biological effects of three new bioactive materials on cell survival, migration, morphology, and attachment in vitro. ACTIVA Kids BioACTIVE Restorative (Pulpdent, Watertown, MA, USA) (Activa), Ionolux (Voco, Cuxhaven, Germany), and Riva Light Cure UV (SDI, Bayswater, Australia) (Riva) were handled and conditioned with a serum-free culture medium. Stem cells from human dental pulp (hDPSCs) were exposed to material extracts, and metabolic activity, cell migration, and cell morphology were evaluated. Cell adhesion to the different materials was analyzed by scanning electron microscopy (SEM). The chemical composition of the materials was evaluated by energy-dispersive X-ray (EDX). One-way analysis of variance followed by a Tukey test was performed (p < 0.05). Ionolux promoted a drastic reduction in metabolic activity and wound closure compared to the control (p < 0.05), whereas Activa induced adequate metabolic activity and cell migration. Moreover, SEM and immunofluorescence analysis showed abundant cells exposed to Activa. The materials showed different surface morphologies, and EDX spectra exhibited different peaks of C, O, Si, S, Ca, and F ions in glass ionomer cements. The results showed that Activa induced cell migration, cell attachment, and cell viability to a greater extent than Riva and Ionolux.The Spanish Net of Cell Therapy (TerCel), RETICS subprograms of the I+D+I 2013-2016 Spanish National Plan, and project “RD16/0011/0001” funded by the Instituto de Salud Carlos III to JMM and co-funded by the European Regional Development Fund supported this workS