Endodontic and Orthodontic Management of Traumatically Intruded Teeth with Horizontal Root Fracture: A Case Report

This report describes the case of an 8-year-old boy that was referred to endodontic and orthodontic treatment after suffering an injury that led to intrusion of the maxillary right permanent central incisor, palatal displacement of the upper right lateral incisor, and root fracture of both central incisors. Both injured teeth were immature and had open apices. The intruded tooth was repositioned by endodontic and orthodontic management. Endodontic therapy was performed in both teeth with periodical changes of calcium-hydroxide-based paste as root canal dressing and introduction of MTA as an apical barrier. The postoperative course was uneventful with clinical and radiographic success up to 3 and 1/2 years of follow up. In the present case, orthodontic repositioning combined with endodontic therapy constitued a viable alternative treatment for intrusive luxations in immature permanent teeth

Effects of a novel calcium aluminate cement on the early events of the progression of osteogenic cell cultures

The present study evaluated the progression of osteogenic cell cultures exposed to a novel calcium aluminate cement (CAC+) in comparison with the gold standard mineral trioxide aggregate (MTA). Cells were enzimatically isolated from newborn rat calvarial bone, plated on glass coverslips containing either CAC+ or a control MTA samples in the center, and grown under standard osteogenic conditions. Over the 10-day culture period, roundening of sample edges was clearly noticed only for MTA group. Although both cements supported osteogenic cell adhesion, spreading, and proliferation, CAC+-exposed cultures showed significantly higher values in terms of total cell number at days 3 and 7, and total protein content and alkaline phosphatase activity at day 10. The present in vitro results indicate that the exposure to CAC+ supports a higher differentiation of osteogenic cells compared with the ones exposed to MTA. Further experimental studies should consider CAC+ as a potential alternative to MTA when the repair of mineralized tissues is one of the desired outcomes in endodontic therapy.O objetivo do presente estudo foi avaliar a progressão de cultura de células osteogênicas expostas a um novo cimento de aluminato de cálcio (CAC+) em comparação ao agregado de trióxido mineral (MTA). As células foram obtidas por digestão enzimática de calvária de ratos recém-nascidos, plaqueadas sobre lamínulas de vidro contendo em sua área central discos de CAC+ ou MTA e crescidas em condições osteogênicas por até 10 dias. Durante a cultura primária, observou-se o arredondamento das bordas das amostras de cimento apenas para MTA. Embora ambos os cimentos tenham permitido a adesão, o espraiamento e a proliferação celulares, as culturas crescidas em contato com CAC+ exibiram valores maiores de número total de células em 3 e 7 dias, e de conteúdo de proteína total e atividade de fosfatase alcalina em 10 dias. Os resultados indicam que a exposição ao CAC+ permite o desenvolvimento de uma proporção maior de células em estágios mais avançados da diferenciação osteoblástica, quando comparado ao MTA. Deve-se considerar em futuros estudos experimentais a utilização do CAC+ como um material alternativo ao MTA especialmente quando um dos objetivos do tratamento endodôntico é o de reparação dos tecidos mineralizados da região periapical.(FAPESP) São Paulo Research Foundation(CNPq) National Council of Scientific and Technological Developmen

Biologia molecular - técnica PCR: monitoração do efeito de curativos de demora à base de hidróxido de cálcio na microbiota de canais radiculares em dentes de humanos portadores de lesão periapical crônica

No presente estudo foi monitorada a microbiota do canal radicular de 30 dentes de humanos portadores de lesão periapical crônica. Foram utilizados curativos de demora à base de hidróxido de cálcio entre sessões: Calen (Grupo I), Calen PMCC (Grupo II) e Calasept (Grupo III), que foram mantidos nos canais radiculares por aproximadamente 30 dias. O material colhido dos canais radiculares, antes e após a realização da terapêutica endodôntica, foi submetido a teste laboratorial baseado na biologia molecular: Reação em Cadeia da Polimerase (PCR). Como controle positivo da presença bacteriana, foi utilizado primer 16S rDNA. As seguintes espécies bacterianas foram monitoradas: Porphyromonas endodontalis, Porphyromonas gingivalis, Prevotella intermedia, Prevotella nigrescens (bacilos pigmentados de negro), e Bacteroides forsythus, microrganismos marcantes na patologia de processos infecciosos dos tecidos pulpoperiapicais. Os resultados evidenciaram diminuição das espécies microbianas, aqui monitoradas de forma indireta à partir da presença de bandas, ou amplicons (produtos do PCR), quando do uso de curativos de demora à base de hidróxido de cálcio. Com relação à eficácia particular a cada material, os Grupos I, II e III não demonstraram entre si diferenças estatisticamente significantes.In the present study the root canal flora of 30 human teeth with chronic periapical lesion was monitored. Dressing pastes based on calcium hydroxide were used, among sessions namely: Calen (Group I), Calen/PMCC (Group II) and Calasept (Group III) that were used as a temporary dressings in root canals for approximately 30 days. The microbial material was colected from root canals, before and after the root canal treatment and submitted to laboratorial test based on molecular biology assay: Polymerase Chain Reaction (PCR). As a positive control of bacterial presence, a primer 16S rDNA was utilized. The following bacterial strains were monitored: Porphyromonas endodontalis, P. gingivalis, P. intermedia, P. nigrescens (black pigmented rods) and B. forsythus, a microorganism with an important role on pulpoperiapical pathosis. The results showed a decrease of bacterial strains population indirectly, based on bands presence (amplicons) where the calcium hydroxide dressing pastes were applied. Concerning the intrinsic efficacy of each material, the Groups I, II and III didn't show significant statistical differences among them

The use of calcium hydroxide and mineral trioxide aggregate on apexification of a replanted tooth: a case report

To report the outcome of the endodontic treatment of a reimplanted central maxillary incisor with open apex after 8 years and 7 months of follow-up.This case report presents the treatment of a right central maxillary incisor of an 8-year old white male patient with history of traumatic avulsion and immediate replantation. The endodontic therapy consisted of periodical changes of calcium hydroxide dressing and a definitive root canal filling with mineral trioxide aggregate (MTA). The treatment was successful without pathologies up to 7 years of follow-up. After the institution of orthodontic treatment a localized and late root resorption was noticed at the last radiographic examination (8 years and 7 months postoperative follow-up). Moreover, the use of MTA promoted a mild crown grey discoloration

Influence of cervical preflaring on determinationof apical file size in mandibular molars: SEM analysis

This study investigated the influence of cervical preflaring with different rotary instruments on determination of the initial apical file (IAF) in mesiobuccal roots of mandibular molars. Fifty human mandibular molars whose mesial roots presented two clearly separated apical foramens (mesiobuccal and mesiolingual) were used. After standard access opening and removal of pulp tissue, the working length (WL) was determined at 1 mm short of the root apex. Five groups (n=10) were formed at random, according to the type of instrument used for cervical preflaring. In group 1, the size of the IAF was determined without preflaring of the cervical and middle root canal thirds. In groups 2 to 5, preflaring was performed with Gates-Glidden drills, ProTaper instruments, EndoFlare instruments and LA Axxes burs, respectively. Canals were sized manually with K-files, starting with size 08 K-files, inserted passively up to the WL. File sizes were increased until a binding sensation was felt at the WL and the size of the file was recorded. The instrument corresponding to the IAF was fixed into the canal at the WL with methylcyanoacrylate. The teeth were then sectioned transversally 1 mm short of the apex, with the IAF in position. Cross-sections of the WL region were examined under scanning electron microscopy and the discrepancies between canal diameter and the diameter of IAF were calculated using the tool "rule" (FEG) of the microscope's proprietary software. The measurements (µm) were analyzed statistically by Kruskal-Wallis and Dunn's tests at 5% significance level. There were statistically significant differences among the groups (p<0.05). The non-flared group had the greatest discrepancy (125.30 ± 51.54) and differed significantly from all flared groups (p<0.05). Cervical preflaring with LA Axxess burs produced the least discrepancies (55.10 ± 48.31), followed by EndoFlare instruments (68.20 ± 42.44), Gattes Glidden drills (68.90 ± 42.46) and ProTaper files (77.40 ± 73.19). However, no significant differences (p>0.05) were found among the rotary instruments. In conclusion, cervical preflaring improved IAF fitting to the canals at the WL in mesiobuccal roots of maxillary first molars. The rotary instruments evaluated in this study did not differ from each other regarding the discrepancies produced between the IAF size and canal diameter at the WL.Este estudo investigou a influência do alargamento cervical feito com diferentes instrumentos rotatórios na determinação do instrumento apical inicial (IAI) das raizes mésio-vestibulares de molares inferiores. Foram utilizados 50 molares inferiores cujas raízes mesiais apresentavam dois forames apicais nitidamente separados (mésio-vestibular e mésio-lingual). Após o acesso à câmara pulpar de forma convencional e remoção do tecido pulpar, o comprimento de trabalho foi definido a 1 mm do ápice radicular. Os dentes foram divididos aleatoriamente em cinco grupos (n= 10) de acordo com o tipo de instrumento utilizado no alargamento cervical. No grupo 1, o IAI foi definido sem o prévio alargamento dos terços médio e cervical das raízes. Nos grupos 2 a 5, o terço cervical e médio do canal radicular foi alargado com as brocas de Gates-Glidden, instrumentos Pro Taper, Endo Flare e brocas LA Axxes, respectivamente. A determinação do IAI foi realizada manualmente com limas tipo K em ordem crescente de diâmetro a partir da lima 08 até se chegar ao instrumento que permitisse ao operador ter a sensação tátil do mesmo estar firmemente ajustado ao CRT. O instrumento que correspondeu ao IAI foi fixado no interior do canal radicular com cianocrilato de metila. Com o IAI posicionado, os dentes foram seccionados transversalmente até 1 mm do ápice. As seções transversais do CRT foram observadas através da microscopia eletrônica de varredura e os desajustes entre o diâmetro do canal e o diâmetro do IAI foram calculados com a função "régua" (FEG) do software do próprio microscópio. Os resultados foram avaliados estatisticamente pelo testes de Kruskal-Wallis e Dunn ao nível de significância de 5%. Houve diferenças estatisticamente significantes entre os grupos (p<0,05). O grupo sem alargamento apresentou o maior desajuste (125,30 ±51,54) e diferiu significativamente dos demais grupos (p<0,05). O alargamento cervical com as brocas LA Axxess apresentou os menores desajustes (55,10 ± 48,31), seguido de EndoFlare (68,20 ± 42,44), Gattes Glidden (68,90 ± 42,46) e limas ProTaper (77,40 ± 73,19). Contudo, não houve diferenças estatisticamente significantes entre os instrumentos rotatórios (p<0,05). Conclui-se que o alargamento cervical melhorou a adaptação do IAI aos canais no CRT das raízes mésio-vestibulares dos primeiros molares inferiores. Os instrumentos rotatórios avaliados neste estudo não apresentaram diferenças estatísticas entre si no que diz respeito aos desajustes entre as dimensões do IAI e o diâmetro do canal no CRT