Avaliação longitudinal do comportamento periodontal clínico e radiográfico de dentes pilares e não pilares de próteses parciais removíveis

TCC (graduação) - Universidade Federal de Santa Catarina. Centro de Ciências da Saúde. Odontologia.Retentores de próteses parciais removíveis (PPRs) podem acumular biofilme e transmitir cargas deletérias aos dentes pilares, com reflexos diretos à saúde periodontal. O presente estudo avaliou o impacto da PPR no comportamento periodontal dos dentes pilares e não pilares. Neste ensaio clínico prospectivo, foram avaliados 18 usuários de PPR (57,41 ± 9,96), na instalação das próteses (baseline) e após 4 meses de uso da PPR. As variáveis dependentes foram a capacidade de amortecimento (Periotest), o Índice de placa visível (IPV), o Índice de sangramento à sondagem (IS), a Profundidade de Sondagem (PS), o Nível Clínico de Inserção (NIC) e a perda óssea vertical, mensurada em radiografias periapicais. Os dados foram avaliados por ANOVA fatorial e Tukey HSD (α=0.05). Os dentes pilares demonstraram maior NCI e PS, em comparação aos dentes não pilares (p<0.001). O tempo não influenciou o NIC (p=0,228); entretanto, a PS reduziu do baseline para os 4 meses (p<0.001), independente do dente ser ou não pilar da PPR. O nível ósseo mesial foi maior que o distal (p<0.001), em ambas avaliações (p=0,273). Os dentes pilares apresentaram maior IPV e IS quando comparados aos dentes não pilares, porém, houve melhora significativa de ambos após 4 meses. A média dos valores de Periotest dos dentes pilares aos 4 meses foi de 10,24 (± 10,2). Os dentes pilares de PPRs são mais comprometidos periodontalmente, portanto, a avaliação criteriosa e permanente destes dentes, onde diferenças sutis, anteriores à instalação da doença, podem ser detectadas, aumentam a longevidade e previsibilidade do tratamento

Dental and composite resin discoloration induced by different hydraulic calcium silicate-based cements: two-year in vitro assessment

Few long-term studies assess the discoloration induced by hydraulic calcium silicate-based cement on dental structures. In addition, as far as we know, no long-term study has assessed the discoloration induced by these cement on composite resin. Objective: This in vitro study aimed to assess, during a period of two years, the discoloration potential of different hydraulic calcium silicate-based cements (hCSCs) on the enamel/dentin structure and composite resin restoration. Methodology: A total of 40 enamel/dentin discs were obtained from bovine incisors, and 40 composite resin discs (10 mm in diameter × 2 mm thick) were fabricated. A 0.8 mm-deep cavity was made in the center of each disc and filled with the following hCSCs (n=10): Original MTA (Angelus); MTA Repair HP (Angelus); NeoMTA Plus (Avalon); and Biodentine (Septodont). An initial color measurement was performed (T0 - baseline). After 7, 15, 30, 45, 90, 300 days, and two years, new color measurements were performed to determine the color (ΔE00), lightness (ΔL’), chroma (ΔC’), hue differences (ΔH’), and whiteness index (WID). Results: For enamel/dentin, the ΔE00 was significant among groups and periods (p&lt;0.05). NeoMTA Plus had the greatest ΔE00. The NeoMTA Plus group had the greatest ΔE00 after two years for composite resin. Significant reduction in lightness was observed for all groups after two years (p&lt;0.05). The most significant WID values were observed after 30 days for Biodentine (enamel/dentin) and MTA Repair HP groups (composite resin) (p&lt;0.05). Conclusions: The hCSCs changed the colorimetric behavior of both substrates, leading to greater darkening over time. The Bi2O3 in the Original MTA seems relevant in the short periods of color change assessment

Comparação do efeito de diferentes protocolos de irrigação final na estrutura da dentina e na resistência de união do material obturador às paredes do canal radicular

Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Odontologia, Florianópolis, 2021.O objetivo do estudo foi comparar o efeito de diferentes protocolos de irrigação final na estrutura da dentina e na resistência de união ao cisalhamento (RU) do material obturador às paredes do canal radicular. O preparo químico-mecânico de 108 dentes humanos foi realizado com instrumento Reciproc R40 e irrigação convencional (IC) com hipoclorito de sódio 2,5% (NaOCl). Os dentes foram distribuídos em quatro diferentes grupos, de acordo com o protocolo de irrigação final: Grupo Controle (GC) ? EDTA 17% ativado com irrigação ultrassônica passiva (PUI) + água destilada (H2O) com IC; G1 ? 3 ciclos de ativação PUI de 20 segundos cada, na sequência: NaOCl 2,5% + EDTA 17% + NaOCl 2,5%; G2 ? EDTA com PUI 30s + NaOCl com PUI 30s + H2O com IC; G3 ? EDTA + NaOCl + H2O + CHX com 30s de PUI em cada solução. Em seguida, os dentes foram submetidos a três diferentes testes: resistência a flexão de três pontos (n=48); microdureza (n=12); e push-out (n=48). Para análise da resistência à flexão, feixes retangulares de dentina radicular foram submetidos a uma força perpendicular até que fosse detectada a fratura. A verificação da microdureza da dentina radicular foi ocorreu através de uma avaliação longitudinal, antes e após o emprego dos protocolos de irrigação final. Para comparação da RU do material obturador à dentina radicular entre os grupos, os dentes selecionados foram obturados pela técnica da condensação lateral com cimento a base de resina epóxi. Em seguida, foram realizados cortes transversais nas raízes, de modo a obter fatias de 1 mm de espessura para a realização do teste de push-out. Os dados alcançados em cada teste foram submetidos à verificação da normalidade através do teste de Shapiro-Wilk e depois analisados pelo teste ANOVA e o post-hoc de Tukey, quando necessário. Para a microdureza, por ter dados pareados, foi aplicado o teste t de Student. O nível de significância estabelecido foi de 5%. No teste de resistência a flexão de três pontos, os grupos não apresentaram diferença estatística entre si. Em relação a microdureza, houve diferença estatística entre os valores obtidos antes e depois do uso dos protocolos, exceto para o GC. No teste push-out, os espécimes do G2 nos terços médio e apical apresentaram valores de RU superiores aos demais grupos, havendo diferença estatística (p<0,05). Conclui-se que os diferentes protocolos alteraram a microdureza da dentina radicular, mas não prejudicaram sua resistência a flexão. O protocolo combinado de EDTA + NaOCl, por 30s cada, foi o que apresentou os melhores resultados em relação à adesão do material obturador à dentina radicular.Abstract: To compare the effect of different final irrigation protocols on the dentin structure and on the push-out bond strength of the filling material to root canal walls. The chemical-mechanical preparation of 108 human teeth was performed with a Reciproc R40 instrument and conventional irrigation (CI) with 2.5% sodium hypochlorite (NaOCl). The teeth were distributed into four different groups, according to the final irrigation protocol: Control Group (CG) - 17% EDTA activated with passive ultrasonic irrigation (PUI) + distilled water (H2O) with CI; G1 - 3 PUI activation cycles of 20 seconds each, in sequence: 2.5% NaOCl + 17% EDTA + 2.5% NaOCl; G2 - EDTA with PUI 30s + NaOCl with PUI 30s + H20 with CI; G3 - EDTA + NaOCl + H2O + CHX with 30s of PUI in each solution. Then, the teeth were subjected to three different tests: three-point flexural strength test (n = 48); microhardness (n = 12); and push-out bond strength (n = 48). For flexural strength analysis, rectangular root dentin beams were subjected to a perpendicular force until fracture was detected. The verification of the microhardness of the root dentin was done through a longitudinal evaluation, before and after the use of the final irrigation protocols. In order to compare the RU of the filling material to the root dentin between the groups, the selected teeth were filled using the lateral condensation technique with epoxy-based cement. Then, transversal cuts were made in the roots, in order to obtain 1 mm thick slices for the push-out test. The data obtained in each test were submitted to the verification of normality through the Shapiro-Wilk test and then analyzed by the ANOVA test and the Tukey post-hoc test, when necessary. The level of significance was set at 5%. In the three-point flexural strength test, the groups showed no statistical difference. Regarding microhardness, there was a statistical difference between the values obtained before and after using the protocols, except for the CG. In the push-out test, the G2 specimens in the middle and apical thirds had higher RU values than the other groups, with statistical difference (p <0.05). The different protocols changed the microhardness of the root dentin, but did not impair its flexural strength. The protocol of EDTA + NaOCl, for 30s each, was the one that presented the best results in relation to the bond strength of the filling material to the root dentin

RESIDUAL ROOT BURIAL IN PATIENT WITH A HISTORICAL OF HEAD AND NECK CANCER: CASE REPORT

Radiotherapy reduces the tissue vascularization potential. Therefore, tooth extraction in irradiated patients has a high risk of osteoradionecrosis. This case report described endodontic treatment followed by residual root burial of two mandibular teeth in a patient undergoing radiotherapy. A 60-year-old female patient underwent radiotherapy in 2018 for the treatment of oropharyngeal squamous cell carcinoma. Teeth 43 and 44 had extensive coronal destruction and indication for tooth extraction. Anesthesia, rubber dam isolation, access to the root canals, negotiation and patency with a #15 K-file (Dentsply) were performed. After electronic odontometry, mechanical preparation was performed with R50 instrument of the Reciproc system (VDW) and irrigation with ultrasonic-activated 2.5% sodium hypochlorite solution.&nbsp; Calcium hydroxide was used as intracanal dressing. After 15 days, the intracanal dressing was removed, and final irrigation with 17% EDTA and 2.5% sodium hypochlorite solution was performed.&nbsp; The root canals were dried with absorbent paper points.&nbsp; Root canal obturation was performed by the lateral condensation technique with epoxy resin-based cement (AH Plus, Dentsply). The entrance of the root canals was sealed with composite resin and residual root burial was performed for subsequent rehabilitation with a lower complete denture. After 12 months of follow-up, the patient was asymptomatic and the periapical region did not present areas of bone rarefaction. Endodontic treatment was successful and it should be indicated in patients undergoing radiotherapy in order to avoid tooth extraction and the development of osteoradionecrosis

ENDODONTIC TREATMENT OF MANDIBULAR MOLAR WITH SUPPLEMENTARY ROOT: CASE REPORT

A proper knowledge of the dental anatomy and its variations is one of the factors that determine the success of endodontic therapy. The first permanent lower molar may have a third root, when located in the buccal region. It is named radix paramolaris and, when located at the lingual region, radix entomolaris. The incidence of this anatomical variation is controversial (1 to 33%). The aim of this case report was to describe the endodontic treatment of a mandibular first molar with a supplementary root (disto-lingual). A 29-year-old male patient complaining of moderate to severe pain in tooth 46 was diagnosed with acute irreversible pulpitis. During the initial radiographic examination, the presence of the additional root was observed. Mechanical preparation was performed with SRF Sequence (MK Life) and ProDesign Logic 2 (Easy Equipment) rotary instruments. Irrigation was performed with 2% chlorhexidine gel and saline solution. The accessory root canal was prepared with a ProDesign Logic 2 rotary file number 25/.04. Root canal obturation was performed with epoxy resin-based cement (AH Plus-Dentsply) by the single-cone technique and hydraulic compression. The treatment was performed in single-session. Afterwards, the tooth was restored with composite resin. Patient is asymptomatic and under clinical and radiographic follow-up. Knowing this unusual root morphology of the mandibular first molar was essential to perform a proper radiographic examination. The inability to recognize and treat this accessory root canal may lead to endodontic failure

Management of coronary disease in patients with advanced kidney disease

BACKGROUND Clinical trials that have assessed the effect of revascularization in patients with stable coronary disease have routinely excluded those with advanced chronic kidney disease. METHODS We randomly assigned 777 patients with advanced kidney disease and moderate or severe ischemia on stress testing to be treated with an initial invasive strategy consisting of coronary angiography and revascularization (if appropriate) added to medical therapy or an initial conservative strategy consisting of medical therapy alone and angiography reserved for those in whom medical therapy had failed. The primary outcome was a composite of death or nonfatal myocardial infarction. A key secondary outcome was a composite of death, nonfatal myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. RESULTS At a median follow-up of 2.2 years, a primary outcome event had occurred in 123 patients in the invasive-strategy group and in 129 patients in the conservative-strategy group (estimated 3-year event rate, 36.4% vs. 36.7%; adjusted hazard ratio, 1.01; 95% confidence interval [CI], 0.79 to 1.29; P=0.95). Results for the key secondary outcome were similar (38.5% vs. 39.7%; hazard ratio, 1.01; 95% CI, 0.79 to 1.29). The invasive strategy was associated with a higher incidence of stroke than the conservative strategy (hazard ratio, 3.76; 95% CI, 1.52 to 9.32; P=0.004) and with a higher incidence of death or initiation of dialysis (hazard ratio, 1.48; 95% CI, 1.04 to 2.11; P=0.03). CONCLUSIONS Among patients with stable coronary disease, advanced chronic kidney disease, and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of death or nonfatal myocardial infarction

Health status after invasive or conservative care in coronary and advanced kidney disease

BACKGROUND In the ISCHEMIA-CKD trial, the primary analysis showed no significant difference in the risk of death or myocardial infarction with initial angiography and revascularization plus guideline-based medical therapy (invasive strategy) as compared with guideline-based medical therapy alone (conservative strategy) in participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease (an estimated glomerular filtration rate of &lt;30 ml per minute per 1.73 m2 or receipt of dialysis). A secondary objective of the trial was to assess angina-related health status. METHODS We assessed health status with the Seattle Angina Questionnaire (SAQ) before randomization and at 1.5, 3, and 6 months and every 6 months thereafter. The primary outcome of this analysis was the SAQ Summary score (ranging from 0 to 100, with higher scores indicating less frequent angina and better function and quality of life). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate the treatment effect with the invasive strategy. RESULTS Health status was assessed in 705 of 777 participants. Nearly half the participants (49%) had had no angina during the month before randomization. At 3 months, the estimated mean difference between the invasive-strategy group and the conservative-strategy group in the SAQ Summary score was 2.1 points (95% credible interval, 120.4 to 4.6), a result that favored the invasive strategy. The mean difference in score at 3 months was largest among participants with daily or weekly angina at baseline (10.1 points; 95% credible interval, 0.0 to 19.9), smaller among those with monthly angina at baseline (2.2 points; 95% credible interval, 122.0 to 6.2), and nearly absent among those without angina at baseline (0.6 points; 95% credible interval, 121.9 to 3.3). By 6 months, the between-group difference in the overall trial population was attenuated (0.5 points; 95% credible interval, 122.2 to 3.4). CONCLUSIONS Participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease did not have substantial or sustained benefits with regard to angina-related health status with an initially invasive strategy as compared with a conservative strategy

Health-status outcomes with invasive or conservative care in coronary disease

BACKGROUND In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients. METHODS We assessed angina-related symptoms, function, and quality of life with the Seattle Angina Questionnaire (SAQ) at randomization, at months 1.5, 3, and 6, and every 6 months thereafter in participants who had been randomly assigned to an invasive treatment strategy (2295 participants) or a conservative strategy (2322). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate differences between the treatment groups. The primary outcome of this health-status analysis was the SAQ summary score (scores range from 0 to 100, with higher scores indicating better health status). All analyses were performed in the overall population and according to baseline angina frequency. RESULTS At baseline, 35% of patients reported having no angina in the previous month. SAQ summary scores increased in both treatment groups, with increases at 3, 12, and 36 months that were 4.1 points (95% credible interval, 3.2 to 5.0), 4.2 points (95% credible interval, 3.3 to 5.1), and 2.9 points (95% credible interval, 2.2 to 3.7) higher with the invasive strategy than with the conservative strategy. Differences were larger among participants who had more frequent angina at baseline (8.5 vs. 0.1 points at 3 months and 5.3 vs. 1.2 points at 36 months among participants with daily or weekly angina as compared with no angina). CONCLUSIONS In the overall trial population with moderate or severe ischemia, which included 35% of participants without angina at baseline, patients randomly assigned to the invasive strategy had greater improvement in angina-related health status than those assigned to the conservative strategy. The modest mean differences favoring the invasive strategy in the overall group reflected minimal differences among asymptomatic patients and larger differences among patients who had had angina at baseline

Initial invasive or conservative strategy for stable coronary disease

BACKGROUND Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, 121.8 percentage points; 95% CI, 124.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used