Combined Endodontic and Surgical Therapy for Resolution of Type III Dens Invaginatus

Dens invaginatus is an abnormal dental developmental, probably resulting of the invagination of mineralized tissues from the tooth crown surface before its calcification. The teeth that are most affected by this abnormality are the maxillary lateral incisors. This dental developmental anomaly has various types and the rarest is type III which has the worst prognosis, because of its complex anatomy. Conventional root canal therapy may not sufficiently resolve the case itself and in some circumstances the surgical intervention is also necessary. This report addresses a complex combined endodontic treatment of a type III dens invaginatus in a maxillary lateral incisor in an 18 years-old female patient, with an extensive periapical lesion affecting the buccal and palatine cortical bone, diagnosed by cone-beam computed tomography (CBCT). The case was conducted with the combination of endodontic and surgical treatment, under the use of the surgical operating microscope. The association of CBCT, visual magnification, XP-endo Finisher, bioceramic sealer, MTA Repair HP and bone graft were important to ensure predictable success.Keywords: Bioceramic Sealer; Dens Invaginatus; Endodontic Surgery; Endodontic Therapy; Periapical Lesio

Guided Endodontics in Complex Scenarios of Calcified Molars

This study aimed to report a case series and describe the use of guided endodontics in complex symptomatic cases of mandibular and maxillary molars; presenting calcification of all three root canals. The arches of the referred patients were scanned, and high-resolution cone-beam computed tomography (CBCT) imaging was performed. Then, the taken CBCT and tooth scans were aligned and processed using software. A virtual copy of a drill was superimposed onto the scans and evaluated in 3 dimensions. Subsequently, a 3-dimensional (3D) template was designed and printed. Drilling was performed and a radiograph was taken to confirm its position. The canals were reached and endodontic treatment was performed. At the 12-month follow-up, the teeth were completely asymptomatic. The use of guided endodontics _in cases of calcification in molars_ was demonstrated to be a viable and reliable alternative treatment. The technique was based on 3D planning.Keywords: Access Opening; Apical Periodontitis; Dental Trauma; Guided Endodontics; Pulp Canal Calcification

Scanning Electron Microscopic/Energy-Dispersive X-Ray Analysis in Cases of Apical Periodontitis Refractory to Endodontic Treatment: A Case Series Study

This study aimed to present a case series of refractory endodontic treatment leading to persistent apical periodontitis. All cases were submitted to scanning electron microscopic/energy-dispersive X-ray analysis (SEM/EDS) of the external surface of the surgically removed samples and identification of the elements present in the specimens. Carbon, oxygen and calcium were elements present in all of the cases in this study. The presence of microorganisms in close contact with the periapical surrounding tissues induced the perpetuation of the inflammation process. Despite the presence of other elements different from those normally expected in the tissues, we may not attribute any interference in the periapical response to them.Keywords: Apical Periodontitis; Bacterial Biofilm; Endodontic Failure; Extra Radicular Infection

Limitations and Management of Static-guided Endodontics Failure

Endodontic treatment in severely calcified canals is always a challenging task because it can result in accidents such as deviations or perforations. Recently, guided endodontics has become an alternative approach for pulp canal calcification, facilitating the location of root canals more predictably through the combined use of cone-beam computed tomographic imaging, oral scanning, and endodontic access guides. Although several reports have shown that guided endodontics is safer, faster and can be performed without an operating microscope and by less experienced operators, the technique has limitations, and iatrogenesis may occur. This article describes the limitations of static-guided endodontics and possible causes of failures. In the present case, not fixing the guide to the bone and inaccuracies generated by manually performing mesh merger software led to root perforation. Endodontic microsurgery was effective in resolving this case and should be considered the treatment of choice when guided endodontics cannot be used safely or when it fails

Microbial Ecosystem Analysis in Root Canal Infections Refractory to Endodontic Treatment

Introduction To combine Multiple Displacement Amplification (MDA) and checkerboard DNA–DNA hybridization to qualitatively and quantitatively evaluate the microbiota present in infections refractory to endodontic treatment. Methods The subjects of this study were 40 patients presenting periapical lesions refractory to endodontic treatment. Samples were taken by scraping or filing root canal walls with a #10 K-type hand file. Sample DNA was amplified by MDA, and the levels of 107 bacterial taxa were analyzed by checkerboard DNA–DNA hybridization. The taxa were divided into three distinct microbial populations, depending on their mean proportion in samples (% DNA probe counts ± SEM), as follows: dominant (≥3.0%), sub-dominant (\u3e1.6 to 3.0%) and residual (≤1.6%) populations. The significance of differences was determined using the Mann-Whitney test. Results The taxa present with the highest mean proportions (constituting the dominant population) were Corynebacterium diphtheriae (8.03±0.98), Porphyromonas gingivalis (5.42±2.09), Streptococcus sobrinus (5.33±0.69), and Stenotrophomonas maltophilia (4.72±1.73). Among the sub-dominant population were Eubacterium saphenum (3.85±1.06), Helicobacter pylori (3.16±0.62), Dialister pneumosintes (3.12±1.1), Clostridium difficile (2.74±0.41), Enterobacter agglomerans (2.64±0.54), Salmonella enterica (2.51±0.52), Mobiluncus mulieris (2.44±0.6), and Klebsiella oxytoca (2.32±0.66). In the population of bacteria present at the lowest mean proportions (the residual population), Bacteroides ureolyticus (0.04±0.01), Haemophilus influenzae (0.04±0.02), and Prevotella oris (0.01±0.01) were found at the lowest mean proportions. Enterococcus faecalis was detected in the residual population (0.52±0.26). Conclusion The microbial climax community in teeth refractory to endodontic treatment not only harbor medically important species, but also contains distinct microbial consortia present with different population levels

Antimicrobial photodynamic therapy and guided endodontics: A case report

A 35-year-old woman with a history of pulp canal obliteration (PCO) and apical periodontitis was treated with guided endodontics combined with antimicrobial photodynamic therapy (aPDT). The use of aPDT was paramount to the approach performed, and its application should be encouraged in cases of severely calcified canals when apical patency is unachievable. The combination of these techniques ensured successful clinical, radiographic, and tomographic outcomes at the 1-year follow-up

Multiple Microsurgery Intervention with Apicoectomy Guidance in Single Session: A Case Report

The aim of this manuscript is to describe and discuss the advantages and obstacles of using a guided implant system adapted for endodontic microsurgery in the execution of a case with indication of multiple endodontic microsurgery intervention in a single appointment. Cone-beam computed tomography (CBCT) scans were aligned and processed with the planning software, complementing the Straumann® guided instruments. The drill handles of the system employed directed milling cutters and guided drills based on the sleeve-in-sleeve concept used in the osteotomy and apical resection of teeth #13, #14, #23 and #24. The root-ends were retro-prepared and sealed with putty bioceramic sealer. The patient was completely asymptomatic at the 12 months follow up visit and CBCT revealed complete tissue healing of the involved teeth. The protocol demonstrated to be reliable and reproducible. Its applicability can be extended to other anatomical complex scenarios. The reproducibility of the technique would encourage the maintenance of teeth in patients with indication to multiple endodontic surgery and permitted the conclusion of this case with precision and comfort to both patient and operator

The use of antimicrobial photodynamic therapy in the successful management of an invasive cervical resorption class 4: A case report with five years follow-up

A 41-year-old male with a dental history of invasive cervical resorption (ICR) was initially treated with a surgical endodontics approach and secondly with antimicrobial photodynamic therapy (aPDT) along with endodontic retreatment. The use of aPDT was essential to promote bacterial reduction in the resorption defect. Combining these techniques allowed for clinical, radiographic, and tomographic success after five years of follow-up

Use of technology in endodontics by undergraduate dental students in a south-eastern state of Brazil

Introduction: This study aimed to determine the level of incorporation of current technologies for endodontic treatment in undergraduate dentistry courses in a south-eastern state of Brazil. Methods: For data collection, a self-assessment-based online questionnaire was created using the “Google Forms” platform, consisting of 12 multiple-choice and a few open-ended questions. The questions were related to the use of current technologies for diagnosis, imaging, use of ultrasonics in endodontics, instrumentation, use of apex locator, microscopy, photodynamic therapy and thermoplastic techniques during endodontic treatment. The questionnaire was sent to 54 dental schools in Minas Gerais. Results: The results show low technological incorporation during the various stages of endodontic treatment by undergraduate students in dentistry courses in Minas Gerais. Conclusion: Despite the availability of several technologies to help perform different stages of endodontic treatment, it was observed that most universities do not teach the use of these technologies. Additional studies are needed to correlate how the lack of incorporation of these technologies could impact on the quality of the endodontic learning for undergraduate students