Dental Press Endodontics
Dental Press International

v. 01, no. 2

Dental Press Endodontics – ISSN 2178-3713

Dental Press Endod.

v. 01, no. 2

July / August / September



Research challenges

Carlos Estrela

3 3

Download pdf

Show abstract

Discovering new knowledge is an amazing fact. The perception is greater than watching a seed germinate after planting. In fact, the impression you get is as if you were preparing the seed itself. The acquisition of a new knowledge seeks to answer open and necessary questions for the progress which characterizes its importance in all areas of human life. Currently, many people fully commit their lives to this essential sector.

The “social and economic development of a country” is linked to science and present technology. Trained staff (researcher), an appropriate location (laboratory) and a condition for execution (available resources) are indispensable. The speed of economic and political return difficults the interests and investments in advances in research and training of new researchers. Brazil has witnessed a special moment, with well-deserved international prominence. It is observed that in several high-impact journals stands a growing number of studies by Brazilian researchers.

The interrelationship between teaching and research values the teacher-researcher, as well as the student, which characterizes the basic goal of knowledge. The association between education and research in dentistry facilitates the understanding of the scientific method, highlighting the need of the teacher-researcher understand it with a view to better implementation. It is worth recalling that the practice of science (educational-investigative, based on the construction and transmission of knowledge) is difficult to be explained and passed, imposing for the correct valorization and learning, the need to experience it. Be open to redirect it when it is needed becomes a constant.

A research challenge is to keep alive the reasons for seeking solutions to the problems created. Scale the consequences of the responses or trials, joys and frustrations, success or failure of the researcher is unpredictable. The balance and timing are crucial to the process. The motivation of the researcher can never end, as well as the value of the teacher, researcher, and father... The perfect interaction between the researcher and his students develops when both have maintained similar levels of reasons for the findings.

Learning teaching (self-education), research (understanding how to solve their own problems), and keep alive the motivation (energy that moves the man) are essential means to education, science and life.

Endo in Endo

Calcific metamorphosis and aseptic necrosis of the pulp: Differential diagnosis of tooth discoloration

Alberto consolaro, Leda A. Francischone, Renata Bianco Consolaro, João Batista Gagno Intra, Armelindo Roldi

11 20

Download pdf

Show abstract

Considerations and assumptions

Scientifically, the following questions have not been accurately answered yet:

  • 1. What determines tooth color, its shades and hues and its variations even in the same person?
  • 2. Does tooth color result from the distribution of a pigment at variable concentrations in tooth structure?
  • 3. Is color a consequence of the level of mineralization of tooth tissues, their thickness or mineral density?
  • 4. Is tooth color genetically determined and what is the genetic transmission pattern?
  • 5. Do teeth have the same color primarily, which then undergoes changes due to intrinsic or extrinsic environmental factors to which the individual is exposed since the first moments of life?


Original articles

Influence of the sodium hypochlorite on the healing process of the dog’s teeth treated in single-visit

Mauro Juvenal Nery, João Eduardo Gomes-Filho, Roberto Holland, Valdir de Souza, Pedro Felício Estrada Bernabé, José Arlindo Otoboni Filho, Elói Dezan Júnior, Luciano Tavares Angelo Cintra, Carolina Simonetti Lodi

Root canal treatment. Irrigating solution. Sodium hypochlorite. Biocompatibility. Healing process.

21 27

Download pdf

Show abstract

Introduction: Elimination of bacteria from root canals is essential in the endodontic treatment of necrotic pulp teeth once bacteria not only cause, but also maintain, periapical lesions.

Objective: The aim of this study was to analyze, in vivo, the influence of the irrigating solutions (1.0% NaOCl, 2.5% NaOCl, 0.9% sterile saline) in single-visit treatment of dogs’ teeth with chronic periapical lesion.

Methods: Forty root canals from three Beagle dogs were left exposed to the oral cavity to allow contamination and formation of the chronic periapical lesion. After that, the root canals were biomechanically prepared. During the instrumentation, three irrigating solutions were used: G1- 2.5% NaOCl; G2- 1.0% NaOCl; G3- 0.9% sterile saline. Control Group (G4) had no treatment and no coronal sealing. The root canals were filled with gutta-percha points and Sealapex. The crown openings were sealed with IRM® and amalgam. After six months, the animals were sacrificed and blocks of tissue histologically processed to be stained with hematoxylin and eosin, or Brown and Brenn.

Results: There was no histological difference between the utilization of 1.0% or 2.5% sodium hypochlorite (p>0.05), but between them and sterile saline (p<0.05).

Conclusion: It was concluded that the use of irrigating solutions with antibacterial potential (1% or 2.5% sodium hypochlorite) provided more favorable conditions for the healing process.

Filling displacement after apicectomy with different instruments: A scanning electron microscopic study

Carlos Alberto Herrero de Morais, Fabrício Dias de Souza, Hugo Ricardo Croti, Danilo Mathias Zanello Guerisoli, Marco Antonio Húngaro Duarte

Apicectomy. Apical surgery. Filling displace

28 33

Download pdf

Show abstract

Objective: To evaluate the displacement of the filling in root canals after apical root resection using various instruments.

Methods: Sixty extracted human canines had their crowns removed at the cement-enamel junction, were instrumented and filled 1 mm short of the apex and randomly assigned to six groups, according to the instruments used for apical root resection 3 mm from the apex. The displacement of the filling during the resection procedure was evaluated under a scanning electron microscope by measuring the gap formed between the root canal wall and the material.

Results: Statistical analysis between groups was performed (Tukey-Kramer’s test), revealing that gaps between the filling material and dentinal walls were smaller in the group where Zekrya surgical burs were used, compared to the other tested instruments (p<0.05).

Conclusions: Apical root resection using Zekrya surgical burs promotes less displacement of the filling when compared to the other tested instruments.

Antibacterial action of intracanal medicaments on infected dentin of deciduous and permanent teeth

Giovanna P. S. R. Rezende, Daniel A. Decurcio, Carlos Estrela, Luciane R. R. S. Costa

Calcium hydroxide. Propolis. Biofilms. Enterococcus faecalis.

34 39

Download pdf

Show abstract

Objective: The purpose of this study was to evaluate the antimicrobial effectiveness of intracanal medicaments on infected dentin of deciduous and permanent teeth.

Methods: Dentin blocks were inoculated with Enterococcus faecalis every 72 h for 60 days; then they were irrigated, dried and completely filled with one of the following mixtures: 1) Calcium hydroxide powder, propolis and propylene glycol; 2) calcium hydroxide powder and propylene glycol; 3) calcium hydroxide powder and sterilized water; 4) propolis and propylene glycol; 5) propolis and sterilized water. After 30 days, the samples were washed with sterilized water, immersed in Letheen Broth and incubated for 48 hours at 37 ºC.

Results and Conclusion: The hypothesis that the association of calcium hydroxide with propolis would be more effective than the medicaments themselves was not confirmed, as the results indicated that all the mixtures tested were not able to inhibit E. faecalis biofilm, either in dentin blocks of deciduous or permanent teeth.

Analysis of concentration and storage method of sodium hypochlorite solutions in dental offices

Matheus Albino Souza, Charles da Cunha Pereira, Roberta Müller, Márcio Luiz Fonseca Menin, Doglas Cecchin, Ana Paula Farina

Sodium hypochlorite. Titration. Concentration. Storage.

40 44

Download pdf

Show abstract

Objective: Evaluate the concentration and storage method of sodium hypochlorite solution in dental offices from Santa Cruz do Sul/RS, Brazil.

Methods: Fifty samples of the solution were collected, where, by titration, we analyzed the concentration of active chlorine. Besides the collection, a questionnaire was conducted in order to verify the type of packaging and cover that the sodium hypochlorite solution was in, as well as the storage location.

Results: Thirty-eight of the 50 samples tested had concentrations below the indicated, 3 had active chlorine content above of the information from the professional and only 9 had the indicated concentration. As regards the packaging and the type of cover that hypochlorite solutions were stored, 40 of the 50 samples were stored in milky plastic containers, 6 in amber plastic containers, 3 in transparent plastic containers and 1 in glass bottle. Regarding the type of cover, 46 of the collected solutions were found stored in containers with screw cover, and only 4 in packages of pressure cover. Moreover, 43 of the 50 solutions collected were stored in cabinets, 6 in refrigerated environments and 1 was found on the counter next to a stove.

Conclusion: The majority of the sodium hypochlorite solutions collected and analyzed showed a lower percentage of active chlorine than the informed by the professional, were stored in milky plastic containers with screw cover and kept at room temperature in cabinets.

Use of nickel-titanium rotary instruments by endodontists in the state of Rio Grande do Sul, Brazil

Clacir de Lourdes Londero Zenkner, Claudia Londero Pagliarin, Gabriele Pavanelo Perez, Fernando Branco Barletta

Instrumentation. Endodontics. Diffusion of innovation.

45 51

Download pdf

Show abstract

Objective: To assess the use of nickel-titanium rotary instruments among endodontists in the state of Rio Grande do Sul, southern Brazil.

Methods: A survey was conducted with all endodontists registered at the Regional Council of Dentistry (CRO/RS).

Results: A total of 430 questionnaires were sent to endodontists via regular mail, and 106 returned (25% return rate). The great majority of respondents (88.7%) reported to have already used nickel-titanium rotary instruments, and 44.3% of these reported to have received training as part of lato sensu specialization programs. The main advantages associated with rotary vs. manual instrumentation were less fatigue to the professional and improved comfort to the patient (29%), and faster instrumentation (24.9%). Cost was the most frequent reason for not using or for interrupting use of rotary instrumentation (55.8% and 59.3%, respectively). The most frequent problem observed was file fracture (54%). A longer time working as an endodontist negatively influenced the use of endodontic instruments (p = 0.03), but did not affect file fracture.

Conclusion: Most of the endodontists in the state of Rio Grande do Sul use and recognize the benefits of rotary instrumentation. However, the high costs involved and frequent file fracture impede a more extensive use of this technology.

In vitro efficiency evaluation of an electronic apex locator in teeth with simulated root resorption

Emmanuel João Nogueira Leal da Silva, Isabela Reis Portella, Patricia Reis Rezende Brito, Karen Machado Magalhães, Tauby de Souza Coutinho-Filho

Odontometry. Tooth resorption. Endodontics.

52 56

Download pdf

Show abstract

Objective: This in vitro study evaluated the efficiency of electronic apex locator Novapex (Forum Technologies, Israel) in determining the working length, when used in different clinical situations, as in teeth with simulated external and internal resorption.

Methods: Thirty single-rooted extracted human teeth (mandibular canines), with completely formed apices and with the same pattern of volume in the apical region, were used, using only its root portion. Initially, the length of each tooth was visually determined with a #10 K-file until the appearance of the apical foramen, subtracting 1 mm, setting the real work length measurement. The measure was taken again with the use of electronic apex locator apparatus and considered Novapex initial electronic length. Soon after, the wears were prepared to simulate the external and internal resorption. Measurements were taken again with the apex locator, and these were tabulated and analyzed.

Results and Conclusion: The results showed that Novapex was highly accurate when considering 1-mm changes in the pre-determined measure. Through this study, we found that the apical locator Novapex was effective, showing to be a reliable method and no significant interference in his reading was detected when simulated external and internal resorption were present.

Incidence of flare-ups in endodontic treatments performed in necrotic teeth in a single and in multiple sessions

Flávia Villela Laurindo, Manoel Matos Neto, Alexandre Mascarenhas Villela, Matheus Melo Pithon

Pain. Endodontics. Dental caries.

57 63

Download pdf

Show abstract

Objective: At present, the literature presents many controversies when correlating the incidence of flare-ups with the approach to endodontic treatment in a single session and multiple sessions.

Methods: The aim of this study was to make a comparative evaluation of the incidence of flare-ups in 117 patients submitted to endodontic treatment in a single session and in multiple sessions.

Results: The results presented by patients that are attended in a single session showed no statistically significant differences from those who were attended in multiple sessions.

Conclusion: According to this study, it was concluded that the number of interventions necessary to conclude endodontic therapy has no correlation with the incidence of flare-ups.

Filling of a C-shaped canal using the Epiphany System and McSpadden compactors

André Luiz da Costa Michelotto, Joel Alves da Silva Jr., Marili Doro Andrade Deonizio

Root canal filling. C-shaped canal. Endodontics.

64 69

Download pdf

Show abstract

The aim of this paper was to report two cases of lower second molars, presenting C-shaped root canal systems. The procedures for root canal treatment were described and discussed along with those presented in the literature. Root canal preparation was performed using a reciprocating system, and the root canal filling was performed using the Epiphany system associated with the McSpadden compactor.

Apical surgery in complement to the endodontic treatment: Case report

Maria Antonieta Veloso Carvalho de Oliveira, Juliana Soares, Kellen Cristina Mendes Azevedo, João Carlos Gabrielli Biffi, Leandro Carvalho Quirino, Rodrigo Antônio Faria

Root canal treatment. Surgical retreatment. Root-end filling. Retrofilling. MTA.

70 74

Download pdf

Show abstract

Introduction: The failure of endodontic treatment may be related primarily to complications arising from the execution of technique, such as the persistence of microorganisms in the canals and iatrogenies. However, even after an endodontic treatment considered technically correct, the persistence of infection may be related to the complexity of the root canal system and extra-radicular factors located within the inflamed periapical tissue. The resolution of failures or accidents in endodontic treatment can be achieved through the retreatment and if necessary, an apical surgery.

Objective: This article describes a case of endodontic treatment followed by apicectomy surgery with retrofilling using Mineral Trioxide Aggregate (MTA) with a 5 years follow-up.

Conclusion: In view of the clinical case follow-up, we can conclude that in teeth with persistent periapical lesions and fistula, after having undergone an appropriate endodontic treatment, surgical retreatment with retrofilling can be an efficient option in the resolution of the infection and periapical tissue repair.

The distance from the intraradicular post tip to the dental apex influences the degree of apical periodontitis

Etevaldo Matos Maia Filho, Suzanni do Amaral Rodrigues Veloso, Cláudia de Castro Rizzi, Fernanda Ferreira Lopes, Erick Miranda Souza

Periapical periodontitis. Root canal filling. Endodontics.

75 80

Download pdf

Show abstract

Objective: The objective of the present study was to investigate the relation between the distance from the intraradicular post tip to the radiographic apex (D) and the degree of apical periodontitis (AP).

Methods: Full mouth periapical radiographs (n=14) were randomly selected from patients of the clinic of orthodontics of Centro Universitário do Maranhão (São Luiz/MA, Brazil). The sample was composed by the first 270 teeth presenting posts (convenience sample). The radiographic analysis was performed using the Periapical Index (PAI). An ordinal regression was used to test the null hypothesis that the degree of AP does not change according to D. The odds ratio (OR) with an confidence interval of 95% (CI 95%) was calculated to estimate the risk of occurring PAI scores 4 and 5 in the teeth with D≤5 mm.

Results: A significative relation between D and PAI was found. Teeth with lower values of D were more prone to present greater values of PAI (R2N =0.167, p&li;0.05). The risk of teeth with D≤5 mm to present PAI scores 4 and 5 was 2.82 times bigger (OR = 2.82, p&li;0.001, CI 95%: 1.6-4.76).

Conclusion: The distance from the intraradicular post to the dental apex had influenced over the degree of AP. The closer the post was from the apex, the higher was the degree of apical periodontitis. Teeth with D≤5 mm showed a 3-fold greater chance of presenting high indices of apical periodontitis.

Modern endodontic microsurgery treatment improves the outcome of challenging cases: A series report

Warley Luciano Fonseca Tavares, Renata Carvalho Portes Lopes, Luiz Carlos Feitosa Henriques, Gustavo Batista de Menezes, Antônio Paulino Ribeiro Sobrinho

Root canal therapy. Biocompatible materials. Dental infection control. Microsurgery.

81 88

Download pdf

Show abstract

Objective: The aim of this report was to describe challenging cases of modern endodontic microsurgery in teeth with persistent periodontitis following previous endodontic treatment.

Methods: Four challenging cases of modern endodontic microsurgery were evaluated.

Results: Healing has occurred at 6 and 12-month review appointments.

Conclusion: The removal of the contamination and satisfactory sealing of the root canal system were paramount for the success observed in these cases. Modern microsurgery protocol with the use of a magnified view, ultrasonic tips and biocompatible materials are an important component of endodontic surgery, improving the success when compared to traditional technique

Accidental swallowing of a Protaper® file during root canal treatment

Simony Hidee Hamoy Kataoka, Flávio Moreira, Lisandro de Boutteville, Celso Luiz Caldeira, Oscar Faciola Pessoa

Deglutition. Rubber dams. Root canal preparation.

89 93

Download pdf

Show abstract

Objective: To demonstrate to the general practitioner the importance of the use of rubber dam during endodontic treatment through a case report where was described the monitoring employed with a patient who accidentally ingested a rotary file S1 ProTaper® (Dentsply Maillefer, Switzerland) during the root canal preparation.

Case report: A 28 years-old patient underwent root canal treatment without rubber dam and during the root canal therapy, swallowed a ProTaper® S1. He was accompanied to the hospital where, at first, was performed a gastrointestinal high endoscopy and a CT scan. He remained asymptomatic after these two early interventions, was monitored over four days, through X-rays of chest and abdomen, until the foreign body was eliminated.

Conclusion: General practitioners who do endodontics should be aware of the risks involved in swallowing and/or accidental aspiration of foreign bodies during endodontic treatment, and know how to avoid this problem by adopting a simple measure, the use of rubber dam.

Dental Press Endodontics - v. 01, no. 2 Download full issue pdf