Dental Press Endodontics
Dental Press International

v. 02, no. 1

Dental Press Endodontics – ISSN 2178-3713

Dental Press Endod.

v. 02, no. 1

January / February / March



To research and to publish: Constant challenges

Carlos Estrela

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Brazil is witnessing a great scientific moment. The vision of self scientific construction, with a value of evidence, valorizes and distinguishes the national research and post-graduation.

The Brazilian research has been well received internationally, which led to the increasing number of citations. These facts have improved the visibility of our researchers, institutes and research laboratories, which favors a higher level of international partnerships and encouragements to keep important new projects.

However, with the increasing volume of research that has been produced, publishing them became another challenge. The specialty journals receive an increasing number of articles each year such a way it is impossible publish all, resulting that many studies correctly outlined don’t represent the real interest. Thus, it becomes natural the anxiety experienced in the whole process of research and publication, which includes the preparation of the study design, the feasibility of the project and its execution and publication. These occur especially when carefully delineated studies are not properly valued.

Thus, new alternatives have been made possible, protecting opportunities to disseminate good researches. The Dental Press Endodontics, in its second year of existence, makes available to researchers, teachers and specialists a new option for submitting their studies. This journal has been wide-read, either nationally or internationally. Proof of this is the English edition of the Dental Press Endodontics which is available for iPad and already totals more than 7,500 download. Countries like the United States, India, China, Japan, Mexico, England, Italy, Spain, Russia and Saudi Arabia have accessed the site from the Apple Store and have downloaded it.

We have been preparing for indexation in the world’s major bases. Starting from this issue this journal will be evaluated by LILACS, BBO, SCOPUS, among others. Our goal, in the near future, is to be approved by the evaluation process of PubMed and achieve international notoriety.

We invite you to submit your work and be part of this story!

Endo in Endo

Repair and regeneration: A contribution to clarify a terminological confusion

Alberto Consolaro

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The concept

The reconstruction of damaged or destroyed areas in the human body can be made by two different and not comparable mechanisms for it occurs in different situations, without competing with each other: The repair and regeneration.

Original articles

Removal of intracanal calcium hydroxide paste with two rotary systems: RaCe and Mtwo

Mehrnoush Ghobadi, Bahareh Dadresanfar, Hamideh Rahmani Raoof, Fatemeh Mashhadi Abbas

Calcium hydroxide. Sodium hypochlorite. Root canal preparation.

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Introduction: The aim of this study was to compare the effectiveness of two rotary systems in calcium hydroxide removal from root canal walls.

Methods: A total of 44 distobuccal root canals of human maxillary molars with curvatures between 15° – 25° were randomly divided into two groups of 20 canals each and two control groups. Specimens in group A were instrumented with RaCe rotary system and in group B with Mtwo rotary system up to #35 (4%). Canals were rinsed by 5 ml of 2.5% NaOCl between each instrument and #10 K-file was used as patency during filling. Calcium hydroxide paste was placed in the canals and after incubation; it was removed from canals by means of master apical rotary and NaOCl in each group. Roots were split longitudinally and the remnants were evaluated by stereomicroscope at three levels using a scoring system. Data were statistically analyzed with ANOVA test.

Results: No significant difference was found in all groups in both RaCe and MTwo systems (p>0.05). Sum of the acceptable scores was found 53.6% in RaCe and 51.3% in Mtwo group, respectively.

Conclusion: None of the canals was totally free of calcium hydroxide remnants. Although there was no significant difference between groups, there was a slightly better clinical impression of cleanliness with Mtwo system as to calcium hydroxide removal.

Anatomic variation of mandibular first molar and the importance of effective cleaning: A case report

Maria Tereza Pedrosa de Albuquerque, Inês de Fátima de Azevedo Jacinto Inojosa, Daniel Pinto de Oliveira, Juliana Yuri Nagata, Paulo de Souza Fraga Filho, Fernanda de Freitas Lins

Models. Anatomic. Molar. Root canal therapy.

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Introduction: Literature relates many classic case reports about anatomic variations of mandibular molars. However, few recent reports have shown treatments of mandibular permanent first molars in according to the current Endodontics view.

Objective: This study aims to report endodontic treatment of a mandibular first molar presenting five root canals emphasizing the importance of an efficient decontamination.

Clinical case: The endodontic treatment was performed through chamber access followed by localization and exploration of the root canals.
Three canals in the mesial root and two in the distal root were noted. Following that, chemical and mechanical preparations were made with rotary and manual files, copiously irrigated with sodium hypochlorite 2.5% throughout all instrumentation. The obturation was made using the Hybrid Tagger technique and the definitive restoration was completed one week later.

Conclusion: Knowledge of root canal sys tem anatomy of mandibular first molars aggregates information in this area, as it will help dental professionals more successfully attempt endodontic treatment.

Radiographic evaluation of root canal treatment technical quality in a Brazilian population

João Eduardo Gomes-Filho, Luciano Tavares Angelo Cintra, Mauro Juvenal Nery, Roberto Holland, Valdir de souza, Pedro Felício Estrada Bernabé, José Arlindo Otoboni Filho, Elói Dezan Júnior, Marianne Di Paula, Camile Marques Gonçalves, Carolina Simonetti Lodi

Follow up. Success rate. Obturation. Education.

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This investigation aims to assess the prevalence of detectable apical periodontitis in periapical radiographs and the relationship between disease and quality of root fillings performed by undergraduate students. A random sample of 131 records of patients who had received root canal treatment (RCT) at the Araçatuba School of Dentistry – UNESP was investigated. Anamnesis, clinical examination to attempt to the pain symptom, presence and quality of the restoration, periodontal pocket, dental mobility and occlusal trauma radiographies were evaluated. The percentage of success obtained with the treatment performed by under graduate students was 87,7%. When the treatment was adequate (43 cases) the percentage of success was 90,69% (39 cases), while for the inadequate treatments (14 cases) the percentage of success was 78,57% with no statistically significant difference (p>0.05). It was not observed statistically significant difference in the success rate related to the gender (p>0.05). The pulp condition also did not interfered on the success rate (p>0.05). It was concluded that the endodontic treatment was satisfactory and achieved a suitable success rate around 90% of the cases.

NiTi endodontic intraosseous implant

J. Edgar Valdivia Cardenas, Enrique Hair Salas Beltrán, Felipe Hernández Añaños

Dental implantation. Intraosseous. Endodontic. NiTi. Root canal therapy.

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Introduction: The Endodontics Implants are the metallic extension intraosseous of a tooth root. They are specially indicated for tooth stabilization. Also, considered an artifice to increase root length in an artificial way, the treated piece can endure the dynamism of its function.

Objective: The objective of this case report is to present a conservative treatment to stabilize and create conditions for restorable two lower incisors, which were implanted in two endodontic intraosseous stabilizers made of NiTi endodontic files in order to restore its function in dental system.

Uncommon fractures of Gates Glidden bur

Fausto Rodrigo Victorino, Renata Fernandes

Endodontics. Root canal therapy. Fracture zone.

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Introduction: Gates Glidden bur, used for preparation of cervical and middle root canal has a weak point on its stem, far from the active point where fractures usually occur, which facilitates its removal.

Objective: To present a case of Gates Glidden bur fracture near its active portion, an unusual fracture site for this instrument.

Clinical case: A 21-years old patient was submitted to endodontic treatment of tooth #37. During preparation of the cervical canal and middle thirds, a fracture occurred in the active tip of the Gates Glidden bur, with its active portion getting trapped in the middle third of the mesial buccal canal. The fractured fragment was removed through the use of a CVDent 1000 (CVDentus) ultrasonic device with a T0S-P1 tip. The fractured bur was removed and the treatment successfully completed. At one year radiographic control, the periapical tissues presented a normal aspect.

Conclusion: According to this present case study, it is possible to say that Gates Glidden bur may suffer an unusual fracture, which makes very difficult their removal from root canal; so, it is advisable to follow always the usage recommendations.

Endodontic files: To sterilize or to discard?

Manuel Marques Ferreira, Andre Luiz da Costa Michelotto, Ana Rita Alexandre, Rodolfo Morganho, Eunice Virginia Palmeirão Carrilho

Prions. Dental infection control. Creutzfeldt-Jakob syndrome. Endodontics.

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Objective: The purpose of this study was to examine both qualitatively and quantitatively the presence of organic debris on endodontic files decontaminated and sterilized after use.

Methods: Thirty K files #30 were used, 10 of which served as positive and negative control. Ten pig molars were instrumented using the Crown-Down technique by inserting one file in each root canal, totaling 25 files. The files in group 1 (n=10) were sterilized by autoclave. Files in group 2 (n=10) were placed in an ultrasonic bath with enzyme solution and then sterilized by autoclave. Those in group 3 (n=5) were used but not sterilized, and finally the files in group 4 (n=5) were neither used nor sterilized. The experimental and control files were subsequently stained with Van Gieson’s solution and observed by optical microscopy. A value representative of the amount of organic material still present on the file was then assigned in accordance with a previously established scale. The same measurement was carried out in the apical, middle and cervical thirds of each file body while tables were formulated comparing the different groups.

Results: The results demonstrated that both experimental groups produced significantly inferior results compared to the files in the positive control group.

Conclusions: In comparing the experimental groups, the files immersed in ultrasonic bath with enzyme solution exhibited values that were inferior to those of the files which had not been subjected to this procedure.

Non-surgical treatment of pulp canal obliteration using contemporary endodontic techniques: Case series

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

Dental pulp calcification. Endodontics. Radiographic image interpretation. Computer-assisted.

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Pulp canal obliteration (PCO) is defined as a deposition of hard tissue within the root canal space. These tissues can eventually produce the radiographic appearance of a root canal space that has become partial or completely calcified. Success in root canal treatment is based on proper debridement, disinfection and obturation of the root canal system. However, this procedure may be difficult or even impossible to achieve if the pulpal space is calcified. The endodontic treatment performed under these circumstances pose the risk of root perforating, a complication that seriously affects the long-term prognosis of tooth. The present article discusses a series of cases of endodontic treatment in teeth with partially or completely PCO and methods for the clinical management of these cases using contemporary endodontic techniques.

Clinical application of Portland cement

Fabiano de Sant’Ana dos Santos

Endodontics. Periapical abscess. Apicoectomy. Retrograde obturation. Dental materials.

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Introduction: Teeth with periapical lesions require special treatment. In this sense, periapical surgery followed by retrograde filling with a biocompatible material and induced tissue repair is indicated. The Portland cement (PC) has all the characteristics of mineral trioxide aggregate (MTA), indicated for endodontic treatment complex. The PC has no radiopacity, however presents low cost. Objective: To present a clinical case that conducted a periapical surgery followed by retrograde filling sealed by PC.

Results: After 40 months, radiographic images suggested repair of periapical lesion and the clinical appearance.

Conclusion: Periapical surgery with retrograde filling with PC suggested efficacy. The treatment presented low cost to the patient. The PC is an alternative to make up the arsenal of the endodontist dental materials.

Computed tomography in the diagnosis of root perforation

Priscila Dias Peyneau, Claudia Scigliano Valerio, Andréia Cruz Pires Ribeiro de Sousa, Flávio Ricardo Manzi

Root canal therapy. Tooth root. Cone-beam Computed tomography. Diagnosis. Root canal therapy.

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Introduction: Perforation is defined as communication between the root canal and the external tooth surface, normally occurs during endodontic treatment and is induced by iatrogenic causes. There are some conditions that favor the perforations, among others the irregular morphology of root canals, root dilaceration, error during pulp chamber preparation, excessive wear of root canal walls and inadequate preparation for intraradicular post placement.

Methods: The definitive diagnosis of this type of iatrogenic condition is very difficult due the limitation of periapical radiography, as it offers a two-dimensional image and superimposition of structures. For this reason, imaging methods such as computerized tomography, which allows all the root faces to be evaluated, should be used in order to diagnose and inform the location of root perforations with greater precision.

Conclusion: The present study demonstrated the importance of cone beam computerized tomography in the diagnosis of root perforation in three clinical cases.

Comparison of the preparation time and deviation caused by Twisted File and Endowave systems in simulated root canals

Arnaldo Sant’Anna-Júnior, Marco Antonio Hungaro Duarte, Juliana Tieme Yoshida, Juliane Silveira Bernardes, Paloma Gagliardi Minotti-Bonfante, Marcus Vinícius Só

Endowave system. Twisted File system. Rotary system. Apical deviation. Deformation of instruments.

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Introduction: The objective of this work was to compare the time required for preparation of simulated root canals, as well as the deviation in degrees caused by the Twisted File and Endowave rotary systems.

Methods: This study was conducted on thirty acrylic blocks with simulated root canals with 30º curvature, which were divided into two groups: Group I – Twisted File system; Group 2 – EndoWave system. The preparation was conducted using the X-Smart motor with 1.4 N/cm of torque at a speed of 250 rpm. The blocks with the instruments were radiographed before and after preparation. The radiographs were then digitized for analysis of the angle formed before and after preparation, using the Image Tools software. The preparation time, number of deformed and fractured instruments and deviation were analyzed.

Results: The results showed that preparation using the Endowave system was significantly faster (p > 0.05) and exhibited less fractures when compared to the Twisted File system. As to the apical deviation, both presented significant deviations (p < 0.05), especially on the inner wall, without significant difference (p > 0.05) between groups.

Conclusions: It was concluded that preparation of simulated root canals using the Endowave system was faster than the Twisted File, with a lower fracture rate.

Knowledge and attitudes of Physical Education undergraduates regarding dental trauma

Ana Helena Gonçalves de Alencar, Kely Firmino Bruno, Maria do Carmo Matias Freire, Marina Rodrigues de Moraes, Luana Braz de Queiroz

Dental trauma. Prevention. Dentoalveolar trauma.

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Introduction: Dental trauma may result in pulpal and periodontal injuries, which cause a negative impact on life quality. Its prognosis is highly influenced by the emergency care.

Objectives: This study aimed to investigate the self-perceived knowledge of undergraduate students Physical Education and attitudes regarding dental trauma.

Methods: Cross-sectional study using a questionnaire to collect information on the profile, knowledge and attitudes of Physical Education undergraduates from four universities in the municipality of Goiânia, Goiás state, Brazil, regarding emergency care for dental trauma patients.

Results: Among the 392 participants, most were male (54.3%) and aged between 20 and 29 years (59.2%). Less than half of them (46.5%) received first-aid training during the course, only 4.4% of them received information on dental trauma, and 74.1% reported lack of knowledge about the subject. Among those who affirmed having some knowledge, 95.6% were dissatisfied with it and did not feel prepared to help the patients. Most (95.7%) of those who were not satisfied with their knowledge declared they would like to receive more information on it.

Conclusions: The Physical Education undergraduate students participating in our study reported insufficient knowledge about dental trauma and inaptitude to provide emergency care to victims of this type of injury. This reveals the need to develop educational strategies to increase their knowledge in order to better contribute to oral health promotion.