Dental Press Endodontics
Dental Press International

v. 04, no. 1

Dental Press Endodontics – ISSN 2178-3713

Dental Press Endod.

v. 04, no. 1

January / April



The current status of young endodontists

Carlos Estrela

007 014

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Endodontics is a specialty that attracts a considerable number of professionals due to its scientific and biological nature, as well as the high degree of involvement of most undergraduate professors. Such factors positively stimulate a tremendous thirst for increasingly up-to-date knowledge which is associated to the most recent technologies.

Despite having dedicated professors, dental surgeons-to-be do not acquire enough endodontic knowledge during college so as to fulfill the clinical needs and complexities of this specialty. Adding well-established protocols — which are continuously discussed and associated to training — to professional clinical practice is an intelligent and necessary measure for those who pursue a successful career.

New dental professionals and young endodontists share the resolution of an imminent and common issue: scientific and clinical preparation necessary to face the daily challenges. The unquenchable thirst for knowledge, the interest in a well-sedimented science and the development of new abilities (continuous psychomotor exercises) favor solution of many issues related to the clinical practice and which may seem impossible to overcome by young endodontists. Those who are open to acquire new knowledge and fearless of making mistakes or being exposed are stimulated to change their attitude and are more likely to successfully overcome the clinical drawbacks they face, all of which favor success and good professional quality of life.

Conversely, some professionals not only believe that they are not able to acquire information, but also do not find pleasure in searching up-to-date science or new knowledge. Working environment and ambience, stress (working routine and fatigue), lack of planning, and daily professional renovation and ability are some of the aspects that must be reanalyzed in order to avoid potential human errors.

Endodontist’s professional ability, whether acquired by young or experienced professionals, requires planning and one of the strategies used to achieve clinical success includes the ongoing quest for excellence in the endodontic science.

Endo in Endo

Why chronic periapical lesions relapse: 15 situations!

Alberto Consolaro

Chronic periapical periodontitis. Relapse. Dentoalveolar abscess. Phoenix abscess. Periapical granuloma. Pericementitis.

007 014

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Some clinical conditions seem to be difficult to explain and/or understand, as it is the case of relapse of chronic periapical lesions. From a pathophysiological standpoint (causes as well as mechanism of action and immune system), a specific approach towards inflammatory periapical lesions may not only broaden one’s understanding, but also deepen clinical approach towards such condition. The aforementioned objective comprised the aim of the present study.

Original Article

In vitro comparison of the efficiency of two electronic apex locators

Sérgio Henrique Staut Brunini, Michel Carlet de Lima, Aryele Cristina Schmidt, Lourival Raimundo dos Santos, Carlos Marcel C. Bonicontro

Odontometry. Root canal preparation. Endodontics.

015 020

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Introduction: Radiography has been widely used to determine working length in Endodontics, even though its limitations have been extensivelly recognized. In order to render the assessment of working length increasingly accurate, different electronic apex locators have been developed.

Objective: The objective of this study is to compare in vitro the effectiveness of two electronic apex locators: Root ZX and Apex DSP.

Methods: After coronary opening and preparation of the cervical and medium thirds of the root canal, a K-type file was inserted into the canal as far as the most cervical edge of the apical foramen. Subsequently, the teeth were placed into containers and embedded in alginate together with the lip clip of the apex locator so as to determine tooth length.

Results: Comparison between measurements showed an 87.5% accuracy rate for Root ZX vs. 77.5% for Apex DSP, suggesting that there is no statistically significant difference between the two apex locators.

Conclusions: Electronic apex locators appear to be efficient and provide a reasonable alternative method to determine the correct working length.

Influence of hypertension on oral infections and endodontic treatment

João Eduardo Gomes-Filho, Christine Men Martins, Gustavo Sivieri-Araujo, Ludmilla Mota da Silva Santos, Índia Olinta de Azevedo Queiroz, Marcelo Tadahiro Wayama, Guilherme Hiroshi Yamanari, Eloi Dezan-Júnior, Luciano Tavares Angelo Cintra

Hypertension. Endodontics. Endodontic medicine.

021 025

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Hypertension is characterized by peripheral vascular resistance that leads to blood pressure increase and several systemic changes that may negatively influence one’s oral health. Thus, the aim of this study was to conduct a literature review on the influence of hypertension over oral conditions and endodontic treatment. Hypertension mainly affects the blood vessels, brain and kidneys. A hypertensive condition can lead to increased levels of parathyroid hormones, abnormal vitamin D metabolism, reduction in the concentration of ionized calcium and decreased calcium absorption. Therefore, hypertension can be closely associated with oral problems such as periodontal diseases, implant loss, difficulty in bone healing, reduced salivary flow and protein concentration in saliva, increased number of neutrophils and, as a consequence, favoring of inflammatory processes. It has also been suggested that the success rate of endodontic treatment in hypertensive patients is lower than in normotensive ones. The response of hypertensive patients to root canal treatment, intracanal medications and sealers should be further studied in order to provide knowledge on the changes, failures and success of endodontic treatment.

Factors that favor tridimensional and hermetic obturation of root canal system

Jefferson J. C. Marion, Déric Meschiari Batista, Sueli Satomi Murata, Valdir de Souza, Roberto Holland

Transverse anatomy. Endodontics. Root canal filling.

026 033

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Objective: This study aims at demonstrating the possibility and importance of filling different types of accessory canals in different teeth.

Methods: The sample comprised 11 cases in which detailed knowledge of the inner anatomy of root canal systems associated with good use of the crown-down preparation technique — irrigation with 1% sodium hypochlorite and 17% trisodium EDTA for cleaning and removing smear layer — enabled different types of filling cement to drain.

Results: Endométhasone, SealapexTM and Zinc Oxide - Eugenol filling cements proved to be efficient in root canal filling with the aid of the Tagger technique.

Conclusion: It could be concluded that a combination of knowledge about anatomy, techniques and substances yield satisfactory results in 3D filling and hermetic seal of root canals, which leads to successful endodontic treatment.

Restorative perspective for endodontically treated teeth: Anatomic post

Maria Geovânia Ferreira, Myrane Cruvinel Nascimento Camapum, Guido Cirilo Ferreira, Marcus Vinícius Perillo, Paula de Carvalho Cardoso, Julio Almeida Silva

Nonvital teeth. Posts. Cores. Dental esthetics.

034 045

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Introduction: Individualized anatomic posts favor adaptation of prefabricated posts to root canal walls and reduce resin cement thickness.

Objective: The aim of this study was to report a case of reconstruction of previously endodontically treated teeth by means of an individualized anatomic post.

Methods: Replacement of endodontically treated central incisor restorations and previous deficient restorations was reported. Initially, deficient resin composites and the individual cast post of tooth #11 were removed. Root canal was endodontically retreated. The amount of residual dentine walls of the root canal were low after removing the endodontic post. Treatment plan included the use of an anatomic post for tooth #11. Composite resin was applied after anatomic post placement. Root canal was shaped by a glass fiber post and composite resin. Subsequently, crown restoration was completed with composite resin.

Conclusion: The technique used to manufacture direct anatomic posts seem to be a good alternative treatment for restoring wide root canals.

Detection of vertical root fractures: An investigation on the impact of using orthogonal and dissociated radiographs in conventional and digital systems

Lisangela da Silva, Priscila Fernanda da Silveira, Mariana Boessio Vizzotto, Gabriela Salatino Liedke, Heraldo Luis Dias da Silveira, Heloísa Emília Dias da Silveira

Diagnosis. Endodontics. Dental radiography.

046 050

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Introduction: Intraoral radiographs are an important investigative aid in the detection of endodontic injuries, including vertical root fractures (VRF).

Objective: The objective of this study was to assess the capacity of orthogonal and angulated conventional as well as digital radiographs to detect VRF in teeth under different root conditions.

Methods: Sixty teeth were divided into three groups according to the canal condition: non-filled, filled with gutta-percha and filled with gutta-percha and metallic post. Ten teeth in each group were artificially fractured, whereas teeth in the control group were not fractured. Orthogonal and horizontally angulated conventional film (Kodak) and digital phosphor plate (VistaScan Dürr Dental) were used. Three blinded and calibrated observers carried out evaluations at four different time intervals. Modal values were used to calculate sensibility, specificity and accuracy. The area under the ROC curve (aucROC) and confidence intervals (CI) was used to compare the performance between radiographic systems, as well as the influence of combined angulated images.

Results: Angulated radiographs showed larger aucROC for both conventional and digital images. CI revealed statistically significant differences between conventional orthogonal and digital angulated radiographs (CI: 0.403 – 0.697 and 0.767 – 0.967, respectively). Moreover, when only orthogonal incidences were considered, digital radiographs yielded better results than the conventional ones (CI: 0.403 – 0.697 and 0.622 – 0.878, respectively).

Conclusion: The strong inclination towards yielding better diagnostic test results provided by digital radiographs suggests that the digital system using angulated projections is more appropriate to investigate VRF than the conventional one.

Influence of menopause on endodontic treatment

João Eduardo Gomes-Filho, Christine Men Martins, Gustavo Sivieri-Araujo, Ludmilla Mota da Silva Santos, Índia Olinta de Azevedo Queiroz, Marcelo Tadahiro Wayama, Guilherme Hiroshi Yamanari, Eloi Dezan-Júnior, Luciano Tavares Angelo Cintra

Endodontics. Systemic diseases. Menopause.

051 056

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Menopause is one of the physiological changes characterized by the end of menstrual and ovulatory cycles occuring in women in their fourth and fifth decade of life. Thereat, production of estrogen, an important hormone that acts in many physiological process of the individual such as the regulation of skeletal system, decreases. The decline in estrogen levels results in loss of bone mineral density, increased fracture risk, as well as bone diseases such as osteoporosis, a pathological process in which there is increased resorption of cavities that are not completely filled by newly formed bone. Furthermore, estrogen deficiency can cause many changes in an individual’s oral health. In the presence of bacterial infection of pulp tissue, this deficiency can aggravate apical periodontitis. Several drugs have been studied as potential therapeutic agents to compensate for deficiency of estrogen. These drugs aim to reduce the likelihood of fractures and prevent bone loss as well as cardiovascular and mental disorders resulting from postmenopausal hormone disabilities. Raloxifene (RLX) is one of the most studied drugs therapies and proves to prevent bone loss. Even though raloxifene is indicated for and produces benefits to bone metabolism and maintenance of bone density, additional studies are warranted to further investigate the role of raloxifene in endodontic infection of osteopenic organisms.

Prevalence of pulp stones in cone beam computed tomography

Vanessa Rodrigues, Isabella Scamardi, Cezar Fioravanti Schacht Junior, Milena Bortolotto, Luiz Roberto Manhães Junior, Luiz Fernando Tomazinho, Sheila Boschini

Dental pulp diseases. Dental pulp calcification. Cone­-beam computed tomography.

057 062

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Introduction: Calcifications of the pulp chamber, known as pulp stones, are common and may be adhered or not to dentin. These changes are detected during routine radiographic evaluations as single or multiple circular or ovoid radiopaque images measuring more than 200 μm. Used in Endodontics, cone-beam computed tomography (CBCT) may demonstrate root and coronary anatomy and detect calcifications, which may help to make an accurate diagnosis.

Objective: This study assessed the prevalence of pulp stone on CBCT scans retrieved from the collection of the Radiology Center of the School of Dentistry — São Leopoldo Mandic.

Methods: A total of 181 images were analyzed by means of multiplanar reconstructions. Results were subjected to biostatistics.

Results: The prevalence of pulp stones was 55%. Prevalence was highest in the 31-40 year age group (89.7%) and in the group of teeth that had been restored (61%). Teeth #16 was the most affected, at a prevalence of 12.8 %, followed by #17 (10.3%).

Conclusion: The prevalence of patients with pulp stones was 55%. Pulp stones were not associated with aging. Most teeth with pulp stones were maxillary permanent molars, and tooth restoration may be the cause of stone formation.

Horizontal root fracture: A case report

Sérgio Henrique Staut Brunini, Élio Gomes da Silva Junior, Iago de Melo Trida

Oral surgery. Root canal treatment. Tooth fracture.

063 066

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Introduction: Root fracture normally occurs in anterior teeth and is a condition oftentimes found in school children. It is commonly caused by horizontal trauma mistakenly subjected to extraction by unprepared and unskilled clinicians. Although trauma involves several different structures, traumatized teeth may be kept in the oral cavity.

Methods: This study reports a case of horizontal root fracture in the middle third of tooth #13 treated by conventional endodontic treatment performed in the coronal segment.

Results: One year after root canal filling, radiographic exams revealed complete fracture repair with bone tissue between fragments.

Conclusion: Tooth with horizontal root fracture may be successfully kept in the oral cavity and exert its normal functions after conventional endodontic treatment is properly performed.

Reimplantation of two incisors avulsed by trauma. A 10-year follow-up

Antonio Henrique Braitt, Maria Adelaide Bastos Bacelar Costa, Ernani da Costa Abad, Evaldo Almeida Rodrigues, Carlos Eduardo da Silveira Bueno

Tooth avulsion. Endodontics. Traumatology.

067 070

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Introduction: Approximately 50% of young people younger than 15 years old are victims of some type of traumatic injury in the orofacial region. Dentoalveolar traumas are among the biggest problems described in the dental literature. The indexes of violence in modern society, traffic accidents and extreme sports contribute to this type of injury. These traumatic episodes occurring in childhood or adolescence may lead to major issues such as psychosomatic disorders in patients, parents or guardians.

Objective: To report the clinical history of a 9-year-old patient who sought dental service due to trauma caused to teeth #21 and 22 at hhr home.

Methods: The patient was examined and subjected to periapical radiograph, confirming the avulsions. After anesthesia, the area was cleaned with saline solution and the alveolar clots removed. A gauze humidened in saline was used. Teeth were reimplanted and splint with polyester strips attatched with light-curing resin removed after 30 days. Endodontic treatment was conducted with change of calcium hydroxide for 90 days, after which the channels were closed.

Results: The patient was clinically and radiographically monitored for 10 years with follow-up radiographs showing the teeth in the alveoli without root resorption.

Conclusion: Dental reiplantation is an alternative treatment that should be done whenever possible, even if the prognosis is bad due to the time between the accident and treatment onset.

Suggesting a new therapeutic protocol for traumatized permanent teeth: Case report

Jefferson J. C. Marion, Laiza Vicente Martelosso, Juliana Yuri Nagata, Thiago Farias R. Lima, Adriana de Jesus Soares

Endodontics. Calcium hydroxide. Tooth socket. Extrusive luxation. Dental trauma. Chlorhexidine gel. Zinc oxide.

071 077

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Introduction: The case reported herein consists of two teeth of one single patient, initially immobilized with a semi-rigid retainer used for 15 days without endodontic intervention.

Objective: The aim of this article is to report a case of two teeth with extrusive luxation treated with a filling paste of calcium hydroxide, 2% chlorhexidine gel and zinc oxide.

Methods: After a one-month follow-up, patient’s teeth did not present evidence of pulp vitality. Radiographic examination revealed signs of external resorption. Endodontic treatment was carried out in association with a new treatment protocol using intracanal dressing applied in one single session and remaining in the root canal for four years.

Results: The filling paste remained in the root canal for 24 months without being replaced. The case presented improvements in periapical lesions without inflammatory resorption.

Conclusion: The filling paste proves to be successful and effective in treating traumatized teeth with root resorption.

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