Publications by authors named "Carlos Estrela"

163 Publications

Guided endodontics: The impact of new technologies on complex case solution.

Aust Endod J 2021 Mar 3. Epub 2021 Mar 3.

School of Dentistry, Federal University of Goiás, Goiânia, Brazil.

Discuss the impact of new diagnostic and planning technologies on the resolution of a clinical case of an upper central incisor with lateral perforation, root canal calcification and apical periodontitis. A 44-year-old woman sought treatment because of a colour change in an anterior tooth. The tooth had already been endodontically accessed, and she reported that two different clinicians had failed to locate the root canal. A Cone Beam Computed Tomography scan showed excessive wear and root perforation in the middle third, as well as pulp canal obliteration in the apical third. The perforation was treated using a biomaterial, and the root canal was located using guided endodontics. This treatment protocol was used to access, prepare, medicate with calcium hydroxide for 21 days and fill the root canal. Treatment results were satisfactory at 6-month follow-up.
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http://dx.doi.org/10.1111/aej.12498DOI Listing
March 2021

Cone-beam computed tomography cinematic rendering: clinical, teaching and research applications.

Braz Oral Res 2021 22;35:e024. Epub 2021 Feb 22.

University of Texas Health at San Antonio, School of Dentistry, Endodontics Department, San Antonio, TX, USA.

Cone-beam computed tomography (CBCT) is an essential imaging method that increases the accuracy of diagnoses, planning and follow-up of endodontic complex cases. Image postprocessing and subsequent visualization relies on software for three-dimensional navigation, and application of indexation tools to provide clinically useful information according to a set of volumetric data. Image postprocessing has a crucial impact on diagnostic quality and various techniques have been employed on computed tomography (CT) and magnetic resonance imaging (MRI) data sets. These include: multiplanar reformations (MPR), maximum intensity projection (MIP) and volume rendering (VR). A recent advance in 3D data visualization is the new cinematic rendering reconstruction method, a technique that generates photorealistic 3D images from conventional CT and MRI data. This review discusses the importance of CBCT cinematic rendering for clinical decision-making, teaching, and research in Endodontics, and a presents series of cases that illustrate the diagnostic value of 3D cinematic rendering in clinical care.
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http://dx.doi.org/10.1590/1807-3107bor-2021.vol35.0024DOI Listing
February 2021

Medications Used for Prevention and Treatment of Postoperative Endodontic Pain: A Systematic Review.

Eur Endod J 2021 Apr 2;6(1):15-24. Epub 2021 Feb 2.

Department of Conservative Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.

Objective: Prevention and management of postoperative endodontic pain is a common challenge for the endodontists. This systematic review was conducted to evaluate the efficacy and safety of medicament therapeutic protocols in the prevention and management of endodontic pain.

Methods: A literature search was undertaken in MEDLINE, Cochrane Library, LILACs, and SciELO, for articles published until December 2017, without year restriction and written only in English. An additional search was performed in the references of the retrieved studies. Study eligibility criteria, participants, and interventions: The inclusion criteria were randomised clinical trials that evaluated the use of medications to prevent or control moderate to severe pain in adult patients, using a visual analog scale as a tool for pain measurement. The primary outcome evaluated was the reduction of pain scores. The second outcome evaluated was the need for additional analgesia and the occurrence of adverse events.

Study Appraisal And Synthesis Methods: The quality assessment of the included studies was performed following the Jadad scale to measure the likelihood of bias in pain research reports.

Results: After removing duplicates and excluding the studies that did not meet the selection criteria, ten studies were included tin the systematic review. Among these studies, five studies administered the medications before the endodontic procedures and five studies after. These studies evaluated non-opioid analgesics (acetaminophen), opioid analgesics (tramadol and codeine), nonsteroidal anti-inflammatories (ibuprofen, flurbiprofen, ketorolac tromethamine, etodolac, tenoxicam, and naproxen), steroidal anti-inflammatory (prednisolone) or the association of medications to prevent or control postoperative pain. It was possible to establish a significant relationship between the use of additional analgesics and periapical diagnosis. Adverse events were not observed when the administration occurred before the endodontic procedure. When it was administered after the procedure, adverse reactions were reported in 2 of 3 trials included in the analysis.

Limitations: A restricted number of randomised clinical trials were found, and the difference in the methodology of the studies did not meet the definition of a systemic treatment protocol for prevention or control of postoperative pain.

Conclusion: Nonsteroidal anti-inflammatory drugs are the most common medicament to prevent and control postoperative pain, with ibuprofen being the most investigated. There is a significant association between the use of additional analgesics and periapical diagnoses.
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http://dx.doi.org/10.14744/eej.2020.85856DOI Listing
April 2021

Analysis of microorganisms in periapical lesions: A systematic review and meta-analysis.

Arch Oral Biol 2021 Apr 12;124:105055. Epub 2021 Feb 12.

Department of Restorative Dentistry, Endodontics Division, Piracicaba Dental School, State University of Campinas-UNICAMP, Piracicaba, SP, Brazil. Electronic address:

Aims: The aim of this study was to systematically review the literature on prevalence of microorganisms and their viability/activity in endodontic periapical lesions.

Design: Literature research was performed on five electronic biomedical databases from their start dates to June 2020. Only studies evaluating the presence of microorganisms in periapical lesions in human permanent teeth with secondary/persistent infection were included. Two reviewers independently assessed the eligibility for inclusion, extracted data and evaluated the risk of bias. Meta-analysis and binominal tests were used to analyse the resulting data.

Results: From the 1,313 records found, 23 full-texts were included for qualitative and quantitative analysis. The prevalence of microorganisms in endodontic periapical lesions was 87 % (95 % CI, 75-94) and the prevalence of viable/active microorganisms was 82 % (95 % CI, 66-91). There were statistical differences in the geographic area subgroup and between viable bacteria and active viruses. The most common detection method of microorganisms was the molecular one (69 %), and the most prevalent bacteria were the species Actinomyces, Fusobacterium and Prevotella (40 %). Most of the included studies had moderate risk of bias.

Conclusions: The prevalence of microorganisms in endodontic periapical lesions was 87 % and the prevalence of viable/active microorganisms was 82 %.
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http://dx.doi.org/10.1016/j.archoralbio.2021.105055DOI Listing
April 2021

A Conservative Approach to Surgical Management of Root Canal Perforation.

Case Rep Dent 2021 20;2021:6633617. Epub 2021 Jan 20.

Department of Stomatology Sciences, Federal University of Goiás, Goiânia, Brazil.

This study describes a conservative approach to surgical management of root canal perforation in maxillary lateral incisors. A patient was referred for retreatment of a maxillary lateral incisor. Her chief complaint was discomfort in the buccal mucosa. Periapical radiography showed radiopaque material consistent with sealing material inside the root canal. A CBCT scan was acquired and revealed a gutta-percha cone outside the root canal, from the middle third to beyond the root apex. The imaging examination showed that the pulp cavity had not been affected. Thus, we took the clinical alternative of surgically managing the perforation by sealing with MTA, thereby avoiding endodontic treatment, and followed up with only clinical and radiographic control. At the two-year follow-up, after the surgical procedure to remove the extruded filling material, we observed bone tissue formation and positive response to pulp tests, without any clinical signs or symptoms. Root perforation is considered an unpleasant error in an operative procedure. Once a perforation is properly diagnosed, located, and sealed with biomaterial, a favorable prognosis is often achieved. MTA offered good sealing of the perforation, with promising results. Decision-making using the CBCT scan enabled us to adopt a conservative approach and favored more reliable treatment predictability.
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http://dx.doi.org/10.1155/2021/6633617DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7843180PMC
January 2021

Central giant cell granuloma of the maxilla: Long-term follow-up of a patient treated with an adjuvant corticosteroid.

Spec Care Dentist 2021 Jan 20. Epub 2021 Jan 20.

Department of Stomatologic Sciences, School of Dentistry, Universidade Federal de Goiás, Goiânia, Goiás, Brazil.

Background: Central giant cell granuloma (CGCG) is one of the most intriguing lesions of the jaws and its nature has not yet been fully elucidated. Clinically, some CGCG behave more aggressively, while others have an indolent course. In cases of aggressive CGCG of the maxilla, effective personalized therapies are worth understanding.

Case Report: We report here a challenging case of aggressive CGCG in a 15-year-old girl which was misdiagnosed as an endodontic lesion. Radiographically, a large osteolytic lesion involving the hard palate from the central incisor to the second premolar, extending into the nasal cavity, with loss of the lamina dura and cortical resorption was observed. The lesion expanded aggressively after extensive curettage. With possible mutilation and defects due to a more radical approach to the lesion, treatment with systemic prednisone and intralesional triamcinolone hexacetonide associated with a calcitonin nasal spray was instituted. The decision in favor of this therapeutic strategy was made after careful immunohistochemical analysis of calcitonin and glucocorticoid receptors. The H-score for the staining of glucocorticoid and calcitonin receptors in multinucleated giant cells was 222 and 153.6, respectively. The lesion reduced in size, and no adverse effects associated with medications were observed. Another curettage was performed, and only fibrous connective tissue was found. The patient is in follow-up for 11 years without evidence of recurrence.

Conclusion: Pharmacological agents hold clinical promise in cases of aggressive CGCG affecting the maxilla of pediatric patients. Investigating the expression of calcitonin and glucocorticoid receptors in order to plan treatment is very helpful in the decision to manage aggressive CGCG.
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http://dx.doi.org/10.1111/scd.12569DOI Listing
January 2021

Dynamic torque analysis of rotary and reciprocating instruments during root canal instrumentation in simulated canals by an endodontist or a general dentist.

J Conserv Dent 2020 Mar-Apr;23(2):126-130. Epub 2020 Nov 5.

Department of Oral Science, School of Dentistry, Federal University of Goiás, Goiânia, Goiás, Brazil.

Background: Excessive torque is associated with engine-driven file fracture.

Aims: The aim of this study to evaluate the real-time torque of rotary and reciprocating instruments, working time, and the occurrence of procedural errors during root canal preparation of simulated canals by an endodontist and a general dentist.

Methods: Thirty-six commercially available simulated "J-shaped" root canals in resin blocks were used. Instrumentation was performed using WaveOne, WaveOne Gold, ProTaper Next, Reciproc, Reciproc Blue, and Mtwo. The real-time torque analysis and the number of times the maximum torque applied to the instrument were evaluated. Images were obtained to assess the occurrence of procedural errors, and working time was recorded.

Statistical Analysis: The one-way analysis of variance with a Bonferroni test, Mann Whitney test and the -test was used for statistical analysis ( < 0.05).

Results: Reciprocating instruments showed lower values in the number of times that reached maximum torque and percentage time in the area of critical torque, with significant differences compared to rotary instruments ( < 0.05). Operators influenced torque values only with rotary motion instruments. There was no significant difference in mean working time between the operators or instruments. No fracture of instruments or canal transportation occurred.

Conclusions: Rotary instruments were associated with higher peaks in real-time torque variation during the preparation of simulated root canals.
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http://dx.doi.org/10.4103/JCD.JCD_380_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7720756PMC
November 2020

Reference values for pulp oxygen saturation as a diagnostic tool in endodontics: a systematic review and meta-analysis.

Restor Dent Endod 2020 Nov 5;45(4):e48. Epub 2020 Oct 5.

Department of Endodontics, Graduate Program in Dentistry, Universidade Luterana do Brasil (ULBRA), Canoas, RS, Brazil.

Objectives: This systematic review aimed to identify mean oxygen saturation values (SpO) using pulse oximetry in permanent maxillary anterior teeth.

Materials And Methods: The MEDLINE, Scientific Electronic Library Online, Cochrane Central Register of Controlled Trials, EMBASE, and Literatura Latino Americana em Ciências da Saúde electronic databases were searched. Combinations and variations of "oximetry" AND "dental pulp test" were used as search terms. Studies reporting means and standard deviations of SpO values were included. Two reviewers independently extracted data following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Heterogeneity was assessed using the statistic, and all analyses were performed using R software. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool and the Newcastle-Ottawa scale.

Results: Of the 251 studies identified, 19 met the eligibility criteria and were included (total sample, 4,541 teeth). In the meta-analysis, the mean SpO values were 84.94% (95% confidence interval [CI], 84.85%-85.04%) for the central incisors, 89.29% (95% CI, 89.22%-89.35%) for the lateral incisors, and 89.20% (95% CI, 89.05%-89.34%) for the canines. The studies were predominantly low-quality due to the high risk of bias associated with the index test, unclear risk regarding patient selection, and concerns about outcome assessment.

Conclusions: Although most studies were low-quality, the oxygen saturation levels in normal pulp could be established (minimum saturation, 77.52%). Despite the risk of bias of the included studies, the reference values reported herein are clinically relevant for assessments of changes in pulp status.

Trial Registration: International Prospective Register of Systematic Reviews Identifier: CRD42018085598.
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http://dx.doi.org/10.5395/rde.2020.45.e48DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7691259PMC
November 2020

Potential of a New Cone-Beam CT Software for Blooming Artifact Reduction.

Braz Dent J 2020 Nov-Dec;31(6):582-588

Department of Basic Sciences, School of Dentistry, UNIC - Universidade de Cuiabá, Cuiabá, MT, Brazil.

This study evaluated the dimensions of intraradicular posts using a new cone beam CT (CBCT) software, and verified the potential of blooming artifact reduction. Sixty-three single-rooted human teeth were shaped, obturated, prepared for intracanal post placement and distributed into three groups: G1: anatomically customized prefabricated glass fiber posts; G2: low-fusion alloy posts; G3: gold alloy posts. After post fabrication and luting with RelyX U200®, specimens were sectioned axially at 9 mm from the root apex, and markings were made on the root surfaces (X-, Y- and Z-axes). The dimensions of the original posts (control group) were measured using a digital micrometer. CBCT scans of the teeth were obtained using a PreXion 3D Elite® scanner. Posts were measured on CBCT scans using DICOM files and the e-Vol DX software. A specific filter, Blooming Artefact Reduction (BAR), was developed to analyze intracanal posts. Statistical data were evaluated using the Van de Waerden nonparametric analysis of variance and, after that, normalized data were analyzed using the Tukey test. The level of significance was set at α = 5%. The measures of the anatomical prefabricated, low-fusion alloy and gold alloy intracanal posts obtained using the e-Vol DX CBCT software and a micrometer were not significantly different (p>0.05). The use of the BAR filter of the e-Vol DX software application did not induce any dimensional differences on CBCT scans of intracanal posts when compared with measurements made with a micrometer on original posts. The use of the BAR filter eliminated blooming artifacts.
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http://dx.doi.org/10.1590/0103-6440202005899DOI Listing
November 2020

Preserving the Neurovascular Bundle in Targeted Endodontic Microsurgery: A Case Series.

J Endod 2021 Mar 20;47(3):509-519. Epub 2020 Oct 20.

Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Electronic address:

Endodontic microsurgery encompasses the use of microscopy, specialized instruments, and advanced imaging with cone-beam computed tomographic (CBCT) imaging. This treatment modality results in high clinical success rates and facilitates the enucleation of osteolytic lesions, the resection of apical root canal complexities harboring persistent bacterial biofilms, and the evaluation of possible root defects and fractures. However, there is the risk of injury to important anatomic structures, particularly when treating posterior teeth. Neurovascular bundles are among these structures at risk for injury. Fortunately, high-resolution CBCT scans can be used to detect these structures that are known to have a high anatomic variability. In addition, CBCT information can be combined with high-resolution intraoral scans to plan, design, and fabricate surgical guides to be used in a targeted endodontic microsurgery (TEMS) approach. We report 3 cases with previous endodontic treatment having persistent apical periodontitis that were treated with TEMS to avoid damage to the neurovascular bundles at risk of injury. In the first case, the palatal root of tooth #14 was adjacent to the greater palatine artery. In the second case, the mental nerve exited through 2 separate foramina close to the predictive osteotomy site for the mesial root of tooth #19. In the third case, the posterior superior alveolar artery was in close proximity to the mesiobuccal root of tooth #14. Collectively, these cases illustrate the diagnostic value of CBCT imaging for detecting neurovascular bundles and the use of TEMS to mitigate the risk of injury to these important structures. Thus, the combination of CBCT imaging and TEMS can potentially minimize the risk of intraoperative complications and postoperative sequelae while increasing the predictability of endodontic microsurgeries in complex cases.
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http://dx.doi.org/10.1016/j.joen.2020.10.008DOI Listing
March 2021

Lateral Luxation of Incisor - A Case Report of Using a New Cone-Beam Computed Tomography Software and Reposition Guideline.

Braz Dent J 2020 Jun 13;31(3):337-343. Epub 2020 Jul 13.

Department of Operative Dentistry and Dental Materials, Dental School, Universidade Federal de Uberlândia, Uberlândia, MG, Brazil.

Lateral luxation injuries are one of the most severe periodontal injuries in dental trauma. The correct diagnosis followed by repositioning of the tooth on the right position is fundamental for the periodontal ligament healing. This study reported a clinical case of lateral luxation of maxillary central incisor involving a new cone beam computed tomography (CBCT) software for reconstruction (e-Vol DX) to confirm the lateral luxation after no conclusive dental trauma injury definition by using conventional exam. The lateral luxation injury was digitally reduced by insertion of tooth back to its alveolus, and at the same session, the tooth was stabilized with a rigid splint and further changed to a semi-rigid nylon splint. During the pulpal status monitoring, the pulp was diagnosed necrotic, then the root canal was treated to prevent root resorption. External office-bleaching and restorative procedure was performed. The 4-years follow up and new imaging exam and digital reconstruction confirmed bone healing and no complication. CBCT images analyzed by eVol DX can be used to determine and to guide lateral luxation treatment.
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http://dx.doi.org/10.1590/0103-6440202003069DOI Listing
June 2020

Interference of coronal enamel and dentin thickness and ambient light on pulse oximetry interpretation.

Braz Oral Res 2020 Jun 24;34:e064. Epub 2020 Jun 24.

Universidade Federal de Goiás - UFG, Faculdade de Odontologia, Departamento de Ciências Estomatológicas, Goiânia, GO, Brazil.

This study evaluated the interference of enamel and coronal dentin thickness and ambient light in pulse oximetry interpretation, using SaO2the human finger as a reference. Forty-two intact human permanent mandibular molars were sectioned mesiodistally in the central portion. Buccal and lingual dentin surfaces were drilled, and 4 mm, 3 mm and 2 mm enamel/dentin thicknesses were interposed between finger and device, after which SaO2 levels were measured by finger pulse oximetry. A reference device was designed to align pulse oximeter light-emitting diode, buccal surface of tooth, little finger, lingual surface of tooth and photodiode. Variables were described as means and standard deviation, and the confidence interval was reported. Repeated measures analysis of variance (ANOVA) was used to compare the groups, followed by Bonferroni correction. Student t test for paired samples was used to determine presence of ambient light (α = 0.05). Mean SaO2 level was lower at 4.0 ± 0.2 mm thickness, regardless of presence or absence of ambient light (92.7% and 89.3%). The other thicknesses yielded values of 95.5% and 94.5% at 3.0 ± 0.2 mm, and 96.4% and 96.0% at 2.0 ± 0.2 mm (p < 0.001). There were significant differences between SaO2 values at 4.0 ± 0.2 mm, 3.0 ± 0.2 mm and 2.0 ± 0.2 mm thicknesses, in the presence of ambient light. Mean SaO2 level in positive control was 96.3%, and mean pulse rate was 69.5 bpm in presence of ambient light; in the absence of light, these values were 96% and 70.5 bpm. Enamel and dentin thickness interfere with SaO2, regardless of presence or absence of ambient light. The lowest SaO2 levels were found for the thickest tooth samples.
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http://dx.doi.org/10.1590/1807-3107bor-2020.vol34.0064DOI Listing
June 2020

Dentin thickness as a risk factor for vertical root fracture in endodontically treated teeth: a case-control study.

Clin Oral Investig 2021 Mar 26;25(3):1099-1105. Epub 2020 Jun 26.

Department of Stomatologic Sciences, School of Dentistry, Federal University of Goiás, Goiânia, Brazil.

Objectives: This study evaluated factors associated with vertical root fracture in endodontically treated teeth, using a cone-beam computed tomography (CBCT) image database.

Materials And Methods: The sample for this case-control study consisted of 81 CBCT scans of teeth with vertical root fracture (VRF) and 81 CBCT scans of non-fractured teeth, matched by age, sex, and tooth position. The analyzed variables included dentin thickness, an intraradicular post, an adjacent implant, and a missing adjacent tooth. Student's t test test was used to compare the quantitative variables. The chi-square test was used to compare the categorical variables. Logistic regression was performed to evaluate the association between the presence of VRF and the independent factors assessed.

Results: The mean dentin thickness of fractured teeth was 1.3 mm, whereas that of non-fractured ones was 1.5 mm (p < 0.001). There was no difference between the fractured and non-fractured groups, regarding implant frequency or missing adjacent tooth (p > 0.05). There were a significantly larger number of teeth with posts in the fractured versus non-fractured group (p = 0.007). However, dentin thickness ≤ 1.3 mm was the only factor associated with VRF in the multiple regression model (OR = 3.60, 95%CI = 1.76-7.37).

Conclusions: Dentin thickness may influence the development of VRF. Dentin thickness ≤ 1.3 mm is associated with a greater likelihood of fracture than ≥ 1.4 mm.

Clinical Relevance: This study suggests there may be a minimum amount of safe dentin thickness that should be preserved after endodontic instrumentation.
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http://dx.doi.org/10.1007/s00784-020-03406-1DOI Listing
March 2021

Cone-beam and micro-computed tomography for the assessment of root canal morphology: a systematic review.

Braz Oral Res 2020 19;34:e056. Epub 2020 Jun 19.

University of Adelaide, Adelaide Dental School, Adelaide, Australia.

This study presents an overview of the accuracy of cone beam computed tomography (CBCT) compared with micro-computed tomography (μCT) in the assessment of root canal morphology of extracted human permanent teeth. A database search in PubMed, PubMed Central, Embase, Scopus, Opengrey, Scielo and Virtual Health Library was conducted which compared root canal morphology of extracted human permanent teeth on the accuracy of CBCT with μCT. In accordance with PRISMA statement guidelines, data were extracted on study characteristics, target mediators, sampling and assay techniques and the parameters associated with obtaining the image and ability to identify the root canal morphology. Amongst 2734 records, ten fulfilled the inclusion criteria. Four studies compared the accuracy of CBCT and μCT in the assessment of root canal morphology using Vertucci's classification, with at least one CBCT group or subgroup of each study presented high agreement compared to the μCT. Six studies assessed more detailed root canal morphology, including two articles that found a lack of agreement between these imaging systems. Risk of bias was deemed low in three studies, moderate in four and high in three. CBCT can be as accurate as μCT in the assessment of several morphological features of extracted human permanent teeth; however there are some exceptions related to the more detailed morphological aspects. Voxel size likely influences the ability to detect these features, though the different aspects of exposure setting used in studies components may be confounding factors. CBCT may be considered for the assessment of root canal morphology ex-vivo.
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http://dx.doi.org/10.1590/1807-3107bor-2020.vol34.0056DOI Listing
June 2020

Root Canal Shape of Human Permanent Teeth Determined by New Cone-Beam Computed Tomographic Software.

J Endod 2020 Jun 8. Epub 2020 Jun 8.

Department of Radiology, School of Dentistry São Leopoldo Mandic, Campinas, São Paulo, Brazil.

Introduction: The purpose of this study was to determine root canal cross-sectional shapes (RCCSSs) of human permanent teeth using new cone-beam computed tomographic (CBCT) software.

Methods: RCCSS was determined on CBCT scans of 1400 teeth (422 patients) as follows: (1) circular, (2) conical/pyramidal, (3) oval/long oval, (4) flat/ribbonlike, (5) 8 shaped, (6) C shaped, (7) calcified, (8) trapezoidal, (9) drop shaped, and (10) other shapes. Root canal shapes were evaluated in the coronal and middle thirds, 2 mm below their beginning, and in the apical third, 1 and 2 mm short of the apical foramen. Categoric variables were described as frequencies and percentages and analyzed using the chi-square test. The level of significance was set at P = .05.

Results: Maxillary anterior teeth and maxillary first and second premolars had a circular RCCSS at 1 and 2 mm from the apical foramen in more than 45% of the cases. The most frequent RCCSS in the buccal canal of maxillary first premolars at 1 mm from the apical foramen was circular (71%) followed by flat/ribbonlike (10%) and oval/long oval (6%). In mesiobuccal roots of maxillary and mandibular first molars at 1 mm from the apical foramen, the circular shape was found in 52% and 49%, respectively.

Conclusions: The RCCSSs in human permanent teeth are variable according to the tooth group and root thirds. The highest frequency of the circular-shaped canal at 1 and 2 mm from the apical foramen was found in maxillary central incisors and mandibular first and second premolars. Oval-shaped canals were detected in practically all tooth groups and root thirds.
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http://dx.doi.org/10.1016/j.joen.2020.05.014DOI Listing
June 2020

Evaluation of bond strength of molar orthodontic tubes subjected to reinforcement with flowable and bonding resins.

J Orofac Orthop 2020 Sep 4;81(5):350-359. Epub 2020 Jun 4.

Department of Stomatological Sciences, School of Dentistry, Universidade Federal de Goiás, Goiânia, Brazil.

Objective: The goal was to evaluate the adhesive shear bond strength (SBS) of orthodontic tubes bonded to molar teeth and reinforced with Transbond XT (3M Science, St. Paul, MN, USA) and flowable resin.

Materials And Methods: In all, 120 molar teeth, previously extracted from patients with a mean age of 30 were included. Orthodontic molar tubes were bonded on the vestibular surface of these teeth with one of two types of adhesive (Transbond XT [3M Science, St. Paul, MN, USA] or Orthobond [Morelli, Sorocaba, Brazil]). Each of these groups was subsequently divided into four further groups: control and those subjected to the use of resin reinforcement on the occlusal surface of the bonded tubes with one of three materials (Transbond XT, Tetric N Flow [Ivoclar Vivadent, Ellwangen, Germany], Z 350 Flow [3M Science, St. Paul, MN, USA]). SBS and adhesive remnant index tests were performed to evaluate bond strength and type of fracture of the tubes bonded with the different methods.

Results: The use of resin reinforcement with Transbond XT significantly increased the SBS of tubes bonded with both materials. Flowable composites did not increase the SBS when used as a reinforcement. Less than 50% of the adhesive remained on the vestibular surface after the SBS test in most samples of all groups.

Conclusion: Transbond XT orthodontic adhesive and Orthobond adhesive had appropriate bonding strengths for clinical use. Furthermore, the use of a resinous reinforcement with Transbond XT significantly increased the SBS of tubes bonded. However this technique with flowable adhesives (Tetric N Flow and Z350 Flow) did not significantly increase SBS when orthodontic tubes were bonded with Transbond XT or Orthobond.
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http://dx.doi.org/10.1007/s00056-020-00235-5DOI Listing
September 2020

Facial profile changes due to bone cement graft to manage the hyperactive muscles of the gingival smile.

Dental Press J Orthod 2020 03 29;25(2):44-51. Epub 2020 May 29.

Divisão de Endodontia, Faculdade de Odontologia, Universidade Federal de Goiás, Goiânia, GO, Brazil.

Objective: To evaluate facial profile changes promoted by polymethyl methacrylate (PMMA) cement graft to reduce excessive gingival display due to hyperactivity of the elevator muscles of the upper lip during smiling.

Methods: Eleven patients (all females, age range: 20 to 43 years) presenting gingival smile that were treated with PMMA cement grafts in a private clinic were selected for this retrospective study. Three angular and ten linear cephalometric facial profile measurements were performed preoperatively (baseline, T1) and at least 6 months postoperatively (T2). Differences between T1 and T2 were verified by Wilcoxon test, and the correlation between the thickness of the graft and facial profile changes was statistically evaluated by Spearman's Coefficient test. The significance level was set at p< 0.05.

Results: The nasolabial angle (p= 0.03) and the labial component of the nasolabial angle showed statistically significant differences (p= 0.04), with higher values in T2. No correlations were found between the graft thickness and the statistically significant facial profile changes (p> 0.05).

Conclusions: The PMMA bone cement graft projected the upper lip forward, thereby increasing the nasolabial angle without affecting the nasal component. No correlations between the graft thickness and the facial profile changes were detected.
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http://dx.doi.org/10.1590/2177-6709.25.2.044-051.oarDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7265667PMC
March 2020

The Contribution of the Brazilian Dental Journal to the Brazilian Scientific Research over 30 Years.

Braz Dent J 2020 Jan-Feb;31(1):3-9

Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, USP - Universidade de São Paulo, Ribeirão Preto, SP, Brazil.

The Brazilian Dental Journal (BDJ) was officially launched in 1990, stimulated by the courage and boldness of researchers dedicated to teaching and research in dentistry. The journal was conceived in a worldwide coverage and universal language to allow publication of the results of Brazilian studies, which otherwise would not be accessible to the scientific dental community. In the year we celebrate the thirtieth anniversary of BDJ, this article presents a brief overview of Brazilian dental research and a bibliometric analysis of the articles published in this journal as a contribution to our readers and fellow researchers. The purpose was to identify the mot frequent categories of study, the most published areas of dentistry and BDJ's top 50 most-cited articles in the Scopus and Google Scholar databases. A search was performed on all BDJ online issues published from 1990 to 2019. In this period, BDJ published 1,710 articles. Based on their distribution by category of study, 557 articles were in the basic research/dental materials area, 527 in the basic research/biology area and 280 in the clinical research area. Eight articles were cited more than 100 times in the Scopus database and 266 times in the Google Scholar database. Endodontics was the most published area. This overview of BDJ production over those 30 years allows establishing a profile of the characteristics, impact and trends of the published studies, as well as the journal's contribution to the top 50 most-cited articles in the Scopus and Google Scholar databases.
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http://dx.doi.org/10.1590/0103-6440202004551DOI Listing
March 2020

Micro-computed tomographic assessment of the variability and morphological features of root canal system and their ramifications.

J Appl Oral Sci 2020 7;28:e20190393. Epub 2020 Feb 7.

Universidade de São Paulo, Faculdade de Odontologia de Ribeirão Preto, Departamento de Odontologia Restauradora, Ribeirão Preto, São Paulo, Brasil.

Objectives: This study assessed the incidence and variability features of root canals system (RCS) and their ramifications according to Pucci & Reig (PR) (1944) and the American Association of Endodontists (AAE) (2017) by micro-computed tomography (μCT).

Methodology: 500 representative extracted human teeth of each tooth group (n=50) (maxillary/mandibular central and lateral incisors, canines, first and second premolars and molars) were scanned by μCT with a resolution of 26.70 μm. The reconstructed cross-sections images and the visualization of the continuous slices in the transversal axis were performed using DataViewer software. RCS were classified according to Pucci & Reig (main canal, collateral canal, lateral canal, secondary canal, accessory canal, intercanal, recurrent canal) and AAE (main canal, accessory canal, lateral canal). The apical deltas were assessed for both classifications. The prevalence of apical deltas was evaluated using the Chi-squared test (p<0.05).

Results: According to PR, a higher incidence of lateral canals was observed in maxillary canines (10%), central incisors (8%) and first premolars (6%). Using AAE, the highest incidence of lateral canals was observed in the mandibular first premolars (85%), first and second molars (84%), lateral incisors (67%), canines (59%), and in maxillary first premolars (52%). Regarding accessory canals, the PR showed a frequency in 2% of the maxillary lateral incisors and maxillary and mandibular first premolars and 3% of mandibular first and second molars. On the other hand, the AAE showed the highest incidence of accessory canals in 86% of the maxillary first premolars, 71% in mandibular lateral incisors, 69% in mandibular first premolars, 65% in mandibular canines, and 56% in maxillary canines. The PR showed the lowest incidence of apical deltas for all dental groups when compared with AAE (p=0.004). Interestingly, distal canals in maxillary molars showed a significant discrepancy between classifications (p=0.027).

Conclusions: μCT enabled accurately describing the RC system and related ramifications, adding to the PR and AAE classifications, with some discrepancies reported for maxillary molars. Clinical Relevance This μCT study enabled a thorough description of the variability among root canals and their ramifications, including clinically relevant details on the presence and location of lateral canals and accessories in all human tooth groups, beyond the currently existing classification systems.
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http://dx.doi.org/10.1590/1678-7757-2019-0393DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6999120PMC
February 2020

CBCT assessment of bone thickness in maxillary and mandibular teeth: an anatomic study.

J Appl Oral Sci 2020 7;28:e20190148. Epub 2020 Feb 7.

Universidade Federal de Goiás, Faculdade de Odontologia, Departamento de Ciências Estomatológicas, Goiânia, Goiás, Brasil.

Objective: The site of the sinus tract depends on the rate of resistance against abscess exudate drainage, bone morphology, and distance from the root apex to the outer cortical bone. To assess apical bone thickness in buccal and palatal/lingual aspects of maxillary and mandibular teeth, using a high-resolution cone-beam computed tomography (CBCT) system.

Methodology: In total, 422 CBCT examinations were included in the study, resulting in a sample of 1400 teeth. The scans were acquired by PreXion 3D, with a high-resolution protocol. The bone thickness was taken as the distance between the center of the apical foramen and the buccal and lingual/palatal cortical bone. The quantitative variables were expressed as mean values±standard deviation. The independent samples were analyzed using the t-test or the Mann-Whitney test (p<0.05).

Results: The lowest mean value of bone thickness was observed in the buccal cortical bone of the upper canines (1.49 mm±0.86) and in the upper central incisors (1.59 mm±0.67). In premolar teeth, the lowest values were found in the buccal cortical bone of upper first premolars (1.13 mm±0.68). In the posterior teeth, the lowest values were found in the buccal cortical bone of upper first molars (1.98 mm±1.33). In the lower second molar region, the buccal cortical bone (8.36 mm±1.84) was thicker than the lingual cortical bone (2.95 mm±1.16) (p<0.05).

Conclusions: The lowest mean values of bone thickness are in the buccal cortical bone of the maxillary teeth. In the mandible, bone thickness is thinner in the buccal bone around the anterior and premolar teeth, and in the lingual aspect of mandibular molars. All these anatomic characteristics could make the occurrence of the sinus tract more susceptible in these specific regions of the maxillary and mandibular alveolar bone.
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http://dx.doi.org/10.1590/1678-7757-2019-0148DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6999116PMC
February 2020

Analysis of Electronic Apex Locators in Human Teeth Diagnosed With Apical Periodontitis.

Braz Dent J 2019 Nov-Dec;30(6):550-554

Research Institute of Biomedical Sciences, CUCS, México.

Electronic apex locators (EAL) have been used to establish the working length (WL) in root canal treatment. In teeth diagnosed with apical periodontitis, resorption of tooth apical structures can lead to difficulties to obtain an appropriate WL. The aim was to compare the capacity of three EAL's (Root ZX II, Raypex 6 and Endo-Eze Quill) to locate the tip of the K-file between 0 to -0.5 mm from the apical foramen (AF) on teeth diagnosed with asymptomatic apical periodontitis (AAP). Electronic working length was performed on 60 roots with AAP. A K-file #15 was inserted in the root canal until the apical foramen (AF) was located, and followed was re-adjusted to -0.5 mm through observation in EAL display. The K-file was fixed to the tooth with composite and teeth were extracted. The 4 apical millimeters were worn out until the K-file could be seen and were prepared and measured its distance to AF in a scanning electron microscope. Appropriate WL was when the tip of the K-file was located between 0 to -0.5 mm from AF. Results: Root ZX II showed significant difference (p<0.01) with the other two EALs. Root ZX II presented the better performance than Raypex 6 or Endo-Eze Quill in teeth with AAP.
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http://dx.doi.org/10.1590/0103-6440201902705DOI Listing
December 2019

Comparison of Dimensions of the Nasopharynx and Oropharynx Using Different Anatomical References: Is There Equivalence?

J Oral Maxillofac Surg 2019 Dec 30;77(12):2545-2554. Epub 2019 Jul 30.

Titular Professor, Department of Oral Sciences, School of Dentistry, Federal University of Goiás, Goiânia, Brazil. Electronic address:

Purpose: To evaluate the equivalence of the volumes obtained using different anatomic references to measure the nasopharynx and oropharynx on cone-beam computed tomography (CBCT) scans. We hypothesized that no variations would be found in the nasopharynx and oropharynx dimensions when measured using different measurement methods.

Materials And Methods: A total of 40 CBCT scans of patients with skeletal Class I (age range, 20 to 50 years) were measured independently by 2 of us. The nasopharynx and oropharynx subregions were volumetrically measured using the adopted limits of 5 different measurement methods (3 for the nasopharynx and 2 for the oropharynx) and InVivoDental software, version 5.4 (Anatomage, San Jose, CA). The minimum area and the minimum area of localization were also evaluated. The intra- and interexaminer concordance for the measurements from the different methods were verified using the interclass correlation coefficient (ICC). The analysis of variance for repeated measures was used to compare the measurements from the 3 nasopharynx methods. The paired t test was used to compare the measurements from the 2 oropharynx methods. The statistical tests were performed at the 5% significance level using SPSS software, version 22.0 (IBM Corp, Armonk, NY).

Results: The intra- and interexaminer ICC values were greater than 0.8. We found a statistically significant difference in the volume measurements among the 3 nasopharynx methods (P = .001). However, no differences were found in the minimum area or minimum area of localization comparisons. Statistically significant differences were also observed for the volume, minimum area, and minimum area of localization between the 2 oropharynx methods (P = .001).

Conclusions: Studies that have used different methods of measurement should not be directly compared. The different measurement methods used for nasopharynx and oropharynx evaluations should not be compared.
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http://dx.doi.org/10.1016/j.joms.2019.07.008DOI Listing
December 2019

Low-level laser therapy as adjunctive treatment for a sodium hypochlorite accident: a case report.

Gen Dent 2019 Jul-Aug;67(4):63-66

A 39-year-old woman sought specialized treatment complaining of a large, painful oral ulcer in the right buccal vestibule after receiving emergency endodontic treatment 3 days earlier. The patient reported that the tooth, the mandibular right first premolar, was not isolated with a rubber dam and that she felt the extrusion of a liquid in the buccal tissues. Clinically, a necrotic area with raised erythematous borders was observed in the mandibular right side. The clinical diagnosis was a chemically induced ulcer caused by a sodium hypochlorite accident. Dexamethasone and amoxicillin were prescribed to control pain and prevent secondary infection. The large size of the lesion was an indication for application of low-level laser therapy (LLLT), which was delivered at a wavelength of 685 nm (output power, 30 mW; power density, 0.5 mW⁄cm2 ; energy density, 6 J⁄cm2 ) every 2 days for a total of 6 sessions. The LLLT was applied to the necrotic area with a punctual mode (2 points) for 12 seconds per point. The patient reported a substantial reduction in pain after the second application, and the wound was completely healed after 6 sessions. The results observed in this patient suggest that LLLT could aid patients in recovering from NaOCl-related lesions.
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December 2019

Difficulty levels of extracted human teeth used for pre-clinical training in endodontics in an Australian dental school.

Aust Endod J 2020 Apr 2;46(1):47-51. Epub 2019 Jul 2.

Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia.

This study aimed to determine the difficulty level of extracted teeth treated by undergraduate students for pre-clinical endodontic training. Two independent observers assessed a consecutive sample of 1000 periapical radiographs of extracted teeth used in endodontic pre-clinical training. Chi-square test was used to evaluate the adjustment of the distribution, and inter- and intra-examiner agreement were calculated. Minimal, moderate and high difficulty teeth represented 23.1%, 52.1% and 24.8%, respectively. The presence of curvature was the most common grading factor, with 'moderate curvature' reported in 28.7%, and 'extreme curvature' reported in 15.6% of the sample. A difference in the distribution of frequencies was found, favouring the moderate category (P < 0.001). The inter- and intra-examiner strength of agreement were 0.78 and 0.86, respectively. More than 50% of the teeth were categorised as moderate complexity. Almost one-quarter of the total sample, in particular molars, was classified as high complexity, thus unsuitable for undergraduate pre-clinical training.
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http://dx.doi.org/10.1111/aej.12355DOI Listing
April 2020

Mesenchymal Stem Cell Marker Expression in Periapical Abscess.

J Endod 2019 Jun 3;45(6):716-723. Epub 2019 May 3.

Department of Oral Diagnosis, School of Dentistry, University of Anápolis, Anápolis, Brazil.

Introduction: There is evidence that acute periapical lesions present a greater potential for cyst formation. Recently, it was found that these lesions have cells with characteristics of pluripotent stem cells, which may influence cyst development. However, a more complete phenotype investigation of stem cells in a specific sample of periapical abscesses is required. The aim of this study was to analyze the immunohistochemical expression of mesenchymal stem cell (MSC) markers in periapical abscesses and to evaluate differences in their expression in relation to acute and chronic periapical lesions.

Methods: Immunohistochemistry was used to access MSC marker expression (CD44, CD73, and CD105) in samples of periapical abscesses (n = 10), granulomas (n = 10), cysts (n = 10), and apical papillae (n = 10). Immunohistochemical expression was evaluated by a quantitative scoring system. The chi-square test was used to assess the association between MSC marker expression and the histopathological diagnosis at a 5% significance level.

Results: CD44 and CD73 immunostaining was observed in mesenchymal cells located in the outer portion of the abscess and periapical cyst specimens. CD105 immunoexpression was found predominantly in mesenchymal and vascular endothelial cells of the lesions studied. MSC marker expression was higher in the periapical abscesses, with a significant association between MSCs and the histopathological diagnosis of an abscess (P < .05).

Conclusions: The periapical region is a rich source of MSCs. The greater presence of MSCs in periapical abscesses found in this study could hold an important clue into understanding the pathological pathway of periapical cyst formation.
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http://dx.doi.org/10.1016/j.joen.2019.03.009DOI Listing
June 2019

Effect of dental bleaching on pulp oxygen saturation in maxillary central incisors - a randomized clinical trial.

J Appl Oral Sci 2019 11;27:e20180442. Epub 2019 Apr 11.

Universidade Federal de Goiás, Faculdade de Odontologia, Departamento de Ciências Estomatológicas, Goiânia, Goiás, Brazil.

Objective: To assess pulp oxygen saturation levels (SaO2) in maxillary central incisors after dental bleaching.

Materials And Methods: 80 participants (160 teeth) were randomly allocated to four groups: G1 In-office bleaching with two applications of 35% hydrogen peroxide (HP) (20 minutes), followed by at-home bleaching with 10% carbamide peroxide (CP) (2 hours/day for 16 days); G2 - Same protocol as G1, plus desensitizing toothpaste; G3 - In-office bleaching with 35% HP and one application of placebo gel (20 minutes), followed by at-home bleaching with 10% CP (2 hours/day for 16 days); and G4 - Same protocol as G3, plus desensitizing toothpaste. Pulp SaO2 levels were measured before (T0) and immediately after (T1) in-office bleaching; on the 5th (T2), 8th (T3), 12th (T4), and 16th days of at-home bleaching (T5); and on the 7th (T6) and 30th (T7) days. Mean (SD) pulp SaO2 levels were compared within groups by generalized estimating equations (GEE) and Student's t-test (P<0.05).

Results: Mean pulp SaO2 at T0 was 84.29% in G1, 84.38% in G2, 84.79% in G3, and 85.83% in G4. At T1, these values decreased to 81.96%, 82.06%, 82.19%, and 81.15% in G1, G2, G3, and G4 respectively, with significant difference in G4 (P<0.05). During home bleaching, pulp SaO2 levels varied in all groups, with 86.55%, 86.60%, 85.71%, and 87.15% means at T7 for G1, G2, G3, and G4, respectively; G2 presented significant difference (P<0.05).

Conclusions: Pulp SaO2 level in maxillary central incisors was similar at baseline, reducing immediately after in-office bleaching, regardless of using desensitizing toothpaste and increasing at 30 days after dental bleaching.
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http://dx.doi.org/10.1590/1678-7757-2018-0442DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6459226PMC
June 2019

Method to Determine the Root Canal Anatomic Dimension by using a New Cone-Beam Computed Tomography Software.

Braz Dent J 2019 Jan-Feb;30(1):3-11

School of Dentistry, UFG - Universidade Federal de Goiás, Goiânia, GO, Brazil.

This study discusses a method to determine the root canal anatomic dimension by using e-Vol DX software. The methodology consists in initially establishes the correct positions which will be measured, define the point on the edge of the anatomical structure, and next adjust the intermediate position in the grayscale of CBCT image. Afterward, thin sections (0.10 mm) are obtained from 3D reconstructed slices in the filter for the measurements, in order to determine the edge of the anatomical surface in the axial plane. A replication of positions in 3D mode is done in multiplanar reconstruction (MPR) of CBCT images, where the correct position is established with the aid of a positioning guide. The 3D density is adjusted so that it is in the same dimension as the 2D image, and a dimension calibration occurs to the point where there is a coincidence between 3D and 2D. This calibration is done only at the beginning of the measurement. Next, the intermediate position of the division between the grayscale is verified in the CBCT scan. Once one side has been completed, it is moved to the other side and follows the same guidelines described above. When setting the position of the courses in the other margin, being that 2D mode is used as reference. Thus, one obtains the required measure, being checked in the two points. The creation of this filter in the e-Vol DX software for measurement, and its appropriate management, allows more effective applications when it is desired to obtain diameters of anatomical structures.
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http://dx.doi.org/10.1590/0103-6440201902462DOI Listing
August 2019

Machine-assisted Agitation Reduces Postoperative Pain during Root Canal Treatment: A Systematic Review and Meta-analysis from Randomized Clinical Trials.

J Endod 2019 Apr 2;45(4):387-393.e2. Epub 2019 Mar 2.

Division of Clinical Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia.

Introduction: This systematic review and meta-analysis aimed to assess whether machine-assisted agitation resulted in less postoperative pain (PP) compared with syringe irrigation with needle alone in adult patients undergoing root canal treatment.

Methods: A literature search was performed in 3 electronic databases for articles published before August 2018. Randomized clinical trials published in English that compared PP between machine-assisted agitation and syringe irrigation with needles as part of nonsurgical root canal treatment were included. Two authors were independently involved in the article selection process, data extraction, and assessment of the quality of included studies using the revised Cochrane risk of bias tool. The pooled effect estimates of the standardized mean difference (SMD) between machine-assisted agitation and syringe irrigation with needle was calculated by a random effects-modeled meta-analysis. A subgroup meta-analysis was performed. The quality of evidence was evaluated by the Grading of Recommendations, Assessment, Development and Evaluations approach.

Results: Six studies were included for systematic review. Meta-analysis was performed using 3 studies and showed that machine-assisted agitation resulted in less PP compared with syringe irrigation with needle at 24 hours (SMD = -0.73; 95% confidence interval, -1.04 to -0.42; I = 30.6%) and 48 hours (SMD = -0.60; 95% CI, -0.85 to -0.35; I = 0%). The quality of evidence by Grading of Recommendations, Assessment, Development and Evaluations for the PP outcomes (24 hours and 48 hours) was graded as "moderate" quality.

Conclusions: Machine-assisted agitation reduced PP compared with syringe irrigation with needles in nonsurgical root canal treatment. Future clinical trials are needed to support the result of this review.
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http://dx.doi.org/10.1016/j.joen.2019.01.013DOI Listing
April 2019

Dental trauma on primary teeth at different root resorption stages-A dynamic finite element impact analysis of the effect on the permanent tooth germ.

Dent Traumatol 2019 Apr 15;35(2):101-108. Epub 2019 Jan 15.

Department of Operative Dentistry and Dental Materials, Dental School, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil.

Background/aim: Dental trauma is a common emergency in children with primary teeth. The aim of this study was to determine stress propagation to the permanent tooth germ and surrounding bone and soft tissues during dental trauma to primary central incisors with three levels of physiological root resorption.

Material And Methods: Stresses were determined using finite element analysis (FEA). Cross-sectional models were created using cone-beam computed tomography images of 3.5, 5, and 6 years olds, representing three different physiological root resorption stages of a maxillary primary central incisor. The models included periodontal ligament, bone, and soft tissues. An impact with an asphalt block moving at 1 m/s,was simulated for two impact two directions, frontal on the labial tooth surface, and on the incisal edge. Stresses and strains were recorded during impact.

Results: The impact caused stress concentrations in the surrounding bone and soft tissues and permanent tooth germ, regardless of the direction of impact and the primary tooth resorption stage. Impact stresses in dental follicles and surrounding bone increased in models with more physiological root resorption of the primary tooth. Incisal impact generated higher stress concentrations in surrounding bone and soft tissues and permanent tooth germ regardless of physiological root resorption stage. The primary incisor with no physiological root resorption showed high stress concentrations at its root apex.

Conclusion: During impact to a primary incisor, stresses most significant for potential damage to the formation of permanent enamel and dentin were at the dental follicle and surrounding bone tissue with the three levels of physiological root resorption.
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http://dx.doi.org/10.1111/edt.12460DOI Listing
April 2019

Effect of At-Home Bleaching on Oxygen Saturation Levels in the Dental Pulp of Maxillary Central Incisors.

Braz Dent J 2018 Nov-Dec;29(6):541-546

Department of Stomatology, UFG - Universidade Federal de Goiás, Goiânia, GO, Brazil.

The present study assessed oxygen saturation (SaO2) levels before, during, and after at-home bleaching treatment in the pulps of healthy maxillary central incisors. SaO2 levels were measured in 136 healthy maxillary central incisors using a pulse oximeter. The bleaching protocol consisted of 10% carbamide peroxide gel placed in individual trays and used for four hours daily for 14 days. SaO2 levels were assessed before bleaching (T0), immediately after the first session (T1), on the 7th day of treatment (T2), on the 15th day (the day following the last session) (T3), and 30 days after completion of the bleaching protocol (T4). Data were statistically analyzed using generalized estimating equations (GEE), Student's t test (p<0.05) and Pearson's correlation. Mean pulp SaO2 levels were 85.1% at T0, 84.9% at T1, 84.7% at T2, 84.3% at T3, and 85.0% at T4. Gradual reductions in SaO2 levels were observed, with significant differences (p<0.001) during the course of home bleaching treatment. However, 30 days after the end of the bleaching protocol, SaO2 levels returned to baseline levels. Home bleaching caused a reversible transient decrease in SaO2 levels in the pulps.
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http://dx.doi.org/10.1590/0103-6440201802170DOI Listing
April 2019