Os bifosfonatos são medicamentos amplamente utilizados no tratamento de doenças relacionadas à perda de mineral ósseo devido ao aumento da reabsorção óssea, sendo as drogas de primeira escolha no tratamento para osteoporose e demais doenças ósseas crônicas, como doença de Paget ou metástases ósseas osteolíticas. Estes medicamentos atuam, direta ou indiretamente, sobre os osteoclastos e osteoblastos, o que resulta na diminuição da remodelação óssea, além de apresentarem efeitos inibitórios sobre mediadores da inflamação inflamatório, podendo influenciar o processo de reparo de lesões ósseas. Dentro desse contexto, propôs-se a apresentar, por meio de uma revista da literatura, os mecanismos de ação dos bifosfonatos e sua influência no prognóstico do tratamento endodôntico, principalmente no que concerne ao reparo de periodontites apicais. Concluiu-se que os bifosfonatos demonstram, a partir de seus mecanismos de ação, potencial para influenciar no processo de reparo de periodontites apicais, e que mais estudos são necessários a fim de estabelecer uma relação causa-efeito entre o uso de bifosfonatos e o processo de reparo de lesões ósseas.
The diagnosis of irreversible pulpitis (IP) depends on clinical data, especially the chief complaint of the patient, visual inspection, response to the application of stimuli, and radiographic examination. The characterization of nerve fibers (NF) in IP may contribute to better interpret painful symptoms, but has been barely explored. This study sought to characterize the density and integrity of NF in 16 samples of IP and in five healthy pulps (HP) using S-100 and PGP 9.5 markers. Immunohistochemistry was performed to determine the density/mm 2 of S-100 + and PGP 9.5 + in NF. The amount of degenerated NF was obtained by subtracting the total NF density from the amount of intact NF. Associations between NF density and integrity and symptomatology were calculated. All samples were positive for S-100 and PGP 9.5. Compared to HP samples (38.20/mm 2 ), IP samples had a lower density of intact NF (6.24/mm 2 ). A significantly higher density of degenerated NF was found in IP samples with spontaneous pain (39.59/mm 2 ) compared to those with provoked pain (23.96/mm 2 ) (p = 0.02). No association was observed between intensity of the inflammatory infiltrate and NF density and integrity (p > 0.05). The findings of this study suggest that pulpitis may involve different stages of degeneration and may be more advanced in cases with spontaneous pain. The symptoms reported by affected individuals do not appear to depend on the intensity of the inflammatory infiltrate, but rather on the integrity of NF.
Aim:This study analyzed the effect of the dimensions of the flute and shank in the first 4 mm of instrument tips on the deformation and dimensional changes of reciprocating instruments after root canal shaping (RCS). Materials and methods:The reciprocating instruments used were Reciproc ® R25, R40, and R50; WaveOne ® Small, Primary, and Large; and Unicone ® #20, #25, and #40. Scanning electron microscopy images of the first 4 mm of the tip were acquired at 30× magnification before and after simulated curved root canals were shaped. Each instrument was used only once. The images were transferred to the AxioVision ® software to measure the flute area (µm 2 ), shank area (µm 2 ), flute length (µm), and crosssectional diameter (µm). Student's t test for paired samples was used to compare differences before and after RCS, and analysis of variance followed by the Tukey test, to compare differences between instruments of similar sizes. The instruments were classified according to deformations after RCS.Results: Reciproc ® instruments had larger flutes and smaller shanks. The Reciproc ® R40 had significant differences in crosssectional diameter at 0.5 mm from the tip. Reciproc ® had no plastic deformations. Unicone ® #20 instruments had significant differences in cross-sectional diameter at 1.5 and 3.0 mm from the tip, and #25 instruments had differences at 1.5 and 3.0 mm and in length of the second and third flutes. One #20 and three #40 instruments had plastic deformations. The differences in length of the first and fourth flutes of WaveOne ® Primary and in cross-sectional diameter at 2.0 mm from the tip of WaveOne ® Large were significant. Two of three WaveOne ® Large instruments had plastic deformations. Conclusion:Reciproc ® instruments had greater flute areas and lengths and smaller shanks than Unicone ® and WaveOne ® instruments of similar sizes. Reciproc ® instruments had a greater flute-to-shank ratio. WaveOne ® instruments had the lowest flute-to-shank ratio. Unicone ® instruments had the most plastic deformations. Instruments with larger flutes and smaller shanks had fewer plastic deformations after curved RCS. Clinical significance:The knowledge of mechanical behavior before choosing the endodontic instrument may avoid fracture, regardless of the clinical condition, and it is essential to the success of root canal treatment.
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