Key Clinical MessageApexification procedures have been widely used to treat teeth with incomplete root development and pulp necrosis. The middle mesial canal (MMC) is an anatomical variation and in most cases represents a challenge during endodontic treatments. In this article, a favorable outcome is reported after apexification in a molar with MMC.
Introduction: Avulsion of permanent teeth is one of the most serious dental injuries, prompt and correct emergency management is essential to achieve the best outcome after this injury. Objective: To analyze the literature on avulsed teeth, particularly its prevalence, storage media, consequences and treatment. Methodology: In order to carry out this literature review, an electronic search was necessary using PubMed and Google Scholar with the words avulsed tooth, and prevalence, storage media, treatment. Results: The prevalence of traumatic dental injuries is greater in male patients of school age. The most common treatment is reimplantation. The main adverse events are dental ankylosis and resorption. When immediate reimplantation is not possible, the most practical means of preservation is cow's milk, currently anti-reabsorption therapy is used to improve the prognosis in addition to the use of a semiflexible stabilizer. Conclusion:The treatment of choice for dental avulsion will always be reimplantation, whether immediate or delayed, regardless of how long the tooth is kept out of the mouth. Although there is no predictable prognosis, it does not mean that reimplantation should not be attempted, since the tooth will be of great importance in contributing to the mandibular and facial development of the child.
A 26-year-old male patient reported to the Department of Endodontics, with a chief complaint of pain in the upper right quadrant, plus unfinished restoration in the first premolar. The clinical and radiographic findings and vitality tests led to a diagnosis of asymptomatic irreversible pulpitis of the right maxillary first premolar, necessitating endodontic therapy [Table/ Fig-1a].The right maxillary first premolar was anaesthetized and isolated with rubber dam and the endodontic access was prepared. In the floor of the first premolar, only two orifices were detected. The access was modified in a cavity with a T-shaped outline and the three canals were detected. The mesiobuccal, distobuccal and the palatal canals were explored with a size 15 Flexofile (Dentsply). The working length was established with an apex locator and cleaning and shaping were performed using ProTaper Next rotary instruments (Dentsply) under abundant irrigation with 5.25% sodium hypochlorite. Final irrigation was done with 17% EDTA plus three periods of 20 seconds passive ultrasonic irrigation with sodium hypochlorite. The root canals were dried with paper points and obturated with laterally condensed gutta-percha and Sealapex sealer. (Sybron Endo) [Table/ Fig-1b]. the glide path, Protaper Next (Dentsply) files were used to shape and finish the canals under abundant irrigation of sodium hypochlorite. Calcium hydroxide was used as an intracanal medicament and after one week, obturated with cold laterally condensed guttapercha and Tubliseal sealer [Table /Fig-2b]. Case 3A 30-year-old mexican male with non-contributory medical history sought treatment, and his chief complaint was pain in the upper left back teeth region. A diagnosis of symptomatic irreversible pulpitis was made and endodontic treatment was planned in 24. Lingual and buccal canals were scouted using a 15 Flex R file. The buccal end of the access was extended mesio-distally using an Endo Z bur. A distobuccal orifice was located and working lengths were confirmed with apex locator. The canals were cleaned and shaped with Light Speed LSX Endo files and sodium hypochlorite. Canals were obturated with standardized gutta-percha points by lateral condensation technique [Table/ Fig-3a,3b].
Introduction:The small access cavities could make it more difficult to visualize the pulp chamber as well as to locate, shape, clean and fill the canals. At the same time, increase the risk of iatrogenic complications. (Silva et al., 2020) Objective: To analyze the literature concerning the influence of minimally invasive endodontic access in pulp therapy, in relation to the degree of disinfection, degree of conformation, quality of obturation and resistance to the fracture. Methodology: By searching in electronic databases such as PubMed, using keywords: "minimally invasive endodontics", "degree of disinfection", "shaping", "obturation" and "resistance to fracture". Results: A true compromise of the degree of conformation of the canal is not demonstrated, although neither a benefit, when performing a contracted endodontic cavity (CEC). It is not possible to reach an adequate conclusion about the degree of disinfection in a CEC; priority should be given to a traditional endodontic cavity (TEC). Efficient canal obturation in CEC is limited to a single obturation technique, but if it is not intended to work under this protocol, the use of a TEC is suggested. No noticeable change in fracture strength is demonstrated in a CEC over a TEC. Conclusions: Success of endodontic treatment is represented by each of the stages that make up the procedure. CECs are an alteration to the traditional protocol and with it to the rest of the treatment stages.
Introduction: Periapical surgery has been indicated for the treatment of teeth with periapical lesions when disease persists despite orthograde periapical root canal treatment, a surgical approach may be indicated when periradicular pathosis cannot be resolved with a non-surgical approach. Objective: To analyze the literature on influencing factors on endodontic surgery, particularly surgical considerations, root-end preparation, root-end filling, and treatment success. Methodology: The search for articles was performed by a researcher in the Pubmed database. Keywords used were "endodontic surgery", "apicoectomy", "flaps", "osteotomy", "preparation of the root or apical end", "retrograde obturation" and "treatment success of endodontic surgeries". Results: The surgical considerations, such as that the flaps can be full thickness or divided and a fundamental part is to achieve a good esthetic in the healing. In the osteotomy the important thing is the diameter in which it is performed, the larger the diameter, the more the healing process will be. Then a resection of the root end will be performed, mainly the apical 3 mm and 3 mm intraconducts will be prepared in a retrograde way with ultrasound tips. The obturation will be performed in a retrograde way where the most used materials for this step in the procedure are MTA and Biodentine. The success rate of this treatment is over 80%. Conclusion: Endodontic surgery treatment is a highly complex and complicated procedure. In order to perform this treatment, good planning with CBCT studies should be carried out.
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