The purpose of this study was to demonstrate the importance of knowledge of the internal anatomy of root canals for the success of endodontic treatment. Lack of knowledge of anatomic variations and their characteristics in different teeth has been pointed out as one of the main causes of endodontic therapy failure. In this report, the authors describe the endodontic treatment of a mandibular first molar with five root canals, evaluate the rate of occurrence of this number of canals, and discuss the importance of their identification and treatment.

RESUMO Justificativa e Objetivo: investigar sobre a metodologia de aplicação do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB): sua avaliação pelos profissionais de saúde, seus resultados e seu impacto na organização e na assistência a saúde, sob, a ótica dos trabalhadores da saúde. Métodos: Pesquisa qualitativa, de caráter exploratório descritivo, com 21 trabalhadores de unidades de Estratégia de Saúde da Família (ESF) de um município da 28ª Região de Saúde -RS com 17 ESFs cadastradas no Departamento de Atenção Básica-MS. Destas, oito possuem certificação como Equipe de Saúde Bucal. A coleta de dados ocorreu em documentos na Secretaria Municipal de Saúde e por meio de entrevistas. Constituíram a amostra o gestor de saúde e um representante por categoria de cada ESF que participou de alguma fase do PMAQ. A análise de conteúdo orientou a organização das informações e dos resultados em temas: PMAQ na visão dos trabalhadores, a metodologia de aplicação, os resultados e mudanças nas unidades de saúde com a implantação do programa. Resultados: Foram entrevistados dois médicos, cinco enfermeiros, sete técnicos de enfermagem, seis odontólogos e uma nutricionista. Identificouse a diversidade de percepções dos trabalhadores quanto à implementação do PMAQ-AB e o descontentamento por falta de retorno da gestão em relação aos resultados da avaliação. Conclusões: A falta de conhecimento dos profissionais sobre a metodologia de aplicação deste programa ficou evidente, pois grande parte dos entrevistados não consegue informar sobre as fases de implementação e o desenvolvimento das mesmas na sua ESF. DESCRITORES: Avaliação em Saúde. Educação em Saúde. Assistência à saúde. Saúde Pública. ABSTRACT Justification andObjective: investigate about the methodology of implementing the National Program for Access and Quality Improvement in Primary Care (PMAQ-AB): review

The purpose of this study was to assess dentin removal during root canal preparation by different operators using a NSK reciprocating handpiece. Eighty-four human single-rooted mandibular premolars were hand instrumented using Triple-Flex stainless-steel files (Kerr) up to #30, weighed in analytical balance and randomly assigned to 4 groups (n=21). All specimens were mechanically prepared at the working length with #35 to #45 Triple-Flex files (Kerr) coupled to a NSK (TEP-E10R, Nakanishi Inc.) reciprocating handpiece powered by an electric motor (Endo Plus; VK Driller). Groups 1 to 4 were prepared by a professor of Endodontics, an endodontist, a third-year dental student and a general dentist, respectively. Teeth were reweighed after root canal preparation. The difference between weights was calculated and the means of dentin removal in each group were analyzed statistically by ANOVA and Tukey's test at 5 % significance level. The greatest amount of dentin removal was found in group 4, followed by groups 2, 3 and 1. Group 4 differed statistically from the other groups regarding dentin removal means [p<0.001 (group 1); p=0.005 (group 2); and p=0.001 (group 3)]. No statistically significant difference was found between groups 1 and 2 (p=0.608), 1 and 3 (p=0.914) and 2 and 3 (p=0.938). In conclusion, although the group prepared by a general dentist differed statistically from the other groups in terms of amount of dentin removal, this difference was clinically irrelevant. The NSK reciprocating handpiece powered by an electric engine was proved an effective auxiliary tool in root canal preparation, regardless of the operator's skills.

Purpose: To report a clinical case of a 36 mm long upper cuspid submitted to root canal treatment, with emphasis on the alternative technique employed.Case description: A 32 years old, male patient had suffered subluxation of teeth 12 and 13 and coronal fracture involving enamel and dentin, as well as pulp exposition, of tooth 14 because of a motorcycle accident. The man was given dental assistance and a semi-rigid splinting of teeth numbers 12 and 13 was carried out followed by the root canal treatment in a single visit on tooth no. 14. At 30-day follow-up pulp necrosis was detected in teeth 12 and 13 and the root canal treatment was implemented. The tooth 13 was 36 mm long and since the longest possible file (31 mm) was already in use, the cervical limit of the access cavity was considered as the reference point.Conclusion: This technique not only provided adequate disinfection, preparation and filling of the root canal, but it also allowed preservation of the remaining tooth structure.Key words: Anatomy; cuspid; dental pulp cavity; endodontics ResumoObjetivo: Descrever o tratamento endodôntico de um canino superior medindo 36 mm de comprimento, mostrando a técnica empregada no preparo do canal radicular e obturação.Descrição do Caso: Paciente do sexo masculino, com 32 anos de idade, sofreu subluxação dos dentes 12 e 13 e fratura coronária envolvendo esmalte e dentina, com exposição pulpar do dente 14, devido a um acidente de moto. No atendimento de urgência, foi realizada a contenção semirrígida dos dentes 12 e 13, seguida da endodontia em sessão única do dente 14. Trinta dias após, foi diagnosticada necrose pulpar dos dentes 12 e 13 e sua endodontia foi, então, iniciada. O comprimento aparente do dente 13 foi estabelecido em 36 mm e como o instrumento mais longo que dipomos no mercado possui 31 mm, o limite cervical da cavidade de acesso foi usado como bordo de referência.Conclusão: Além de garantir uma correta sanificação, modelagem e obturação do canal, esta técnica também permitiu a preservação da estrutura dental remanescente.

The purpose of the present study was to verity whether different conditions of contact with a dye solution would result in different levels of the impregnation by the marker agent in human radicular dentin. The root canals of 60 upper human canines were immersed in methylene blue dye (0.5%, pH 7.0) for 24 h under six different conditions: passive immersion; pre-agitation for 10 min using an endodontic ultrasound; pre-agitation for 10 min using a cleaning ultrasound; 25-mmHg vacuum for 10 min followed by passive immersion; 30-mmHg and 650-mmHg vacuum for 24 h. The roots were longitudinally sectioned and dye impregnation was assessed by a trained and calibrated examiner, using the Q 550 IW image analyser (Leica Qwin, Cambridge, England). The measurements were analysed with anova and Tukey test. The results revealed no significant difference among the different methods for dye impregnation. In the cervical third, impregnation with 30 mmHg was significantly more effective than with endodontic ultrasound or 25 mmHg. At the apical third, no differences were observed between any of the dye impregnation methods. The comparison of different thirds revealed a statistically significant difference between the cervical and apical and the middle and apical thirds, but not between the cervical and middle thirds.