Aim: To assess the prevalence of apical periodontitis, root-filled teeth, and related covariates, considered potential risk factors for cardiovascular diseases in patients with a self-reported cardiovascular disease history, who first attended the Faculty of Dentistry, University of Porto, in 2018. Methodology: Out of 2,063 reviewed medical and dental records, 1,841 individuals met the inclusion criteria. Endodontic infections and oral status were assessed through orthopantomography. Cardiovascular disease classification was based on self-reported diagnosis. Medical history included dichotomous data on hypertension, diabetes mellitus, and smoking. Bivariate analyses were conducted using Student's t-test for quantitative variables and Pearson's Chisquare test for categorical variables (95% CI, alpha = 0.05). Multivariate logistic regression assessed the impact of confounders on the presence of apical periodontitis and root-filled teeth. Statistical significance was set at p < 0.05. Results: The prevalence of apical periodontitis and root-filled teeth was 72% and 57% in patients with cardiovascular diseases, and 45.6% and 47.8% in those without. Bivariate analysis revealed significant associations between cardiovascular disease and age, gender, number of teeth, apical periodontitis, hypertension, diabetes, and smoking. No significant association was found between cardiovascular disease and root-filled teeth. In the multivariate model, the association between apical periodontitis and cardiovascular disease was no longer statistically significant. Conclusion: Although the prevalence of apical periodontitis and root-filled teeth was higher in patients with self-reported cardiovascular disease, no significant association was observed. Hypertension and smoking emerged as key risk factors for cardiovascular disease. Further research is warranted to clarify the potential link between endodontic infections and cardiovascular conditions.
Aim: To investigate root dentin defects induced by different cast post removal techniques. Methodology: One hundred bovine incisors were standardized to 15 mm. Twenty roots served as unprepared controls; the remaining 80 were instrumented with the BioRace system (to size 40/.04), obturated using lateral condensation, and prepared for post space with #1-4 Largo drills. Of these, 60 received directly fabricated cast posts cemented with zinc phosphate. Post removal was performed using ultrasonic vibration, a carbide bur, or a spring-activated device. Roots were sectioned at 4, 8 and 12 mm from the apex and examined at 25 & times; magnification to assess the presence of fractures and other dentinal defects (partial cracks and craze lines). Data were analyzed with the Chi-square test (alpha = 0.05) and Bonferroni-adjusted pairwise z-tests. Results: Among 300 sections, 103 (34.3%) showed defects. The control group showed none. All removal techniques produced defects, with no significant difference among protocols for other defects (P>0.05). The spring-activated device was associated with a higher number of root fractures (P<0.05). Defects distribution was similar across root levels (4, 8 and 12 mm). Conclusions: All techniques caused dentin damage. Only the spring-activated device increased fractures. Careful selection of the removal strategy is advised.
Background: The anatomical relationship between posterior maxillary teeth and the maxillary sinus may predispose to intraoperative complications during endodontic treatment. While sodium hypochlorite extrusion into the sinus has been sporadically reported, no case series has described direct intraoperative endo-sinus communications. Methods: Fifteen cases of intraoperative endo-sinus communication were documented during root canal treatment or retreatment of maxillary premolars and molars. Clinical signs included profuse bleeding synchronous with respiration, the presence of nasal mucus in the pulp chamber, disappearance of sodium hypochlorite solution, and contamination of paper points. In all cases, a Valsalva maneuver was performed and confirmed the presence of communication. Management strategies included immediate obturation when the canal could be dried or hemostasis achieved, or provisional sealing with Teflon and IRM with or without calcium hydroxide dressing when immediate obturation was not possible. Patients were followed clinically and radiographically.. Results: In 4 cases (26.7%), endodontic obturation was completed in a single visit, while in 11 cases (73.3%) obturation was postponed. Among the latter, 4 cases received calcium hydroxide dressing and 7 had no intracanal medicament. In all cases, the communication resolved spontaneously within one week. At a mean follow-up of 3.9 years (range: 1-10 years), no patient developed persistent sinonasal symptoms or radiographic evidence of sinus pathology. Conclusions: This case series provides the first clinical description of intraoperative endo-sinus communications. When promptly recognized and appropriately managed, these events do not appear to compromise the long-term prognosis of endodontic treatment. Careful preoperative radiographic assessment, accurate working length determination at the first appointment, and controlled instrumentation are essential to prevent recurrence. Different obturation techniques may be successfully applied, with bioceramic sealers offering potential advantages in postoperative comfort.
Introduction: Endodontic treatment aims to clean and fill the root canals to maintain periapical health and alleviate pain, with postoperative pain influenced by multiple clinical factors. Sodium hypochlorite irrigation, although effective, can cause debris extrusion, with gel being an alternative that reduces this risk while maintaining antimicrobial efficiency. Objective: This study aimed to assess postoperative pain incidence in asymptomatic upper premolars with pulp necrosis and chronic periapical lesions undergoing endodontic intervention. Materials and Methods: Sixty-six patients were divided into three groups (n=22): Group SHG/SS used 3% sodium hypochlorite (SH) gel and saline solution (SS). Group SHG/S employed 3% SH gel and 2.5% SH solution (S). Group SHS/S used 2.5% SH solution for both purposes. Procedures lasted 40 to 60 minutes, conducted by the same operator in a single session. Clinical data was recorded, and postoperative pain was evaluated at 24, 48, and 72 hours using a modified Numeric Rating Scale. Statistical analysis was applied to the collected data. Results: Within the first 24 hours, auxiliary chemical substances significantly impacted postoperative pain (p = 0.021). SHS/S showed lower pain scores compared to SHG/S, while SHG/SS scores were intermediate. At 48 hours (p = 0.548) and 72 hours (p = 0.127), postoperative pain did not show statistical significance. SHS/S and SHG/SS did not significantly influence postoperative pain, but SHG/S had an impact. Conclusions: Postoperative pain did not significantly differ at 48 and 72 hours. SHG/S and SHG/SS did not markedly influence postoperative pain. Notably, the use of 3% SH gel with 2.5% SH solution increased postoperative pain levels. Clinical Relevance: The application of 3% sodium hypochlorite gel used as an auxiliary chemical associated with the 2.5% sodium hypochlorite solution used as an irrigant had an impact on postoperative pain, which resulted in higher levels of post-operative pain.
Aim: This study aimed to histologically evaluate dentin bridge formation and pulpal response following direct pulp capping using either mineral trioxide aggregate (MTA) or Well-Root PT, with and without adjunctive diode laser (DL) application, and to assess the independent effects of DL on pulpal tissues. Methodology: Ninety-six teeth from eight healthy adult mongrel dogs underwent Class V cavity preparation with mechanical pulp exposure. Specimens were randomly assigned to three primary groups: Group I (control) with Teflon disc placement; Group II with MTA; and Group III with Well-Root PT. Each group was further subdivided based on the application or absence of an 810 nm DL pretreatment. Histological samples were collected at 2-and 8-weeks post-treatment to assess pulpal response and dentin bridge formation. Results: Chi-square analysis showed statistically significant differences (P < 0.05) between the control group and both MTA and Well-Root PT groups at both time points. No significant differences (P > 0.05) were observed between the MTA and Well-Root PT groups, regardless of laser application. Similarly, DL pretreatment did not produce significant differences in histological outcomes within any group. Conclusion: From a clinical perspective, Well-Root PT represents a viable alternative to MTA for direct pulp capping. However, the application of an 810 nm diode laser did not significantly enhance regenerative outcomes for either bioceramic materials.
