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Papers by Clóvis Bramante
International Endodontic Journal, 2014
AimTo describe morphometric aspects of the internal anatomy of C‐shaped mandibular premolars from... more AimTo describe morphometric aspects of the internal anatomy of C‐shaped mandibular premolars from a Brazilian subpopulation using micro‐CT analysis.MethodologyFirst mandibular premolars with radicular grooves (n = 123) were scanned using a micro‐computed tomography system. After cross‐section analysis, 83 specimens were identified with a C‐shaped canal and selected for micro‐CT analysis. Number and location of canals according to Vertucci's classification, distances between anatomic landmarks, occurrence of apical deltas, furcation canals, prevalence of C‐shaped cross‐sections at five levels as well as 2‐dimensional analysis (Area, perimeter, roundness, aspect ratio, major and minor diameters) were performed for the more prevalent anatomical features. Data were compared statistically using Kruskal–Wallis tests (α = 0.05).ResultsThe more prevalent anatomical types according to Vertucci's classification were Type I (13%), III (8%), V (37%) and VII (2%). Mean distances from the...
Journal (Canadian Dental Association), 2005
An accurate understanding of the morphology of the root canal system is a prerequisite for succes... more An accurate understanding of the morphology of the root canal system is a prerequisite for successful root canal treatment. Invaginated teeth have a complex root canal configuration that cannot be instrumented effectively and should be treated by both endodontic therapy and surgery. A case of dens invaginatus Type 3 in a maxillary lateral incisor with a periapical lesion and its successful treatment by these combined methods is reported.
Clinical Oral Investigations, 2020
Objectives To assess the internal and external morphologies of the mesiobuccal (MB) root of maxil... more Objectives To assess the internal and external morphologies of the mesiobuccal (MB) root of maxillary molars presenting a third root canal (MB3), using micro-computed tomography (micro-CT). Material and methods Two-hundred and sixty-five extracted maxillary first and second molars with different root configurations were imaged in a micro-CT scanner at 19.6-μm pixel size. Sixteen teeth presenting MB3 canal were selected and evaluated regarding root configuration, minimal dentine thickness 2 mm under the furcation area, canal configuration of the MB root, MB3 canal morphology (location, independent or confluent orifice, and anatomy types), and the apical anatomy (aspect ratio, number of accessory canals and foramina, presence of isthmus, and independent MB3 foramen). Results Overall, a high variability in canal configuration was detected in the MB root. MB3 canal was observed in 10 maxillary first molars and 6 maxillary second molars (n = 16). Minimal dentine thickness related to the MB3 canal at the coronal third was smaller than that of the MB1 canal. A complex internal anatomy comprising 13 different root canal configurations was observed. A high number of independent MB3 orifices at the pulp chamber floor was observed in the first molars (7 out of 10 teeth), while most of the specimens (n = 14) showed a confluent anatomy of the MB3 canal. A varied number of accessory canals and foramina were observed. At the apical third, isthmus could be observed in 6 specimens, while an independent MB3 foramen was present in 37.5% of the MB roots. Conclusions MB3 canal is a rare anatomical variation present in maxillary first and second molars. Its presence can be associated to a complex internal anatomy of the MB root which includes the presence of isthmuses and multiple accessory canals and foramina at the apical third, but also a thin dentine thickness at the coronal third and a confluent anatomy of the MB3 with the other main canals.
Journal of clinical and experimental dentistry, 2017
This study aimed to describe the anatomy of maxillary canines from a Western Mexican sub-populati... more This study aimed to describe the anatomy of maxillary canines from a Western Mexican sub-population using micro-computed tomography (micro-CT). Maxillary canines (n=32) were scanned at 19.6µm voxel resolution. Number and location of canals, the distance between the cemento-enamel junction and apex, occurrence of accessory and lateral canals, presence of oval canals, number of foraminas as well as two- (area, perimeter, roundness, aspect ratio, major and minor diameters) and three-dimensional (volume, surface area, and SMI) analysis were performed. Data of two-dimensional analyses at 5 different apical levels was statistically compared using Kruskal-Wallis tests (α=0.05). Overall, 31 specimens had one root with a main canal (Vertucci type I). Mean distance from the apex to the cemento-enamel junction was 16.32±2.27. Apical foraminas were present in 14 specimens (43.75%). No statistical differences were found in the two-dimensional analyses between the foramen and the 1 and 2mm apical...
Journal of conservative dentistry : JCD
This study aimed to describe the morphological and morphometric aspects of fused mandibular secon... more This study aimed to describe the morphological and morphometric aspects of fused mandibular second molars with radicular shallow grooves using micro-computed tomography (CT). Eighty-eight mandibular second molars with fused roots were scanned in a micro-CT scanner at a voxel size of 19.6 μm. After reconstruction, only molars without C-shaped roots and presenting shallow radicular grooves were selected. 30 molars were chosen for further analysis. Canal cross-sections were classified according to Fan's modified classification (C1, C2, C3, and C4) and morphometric parameters at the apical region, examination of accessory foramina and tridimensional configuration were evaluated. Three-dimensional reconstructions indicated a higher prevalence of merging type ( = 22). According to Fan's modified classification, the C4 configuration was predominant in the 3 apical mm. Roundness median values revealed a more round-shaped canals at 3 mm (0.72) than at 2 (0.63) and 1 (0.61) mm from th...
Journal of Research in Dentistry
Internal inflammatory root resorption (IIRR) can occur as a serious complication of dental trauma... more Internal inflammatory root resorption (IIRR) can occur as a serious complication of dental trauma which leads to progressive loss of the root structure. An early diagnosis could influence the therapeutic approach, but endodontic treatment becomes a challenge with a doubtful prognosis. The present report described an unusual clinical presentation of an IIRR with perforation resulting from a trauma four years previous. A 15-year-old female patient was presented to our service with pain in the maxillary incisor region. Intraoral radiography revealed a large radioloucent area compatible with IIRR, communicating with the periodontium in the middle third on the distal root face of the right central incisor. The root canal of the right central incisor was chemo-mechanically prepared. The calcium hydroxide (CH) intracanal medication was used and renewed periodically four times. The root canal was filled only in the cervical region to the level of resorption by the inverted gutta-percha cone...
Journal of Materials Science: Materials in Medicine, 2021
Objectives: The objective of the present work was to evaluate the ultrasonic agitation, time and ... more Objectives: The objective of the present work was to evaluate the ultrasonic agitation, time and vehicle (propylene glycol or distilled water) on the antimicrobial potential and penetrability of calcium hydroxide pastes on infected dentin by means of Confocal Laser Scanning Microscopy (CLSM) and microbiological culture (MC). Materials and methods: Dentin specimens were infected with Enterococcus faecalis using a new contamination protocol of 5 days. The specimens were divided into eight groups and dressed with the pastes for 7 or 15 days: G1) calcium hydroxide (CH) + propylene glycol (prop)/7 days (d), G2) CH + prop/7d + ultrasonic agitation (U), G3) CH + distilled water (dw)/7d, G4) CH + dw/7d + U, G5) CH + prop/15d, G6) CH + prop/15d + U, G7) CH + dw/15d, G8) CH + dw/15d + U. The ultrasonic activation was made for 1 min in both directions with a plain point insert. After medications removal, the images obtained by CLSM showed the viable (green) and dead (red) bacteria with Live an...
OBJETIVO: O objetivo deste trabalho foi avaliar, por meio do microscopio clinico e eletronico dev... more OBJETIVO: O objetivo deste trabalho foi avaliar, por meio do microscopio clinico e eletronico devarredura, as paredes de cavidades apicais, as irregularidades produzidas com as pontas ultrassonicas diamantadas,lisas e com a combinacao de ambas. MATERIAL E METODO: Dezoito dentes pre-molaresinferiores de humanos, com apenas um conduto, foram apicetomizados e, no apice, foram realizadascavidades para obturacao retrograda divididas em tres grupos: grupo 1: cavidades preparadas com pontaultrassonica lisa; grupo 2: cavidades preparadas com ponta ultrassonica diamantada e grupo 3: cavidadespreparadas, iniciando com a ponta diamantada e seguida pela lisa. As paredes das cavidades foramobservadas inicialmente sob microscopio clinico e, a seguir, os apice foram seccionados, metalizados eanalisados no microscopio eletronico de varredura, atribuindo-se-lhes os seguintes escores: 1 - adequada;2 - regulares e 3 - irregulares. RESULTADOS: A ponta diamantada produziu 3 cavidades adequadas, 2regular...
Revista da ABENO, 2005
Entre os sistemas de aprendizado é muito importante que o aluno se familiarize com as técnicas ra... more Entre os sistemas de aprendizado é muito importante que o aluno se familiarize com as técnicas radiográficas das quais fará uso na clínica, principalmente na Endodontia. Neste trabalho é apresentado um kit radiográfico com o qual o aluno pode aprender melhor as técnicas radiográficas de Clark e de Bramante, Berbert. Esse kit é de fácil confecção, baixo custo e fácil de transportar.
Journal of applied oral science : revista FOB
The aim of this study was evaluate the influence of ultrasonic activation (UA) of AH Plus to impr... more The aim of this study was evaluate the influence of ultrasonic activation (UA) of AH Plus to improve canal and isthmus filing, and analyse the antimicrobial effect against Enterococcus faecalis within dentinal tubules. Thirty mesial roots of mandibular first molars were selected and divided into 2 groups (n = 15): with and without UA of the sealer. Then the root canals were filled by using the single cone technique, and the specimens were sectioned at 2, 4 and 6 mm from the apex for stereomicroscope and confocal laser scanner microscopy (CLSM) analysis. In addition, 30 bovine incisors were contaminated with Enterococcus faecalis and divided into 3 groups (n = 10). The specimens were obturated by using the single cone technique with (G1) and without (G2) UA of the sealer and G3 as the control group. All were sectioned into 6 mm-long cylinders and stained with LIVE/DEAD to assess bacterial viability by CLSM. The UA of the sealer significantly reduced the presence of unfilled areas in ...
Journal of Endodontics, 2005
Root perforations are undesired complications of endodontic treatment. In the recent literature, ... more Root perforations are undesired complications of endodontic treatment. In the recent literature, MTA has been regarded as an ideal material for perforation repair. This article describes a case report where an iatrogenic supracrestal perforation was repaired successfully with mineral trioxide aggregate (MTA).
Brazilian dental journal
The aim of this study was to evaluate the influence of different passive ultrasonic irrigation pr... more The aim of this study was to evaluate the influence of different passive ultrasonic irrigation protocols on the removal of debris in artificially created grooves in the cervical, middle and apical root thirds. Forty extracted bovine incisor roots were instrumented to 1 mm of the root apex with a R50 Reciproc instrument and irrigated with 2.5% sodium hypochlorite. The roots were then inserted in a muffle and cleaved into two hemisections. Grooves (3-mm long) were done at 2, 7 and 12 mm from the root apex in one hemisection and filled with dentinal debris. The hemisections were regrouped into the muffle and divided into 4 groups (n=10) according to the final irrigation protocol: Control group: 3x20 s using a #30 gauge needle without agitation of the irrigating solution; Group PUI-s (static passive ultrasonic irrigation): 3x20 s of passive ultrasonic irrigation with the tip of the insert maintained static on the apical third; Group PUI-t (passive ultrasonic irrigation per third): 20 s ...
Objective: To evaluate the influence of the sterilization process on paper cones as regards their... more Objective: To evaluate the influence of the sterilization process on paper cones as regards their absorption capacity, and consequently, root canal drying, in addition to the possible release of any antimicrobial or cytotoxic product. Methods: The cones used were of three of the brands found on the Brazilian market Dentsply (Dentsply Indústria e Comércio Ltda., Petrópolis, Brazil), Endopoints (Endopoints Indústria e Comércio Ltda., Paraíba do Sul, Brazil) and Tanari (Tanari Industrial Ltda., São Paulo, Brazil). To evaluate the absorption capacity, the cones were submitted to four sterilization cycles, and the modified Holland technique was performed. The antimicrobial/cytotoxic capacity was verified by means of depositing the sterilized cones in Petri dishes containing Miller-Hinton Agar and Blood Agar, seeded with S.aureus and E. coli. Results: The Dentsply (Dentsply Indústria e Comércio Ltda., Petrópolis, Brazil) and Tanari (Tanari Industrial Ltda., São Paulo, Brazil)cones present...
Endodontic treatment of immature teeth with necrotic pulp and incomplete root formation has been ... more Endodontic treatment of immature teeth with necrotic pulp and incomplete root formation has been recently treated with pulp revascularization. It is a promising alternative treatment to promote apical closure and root development. To date, a variety of revascularization protocols have been described, however little is known about the success of combining mechanical instrumentation and intracanal medication such as calcium hydroxide or triantibiotic paste. Thus, the aim of this study is to present a review of literature of pulp revascularization protocols and its clinical implications for treatment of teeth with pulp necrosis and incomplete apex. The causes that usually interrupt the root formation are dental traumatisms and caries, which can lead to pulp necrosis. Therefore, the immature permanent teeth and pulp necrosis were usually treated by apexification or the confection of an apical MTA plug, in order to accomplish the formation of an apical barrier. However, by this method, t...
Microscopy Research and Technique, 2015
The aim of this study was to evaluate the antimicrobial activity, pH level, calcium ion release, ... more The aim of this study was to evaluate the antimicrobial activity, pH level, calcium ion release, and radiopacity of calcium hydroxide pastes associated with three radiopacifying agents (iodoform, zinc oxide, and barium sulfate). For the pH and calcium release tests, 45 acrylic teeth were utilized and immersed in ultrapure water. After 24 h, 72 h, and 7 days the solution was analyzed by using a pH meter and an atomic absorption spectrophotometer. Polyethylene tubes filled with the pastes were used to perform the radiopacity test. For the antimicrobial test, 25 dentin specimens were infected intraorally in order to induce the biofilm colonization and treated with the pastes for 7 days. The Live/Dead technique and a confocal microscope were used to obtain the ratio of live cells. Parametric and nonparametric statistical tests were performed to show differences among the groups (P < 0.05). The pH analysis at 7 days showed significant differences (P < 0.05) among the groups. No differences among the pastes were found in the calcium release test on the 7th day (P > 0.05). The calcium hydroxide/iodoform samples had the highest radiopacity and antimicrobial activity against the biofilm-infected dentin in comparison to the other pastes (P < 0.05). Calcium hydroxide mixed with 17% iodoform and 35% propylene glycol into a paste had the highest pH, calcium ion release, radiopacity, and the greatest antimicrobial action versus similar samples mixed with BaSO4 or ZnO. Microsc. Res. Tech., 2015. © 2015 Wiley Periodicals, Inc.
Journal of Endodontics, 2015
Introduction: The goal of the present study was to evaluate the morphometric aspects of the inter... more Introduction: The goal of the present study was to evaluate the morphometric aspects of the internal anatomy of the root canal system of mandibular second molars with C-shaped canals. Methods: Fiftytwo extracted second mandibular molars with C-shaped canals, fused roots, and radicular grooves were selected from a Brazilian population. The samples were scanned with a micro-computed tomographic scanner at a voxel size of 19.6 mm. The root canal cross sections were recorded as C1, C2, C3, and C4 root canal configurations according to the modified Melton classification. Morphometric parameters, including the major and minor diameters of the root canals, the aspect ratio, the roundness, and the tridimensional configuration (merging, symmetric, and asymmetric), were evaluated. Results: The 3-dimensional reconstruction images of the teeth indicated an even distribution within the sample. The analysis of the prevalence of the different crosssectional configurations of the C-shaped molars revealed that these were predominantly of the C4 and C3 configurations (1 mm from the apex) and the C1 and C2 configurations in the cervical third. According to the morphometric parameters, the C1 and the distal aspect of the C2 configurations exhibited the lowest roundness values and higher values for the area, major diameter, and aspect ratio in the apical third. Conclusions: Mandibular molars with C-shaped root canals exhibited similar distributions of symmetric, asymmetric, and merging type canals. The C1 configuration and the distal aspect of the C2 configuration exhibited the highest area values, low roundness values, and large apical diameters.
Journal of Endodontics, 2008
RANKL and OPG are expressed in apical periodontitis, suggesting a role for these molecules during... more RANKL and OPG are expressed in apical periodontitis, suggesting a role for these molecules during lesion development. However, the profiles of RANKL/OPG expression in periapical lesions remain unknown. In this study we investigated the patterns of RANKL and OPG mRNA expression by RealTime-PCR in human periapical granulomas (N=44), and compared them with sites presenting characteristic bone resorpting activity: healthy (n=14) and orthodontically stretched and compressed periodontal ligament (n=26), healthy gingiva (n=24), chronic gingivitis (n=32) and chronic periodontitis (n=34) samples. Both RANKL and OPG mRNA expression was higher in periapical granulomas when compared to healthy periodontal ligament. Distinct patterns of RANKL and OPG expression ratio were found in the granulomas and in different physiological and pathological conditions with characteristic bone resorption activity potentially being an indicative of the stable or progressive nature of the lesions. Lesions with radiographic image smaller than 5mm demonstrated higher RANKL/OPG expression than images greater than 5mm. Periapical granulomas presented heterogeneous patterns of RANKL and OPG expression, ranging from samples with RANKL/OPG ratio similar to that seen in sites with minimal or absent bone resorption, until samples with RANKL/ OPG expression pattern comparable with active bone resorption sites.
Journal of Endodontics, 2010
The complete microfloral debriment of the root canal is possible only through successful endodont... more The complete microfloral debriment of the root canal is possible only through successful endodontic treatment. Due to complexicity constraints of root canal system complete microfloral removal by simply mechanical instruments is not sufficient. Therefore we aim to evaluate the antimicrobial efficacy of five different intracanal medicaments such as calcium hydroxide, chlorhexidiene, octenidol, endosepton and calcium hydroxide and chlorhexidine against Enterococcus faecalis. The Antibacterial activity of aforesaid medicaments was done against Enterococcus feacalis using agar disk diffusion method, over a period of 24 hrs and 72 hrs. The samples were divided into 6 groups. The zone of inhibition was measured after 24 and 72 hrs and were recorded in millimeters and compared with respect to control. There was a significant difference in the mean zone of inhibition at 24 and 72 hrs between calcium hydroxide, endoseptone, octenidol, calcium hydroxide and chlorohexidine combination, chlorohexidine and control group. Chlorohexidine was found to have maximum inhibitory efficacy followed by calcium hydroxide and chlorohexidine combination. Within the limitations of this study it may be concluded that Chlorhexidine can be used as an efficient intracanal medicament.
International Journal of Oral Science, 2013
This study investigated the efficacy of calcium hydroxide and chlorhexidine gel for the eliminati... more This study investigated the efficacy of calcium hydroxide and chlorhexidine gel for the elimination of intratubular Candida albicans (C. albicans). Human single-rooted teeth contaminated with C. albicans were treated with calcium hydroxide, 2% chlorhexidine gel, calcium hydroxide plus 2% chlorhexidine gel, or saline (0.9% sodium chloride) as a positive control. The samples obtained at depths of 0-100 and 100-200 mm from the root canal system were analyzed for C. albicans load by counting the number of colony forming units and for the percentage of viable C. albicans using fluorescence microscopy. First, the antimicrobial activity of calcium hydroxide and the 2% chlorhexidine gel was evaluated by counting the number of colony forming units. After 14 days of intracanal medication, there was a significant decrease in the number of C. albicans colony forming units at a depth of 0-100 mm with chlorhexidine treatment either with or without calcium hydroxide compared with the calcium hydroxide only treatment. However, there were no differences in the number of colony forming units at the 100-200 mm depth for any of the medications investigated. C. albicans viability was also evaluated by vital staining techniques and fluorescence microscopy analysis. Antifungal activity against C. albicans significantly increased at both depths in the chlorhexidine groups with and without calcium hydroxide compared with the groups treated with calcium hydroxide only. Treatments with only chlorhexidine or chlorhexidine in combination with calcium hydroxide were effective for elimination of C. albicans.
Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 2011
The aim of this study was to determine the influence of periapical radiographs, cone beam compute... more The aim of this study was to determine the influence of periapical radiographs, cone beam computed tomography (CBCT) sections, and cone beam volumetric data on the determination of periapical bone destruction in endodontically treated distal root canals of premolar canine teeth. Nontreated mesial roots were used as controls. Study design. Enterococcus faecalis strain (ATCC 29212) was inoculated into 30 root canals of 2 mongrel dogs to induce apical periodontitis. After 60 days, the root canals of the distal roots of the 11 mandibular and 4 maxillary premolars were endodontically treated (n ϭ 15). The mesial root canals were used as controls (no treatment). The bone destruction was evaluated after 6 months by 5 evaluators using periapical radiographs and by CBCT (coronal and sagittal sections). After the experimental period, the area of the lesions in periapical radiographs and CBCT sections were measured in mm 2 using the ImageTool software. A single evaluator measured the volumetric data using the OsiriX software. The comparison between the diagnosis methods in treated root canals and controls was performed using parametric and nonparametric criteria. The Pearson correlation coefficient was computed between radiographic values and CBCT volumetric data in treated root canals and controls. Results. The results showed the presence of chronic apical periodontitis in every inoculated tooth. After 6 months, periapical radiographs, coronal CBCT sections, and volumetric data showed lower bone destruction in endodontically treated teeth in comparison with the control group (P Ͻ .05). The 5 evaluators found no differences between the apical periodontitis area of treated teeth and controls when CBCT sagittal sections were used (P Ͼ .05). No correlation was found between x-ray and CBCT volumetric values in treated root canals. Conclusions. Although selected CBCT sagittal sections showed similar values of bone destruction in endodontically and nontreated root canals, volumetric CBCT data showed that periapical lesions of endodontically treated root canals had half of the volume of periapical lesions in nontreated root canals. No relationship could be found between the periapical values of bone destruction and volumetric data found in CBCT of treated rood canals.
International Endodontic Journal, 2014
AimTo describe morphometric aspects of the internal anatomy of C‐shaped mandibular premolars from... more AimTo describe morphometric aspects of the internal anatomy of C‐shaped mandibular premolars from a Brazilian subpopulation using micro‐CT analysis.MethodologyFirst mandibular premolars with radicular grooves (n = 123) were scanned using a micro‐computed tomography system. After cross‐section analysis, 83 specimens were identified with a C‐shaped canal and selected for micro‐CT analysis. Number and location of canals according to Vertucci's classification, distances between anatomic landmarks, occurrence of apical deltas, furcation canals, prevalence of C‐shaped cross‐sections at five levels as well as 2‐dimensional analysis (Area, perimeter, roundness, aspect ratio, major and minor diameters) were performed for the more prevalent anatomical features. Data were compared statistically using Kruskal–Wallis tests (α = 0.05).ResultsThe more prevalent anatomical types according to Vertucci's classification were Type I (13%), III (8%), V (37%) and VII (2%). Mean distances from the...
Journal (Canadian Dental Association), 2005
An accurate understanding of the morphology of the root canal system is a prerequisite for succes... more An accurate understanding of the morphology of the root canal system is a prerequisite for successful root canal treatment. Invaginated teeth have a complex root canal configuration that cannot be instrumented effectively and should be treated by both endodontic therapy and surgery. A case of dens invaginatus Type 3 in a maxillary lateral incisor with a periapical lesion and its successful treatment by these combined methods is reported.
Clinical Oral Investigations, 2020
Objectives To assess the internal and external morphologies of the mesiobuccal (MB) root of maxil... more Objectives To assess the internal and external morphologies of the mesiobuccal (MB) root of maxillary molars presenting a third root canal (MB3), using micro-computed tomography (micro-CT). Material and methods Two-hundred and sixty-five extracted maxillary first and second molars with different root configurations were imaged in a micro-CT scanner at 19.6-μm pixel size. Sixteen teeth presenting MB3 canal were selected and evaluated regarding root configuration, minimal dentine thickness 2 mm under the furcation area, canal configuration of the MB root, MB3 canal morphology (location, independent or confluent orifice, and anatomy types), and the apical anatomy (aspect ratio, number of accessory canals and foramina, presence of isthmus, and independent MB3 foramen). Results Overall, a high variability in canal configuration was detected in the MB root. MB3 canal was observed in 10 maxillary first molars and 6 maxillary second molars (n = 16). Minimal dentine thickness related to the MB3 canal at the coronal third was smaller than that of the MB1 canal. A complex internal anatomy comprising 13 different root canal configurations was observed. A high number of independent MB3 orifices at the pulp chamber floor was observed in the first molars (7 out of 10 teeth), while most of the specimens (n = 14) showed a confluent anatomy of the MB3 canal. A varied number of accessory canals and foramina were observed. At the apical third, isthmus could be observed in 6 specimens, while an independent MB3 foramen was present in 37.5% of the MB roots. Conclusions MB3 canal is a rare anatomical variation present in maxillary first and second molars. Its presence can be associated to a complex internal anatomy of the MB root which includes the presence of isthmuses and multiple accessory canals and foramina at the apical third, but also a thin dentine thickness at the coronal third and a confluent anatomy of the MB3 with the other main canals.
Journal of clinical and experimental dentistry, 2017
This study aimed to describe the anatomy of maxillary canines from a Western Mexican sub-populati... more This study aimed to describe the anatomy of maxillary canines from a Western Mexican sub-population using micro-computed tomography (micro-CT). Maxillary canines (n=32) were scanned at 19.6µm voxel resolution. Number and location of canals, the distance between the cemento-enamel junction and apex, occurrence of accessory and lateral canals, presence of oval canals, number of foraminas as well as two- (area, perimeter, roundness, aspect ratio, major and minor diameters) and three-dimensional (volume, surface area, and SMI) analysis were performed. Data of two-dimensional analyses at 5 different apical levels was statistically compared using Kruskal-Wallis tests (α=0.05). Overall, 31 specimens had one root with a main canal (Vertucci type I). Mean distance from the apex to the cemento-enamel junction was 16.32±2.27. Apical foraminas were present in 14 specimens (43.75%). No statistical differences were found in the two-dimensional analyses between the foramen and the 1 and 2mm apical...
Journal of conservative dentistry : JCD
This study aimed to describe the morphological and morphometric aspects of fused mandibular secon... more This study aimed to describe the morphological and morphometric aspects of fused mandibular second molars with radicular shallow grooves using micro-computed tomography (CT). Eighty-eight mandibular second molars with fused roots were scanned in a micro-CT scanner at a voxel size of 19.6 μm. After reconstruction, only molars without C-shaped roots and presenting shallow radicular grooves were selected. 30 molars were chosen for further analysis. Canal cross-sections were classified according to Fan's modified classification (C1, C2, C3, and C4) and morphometric parameters at the apical region, examination of accessory foramina and tridimensional configuration were evaluated. Three-dimensional reconstructions indicated a higher prevalence of merging type ( = 22). According to Fan's modified classification, the C4 configuration was predominant in the 3 apical mm. Roundness median values revealed a more round-shaped canals at 3 mm (0.72) than at 2 (0.63) and 1 (0.61) mm from th...
Journal of Research in Dentistry
Internal inflammatory root resorption (IIRR) can occur as a serious complication of dental trauma... more Internal inflammatory root resorption (IIRR) can occur as a serious complication of dental trauma which leads to progressive loss of the root structure. An early diagnosis could influence the therapeutic approach, but endodontic treatment becomes a challenge with a doubtful prognosis. The present report described an unusual clinical presentation of an IIRR with perforation resulting from a trauma four years previous. A 15-year-old female patient was presented to our service with pain in the maxillary incisor region. Intraoral radiography revealed a large radioloucent area compatible with IIRR, communicating with the periodontium in the middle third on the distal root face of the right central incisor. The root canal of the right central incisor was chemo-mechanically prepared. The calcium hydroxide (CH) intracanal medication was used and renewed periodically four times. The root canal was filled only in the cervical region to the level of resorption by the inverted gutta-percha cone...
Journal of Materials Science: Materials in Medicine, 2021
Objectives: The objective of the present work was to evaluate the ultrasonic agitation, time and ... more Objectives: The objective of the present work was to evaluate the ultrasonic agitation, time and vehicle (propylene glycol or distilled water) on the antimicrobial potential and penetrability of calcium hydroxide pastes on infected dentin by means of Confocal Laser Scanning Microscopy (CLSM) and microbiological culture (MC). Materials and methods: Dentin specimens were infected with Enterococcus faecalis using a new contamination protocol of 5 days. The specimens were divided into eight groups and dressed with the pastes for 7 or 15 days: G1) calcium hydroxide (CH) + propylene glycol (prop)/7 days (d), G2) CH + prop/7d + ultrasonic agitation (U), G3) CH + distilled water (dw)/7d, G4) CH + dw/7d + U, G5) CH + prop/15d, G6) CH + prop/15d + U, G7) CH + dw/15d, G8) CH + dw/15d + U. The ultrasonic activation was made for 1 min in both directions with a plain point insert. After medications removal, the images obtained by CLSM showed the viable (green) and dead (red) bacteria with Live an...
OBJETIVO: O objetivo deste trabalho foi avaliar, por meio do microscopio clinico e eletronico dev... more OBJETIVO: O objetivo deste trabalho foi avaliar, por meio do microscopio clinico e eletronico devarredura, as paredes de cavidades apicais, as irregularidades produzidas com as pontas ultrassonicas diamantadas,lisas e com a combinacao de ambas. MATERIAL E METODO: Dezoito dentes pre-molaresinferiores de humanos, com apenas um conduto, foram apicetomizados e, no apice, foram realizadascavidades para obturacao retrograda divididas em tres grupos: grupo 1: cavidades preparadas com pontaultrassonica lisa; grupo 2: cavidades preparadas com ponta ultrassonica diamantada e grupo 3: cavidadespreparadas, iniciando com a ponta diamantada e seguida pela lisa. As paredes das cavidades foramobservadas inicialmente sob microscopio clinico e, a seguir, os apice foram seccionados, metalizados eanalisados no microscopio eletronico de varredura, atribuindo-se-lhes os seguintes escores: 1 - adequada;2 - regulares e 3 - irregulares. RESULTADOS: A ponta diamantada produziu 3 cavidades adequadas, 2regular...
Revista da ABENO, 2005
Entre os sistemas de aprendizado é muito importante que o aluno se familiarize com as técnicas ra... more Entre os sistemas de aprendizado é muito importante que o aluno se familiarize com as técnicas radiográficas das quais fará uso na clínica, principalmente na Endodontia. Neste trabalho é apresentado um kit radiográfico com o qual o aluno pode aprender melhor as técnicas radiográficas de Clark e de Bramante, Berbert. Esse kit é de fácil confecção, baixo custo e fácil de transportar.
Journal of applied oral science : revista FOB
The aim of this study was evaluate the influence of ultrasonic activation (UA) of AH Plus to impr... more The aim of this study was evaluate the influence of ultrasonic activation (UA) of AH Plus to improve canal and isthmus filing, and analyse the antimicrobial effect against Enterococcus faecalis within dentinal tubules. Thirty mesial roots of mandibular first molars were selected and divided into 2 groups (n = 15): with and without UA of the sealer. Then the root canals were filled by using the single cone technique, and the specimens were sectioned at 2, 4 and 6 mm from the apex for stereomicroscope and confocal laser scanner microscopy (CLSM) analysis. In addition, 30 bovine incisors were contaminated with Enterococcus faecalis and divided into 3 groups (n = 10). The specimens were obturated by using the single cone technique with (G1) and without (G2) UA of the sealer and G3 as the control group. All were sectioned into 6 mm-long cylinders and stained with LIVE/DEAD to assess bacterial viability by CLSM. The UA of the sealer significantly reduced the presence of unfilled areas in ...
Journal of Endodontics, 2005
Root perforations are undesired complications of endodontic treatment. In the recent literature, ... more Root perforations are undesired complications of endodontic treatment. In the recent literature, MTA has been regarded as an ideal material for perforation repair. This article describes a case report where an iatrogenic supracrestal perforation was repaired successfully with mineral trioxide aggregate (MTA).
Brazilian dental journal
The aim of this study was to evaluate the influence of different passive ultrasonic irrigation pr... more The aim of this study was to evaluate the influence of different passive ultrasonic irrigation protocols on the removal of debris in artificially created grooves in the cervical, middle and apical root thirds. Forty extracted bovine incisor roots were instrumented to 1 mm of the root apex with a R50 Reciproc instrument and irrigated with 2.5% sodium hypochlorite. The roots were then inserted in a muffle and cleaved into two hemisections. Grooves (3-mm long) were done at 2, 7 and 12 mm from the root apex in one hemisection and filled with dentinal debris. The hemisections were regrouped into the muffle and divided into 4 groups (n=10) according to the final irrigation protocol: Control group: 3x20 s using a #30 gauge needle without agitation of the irrigating solution; Group PUI-s (static passive ultrasonic irrigation): 3x20 s of passive ultrasonic irrigation with the tip of the insert maintained static on the apical third; Group PUI-t (passive ultrasonic irrigation per third): 20 s ...
Objective: To evaluate the influence of the sterilization process on paper cones as regards their... more Objective: To evaluate the influence of the sterilization process on paper cones as regards their absorption capacity, and consequently, root canal drying, in addition to the possible release of any antimicrobial or cytotoxic product. Methods: The cones used were of three of the brands found on the Brazilian market Dentsply (Dentsply Indústria e Comércio Ltda., Petrópolis, Brazil), Endopoints (Endopoints Indústria e Comércio Ltda., Paraíba do Sul, Brazil) and Tanari (Tanari Industrial Ltda., São Paulo, Brazil). To evaluate the absorption capacity, the cones were submitted to four sterilization cycles, and the modified Holland technique was performed. The antimicrobial/cytotoxic capacity was verified by means of depositing the sterilized cones in Petri dishes containing Miller-Hinton Agar and Blood Agar, seeded with S.aureus and E. coli. Results: The Dentsply (Dentsply Indústria e Comércio Ltda., Petrópolis, Brazil) and Tanari (Tanari Industrial Ltda., São Paulo, Brazil)cones present...
Endodontic treatment of immature teeth with necrotic pulp and incomplete root formation has been ... more Endodontic treatment of immature teeth with necrotic pulp and incomplete root formation has been recently treated with pulp revascularization. It is a promising alternative treatment to promote apical closure and root development. To date, a variety of revascularization protocols have been described, however little is known about the success of combining mechanical instrumentation and intracanal medication such as calcium hydroxide or triantibiotic paste. Thus, the aim of this study is to present a review of literature of pulp revascularization protocols and its clinical implications for treatment of teeth with pulp necrosis and incomplete apex. The causes that usually interrupt the root formation are dental traumatisms and caries, which can lead to pulp necrosis. Therefore, the immature permanent teeth and pulp necrosis were usually treated by apexification or the confection of an apical MTA plug, in order to accomplish the formation of an apical barrier. However, by this method, t...
Microscopy Research and Technique, 2015
The aim of this study was to evaluate the antimicrobial activity, pH level, calcium ion release, ... more The aim of this study was to evaluate the antimicrobial activity, pH level, calcium ion release, and radiopacity of calcium hydroxide pastes associated with three radiopacifying agents (iodoform, zinc oxide, and barium sulfate). For the pH and calcium release tests, 45 acrylic teeth were utilized and immersed in ultrapure water. After 24 h, 72 h, and 7 days the solution was analyzed by using a pH meter and an atomic absorption spectrophotometer. Polyethylene tubes filled with the pastes were used to perform the radiopacity test. For the antimicrobial test, 25 dentin specimens were infected intraorally in order to induce the biofilm colonization and treated with the pastes for 7 days. The Live/Dead technique and a confocal microscope were used to obtain the ratio of live cells. Parametric and nonparametric statistical tests were performed to show differences among the groups (P < 0.05). The pH analysis at 7 days showed significant differences (P < 0.05) among the groups. No differences among the pastes were found in the calcium release test on the 7th day (P > 0.05). The calcium hydroxide/iodoform samples had the highest radiopacity and antimicrobial activity against the biofilm-infected dentin in comparison to the other pastes (P < 0.05). Calcium hydroxide mixed with 17% iodoform and 35% propylene glycol into a paste had the highest pH, calcium ion release, radiopacity, and the greatest antimicrobial action versus similar samples mixed with BaSO4 or ZnO. Microsc. Res. Tech., 2015. © 2015 Wiley Periodicals, Inc.
Journal of Endodontics, 2015
Introduction: The goal of the present study was to evaluate the morphometric aspects of the inter... more Introduction: The goal of the present study was to evaluate the morphometric aspects of the internal anatomy of the root canal system of mandibular second molars with C-shaped canals. Methods: Fiftytwo extracted second mandibular molars with C-shaped canals, fused roots, and radicular grooves were selected from a Brazilian population. The samples were scanned with a micro-computed tomographic scanner at a voxel size of 19.6 mm. The root canal cross sections were recorded as C1, C2, C3, and C4 root canal configurations according to the modified Melton classification. Morphometric parameters, including the major and minor diameters of the root canals, the aspect ratio, the roundness, and the tridimensional configuration (merging, symmetric, and asymmetric), were evaluated. Results: The 3-dimensional reconstruction images of the teeth indicated an even distribution within the sample. The analysis of the prevalence of the different crosssectional configurations of the C-shaped molars revealed that these were predominantly of the C4 and C3 configurations (1 mm from the apex) and the C1 and C2 configurations in the cervical third. According to the morphometric parameters, the C1 and the distal aspect of the C2 configurations exhibited the lowest roundness values and higher values for the area, major diameter, and aspect ratio in the apical third. Conclusions: Mandibular molars with C-shaped root canals exhibited similar distributions of symmetric, asymmetric, and merging type canals. The C1 configuration and the distal aspect of the C2 configuration exhibited the highest area values, low roundness values, and large apical diameters.
Journal of Endodontics, 2008
RANKL and OPG are expressed in apical periodontitis, suggesting a role for these molecules during... more RANKL and OPG are expressed in apical periodontitis, suggesting a role for these molecules during lesion development. However, the profiles of RANKL/OPG expression in periapical lesions remain unknown. In this study we investigated the patterns of RANKL and OPG mRNA expression by RealTime-PCR in human periapical granulomas (N=44), and compared them with sites presenting characteristic bone resorpting activity: healthy (n=14) and orthodontically stretched and compressed periodontal ligament (n=26), healthy gingiva (n=24), chronic gingivitis (n=32) and chronic periodontitis (n=34) samples. Both RANKL and OPG mRNA expression was higher in periapical granulomas when compared to healthy periodontal ligament. Distinct patterns of RANKL and OPG expression ratio were found in the granulomas and in different physiological and pathological conditions with characteristic bone resorption activity potentially being an indicative of the stable or progressive nature of the lesions. Lesions with radiographic image smaller than 5mm demonstrated higher RANKL/OPG expression than images greater than 5mm. Periapical granulomas presented heterogeneous patterns of RANKL and OPG expression, ranging from samples with RANKL/OPG ratio similar to that seen in sites with minimal or absent bone resorption, until samples with RANKL/ OPG expression pattern comparable with active bone resorption sites.
Journal of Endodontics, 2010
The complete microfloral debriment of the root canal is possible only through successful endodont... more The complete microfloral debriment of the root canal is possible only through successful endodontic treatment. Due to complexicity constraints of root canal system complete microfloral removal by simply mechanical instruments is not sufficient. Therefore we aim to evaluate the antimicrobial efficacy of five different intracanal medicaments such as calcium hydroxide, chlorhexidiene, octenidol, endosepton and calcium hydroxide and chlorhexidine against Enterococcus faecalis. The Antibacterial activity of aforesaid medicaments was done against Enterococcus feacalis using agar disk diffusion method, over a period of 24 hrs and 72 hrs. The samples were divided into 6 groups. The zone of inhibition was measured after 24 and 72 hrs and were recorded in millimeters and compared with respect to control. There was a significant difference in the mean zone of inhibition at 24 and 72 hrs between calcium hydroxide, endoseptone, octenidol, calcium hydroxide and chlorohexidine combination, chlorohexidine and control group. Chlorohexidine was found to have maximum inhibitory efficacy followed by calcium hydroxide and chlorohexidine combination. Within the limitations of this study it may be concluded that Chlorhexidine can be used as an efficient intracanal medicament.
International Journal of Oral Science, 2013
This study investigated the efficacy of calcium hydroxide and chlorhexidine gel for the eliminati... more This study investigated the efficacy of calcium hydroxide and chlorhexidine gel for the elimination of intratubular Candida albicans (C. albicans). Human single-rooted teeth contaminated with C. albicans were treated with calcium hydroxide, 2% chlorhexidine gel, calcium hydroxide plus 2% chlorhexidine gel, or saline (0.9% sodium chloride) as a positive control. The samples obtained at depths of 0-100 and 100-200 mm from the root canal system were analyzed for C. albicans load by counting the number of colony forming units and for the percentage of viable C. albicans using fluorescence microscopy. First, the antimicrobial activity of calcium hydroxide and the 2% chlorhexidine gel was evaluated by counting the number of colony forming units. After 14 days of intracanal medication, there was a significant decrease in the number of C. albicans colony forming units at a depth of 0-100 mm with chlorhexidine treatment either with or without calcium hydroxide compared with the calcium hydroxide only treatment. However, there were no differences in the number of colony forming units at the 100-200 mm depth for any of the medications investigated. C. albicans viability was also evaluated by vital staining techniques and fluorescence microscopy analysis. Antifungal activity against C. albicans significantly increased at both depths in the chlorhexidine groups with and without calcium hydroxide compared with the groups treated with calcium hydroxide only. Treatments with only chlorhexidine or chlorhexidine in combination with calcium hydroxide were effective for elimination of C. albicans.
Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 2011
The aim of this study was to determine the influence of periapical radiographs, cone beam compute... more The aim of this study was to determine the influence of periapical radiographs, cone beam computed tomography (CBCT) sections, and cone beam volumetric data on the determination of periapical bone destruction in endodontically treated distal root canals of premolar canine teeth. Nontreated mesial roots were used as controls. Study design. Enterococcus faecalis strain (ATCC 29212) was inoculated into 30 root canals of 2 mongrel dogs to induce apical periodontitis. After 60 days, the root canals of the distal roots of the 11 mandibular and 4 maxillary premolars were endodontically treated (n ϭ 15). The mesial root canals were used as controls (no treatment). The bone destruction was evaluated after 6 months by 5 evaluators using periapical radiographs and by CBCT (coronal and sagittal sections). After the experimental period, the area of the lesions in periapical radiographs and CBCT sections were measured in mm 2 using the ImageTool software. A single evaluator measured the volumetric data using the OsiriX software. The comparison between the diagnosis methods in treated root canals and controls was performed using parametric and nonparametric criteria. The Pearson correlation coefficient was computed between radiographic values and CBCT volumetric data in treated root canals and controls. Results. The results showed the presence of chronic apical periodontitis in every inoculated tooth. After 6 months, periapical radiographs, coronal CBCT sections, and volumetric data showed lower bone destruction in endodontically treated teeth in comparison with the control group (P Ͻ .05). The 5 evaluators found no differences between the apical periodontitis area of treated teeth and controls when CBCT sagittal sections were used (P Ͼ .05). No correlation was found between x-ray and CBCT volumetric values in treated root canals. Conclusions. Although selected CBCT sagittal sections showed similar values of bone destruction in endodontically and nontreated root canals, volumetric CBCT data showed that periapical lesions of endodontically treated root canals had half of the volume of periapical lesions in nontreated root canals. No relationship could be found between the periapical values of bone destruction and volumetric data found in CBCT of treated rood canals.