Abstract: Root perforation results in the communication between root canal walls and periodontal space (external tooth surface). It is commonly caused by an operative procedural accident or pathological alteration (such as extensive dental caries, and external or internal inflammatory root resorption). Different factors may predispose to this communication, such as the presence of pulp stones, calcification, resorptions, tooth malposition (unusual inclination in the arch, tipping or rotation), an extra-coronal restoration or intracanal posts. The diagnosis of dental pulp and/or periapical tissue previous to root perforation is an important predictor of prognosis (including such issues as clinically healthy pulp, inflamed or infected pulp, primary or secondary infection, and presence or absence of intracanal post). Clinical and imaging exams are necessary to identify root perforation. Cone-beam computed tomography constitutes an important resource for the diagnosis and prognosis of this clinical condition. Clinical factors influencing the prognosis and healing of root perforations include its treatment timeline, extent and location. A small root perforation, sealed immediately and apical to the crest bone and epithelial attachment, presents with a better prognosis. The three most widely recommended materials to seal root perforations have been calcium hydroxide, mineral trioxide aggregate and calcium silicate cements. This review aimed to discuss contemporary therapeutic alternatives to treat root canal perforations. Accordingly, the essential aspects for repairing this deleterious tissue injury will be addressed, including its diagnosis, prognosis, and a discussion about the materials actually suggested to seal root canal perforation.

Resumo Introdução Os contraceptivos são amplamente utilizados pelas mulheres em grande parte do mundo. O estresse associado a sua utilização pode conduzir respostas adversas no organismo. Objetivo O objetivo deste trabalho foi avaliar os efeitos do estresse crônico associado ou não com o uso de contraceptivos na progressão de periodontite induzida por ligadura em ratas Lewis. Material e método Para tanto, quarenta ratas foram divididas aleatoriamente em 5 grupos (n = 8): Grupo Contraceptivo e Ligadura (CG); Grupo Estresse e Ligadura (SG); Grupo Contraceptivo, Estresse e Ligadura (CSG); Grupo Ligadura (LG); e Grupo Controle (CtrlG). Um contraceptivo injetável foi administrado nos grupos CG e CSG no início do experimento. No dia seguinte, a periodontite foi induzida nos grupos CG, SG, LG e CSG, através da colocação de ligaduras no segundo molar superior direito destes animais. No terceiro dia, o SG e o CSG foram submetidos a um modelo de estresse crônico usando contenção física e exposição ao frio. Após 60 dias, os animais foram sacrificados e submetidos a medidas histométricas. Foram considerados dois parâmetros: perda de inserção histológico (CEJ-PL) e perda óssea (CEJ-BC). Resultado Os resultados indicaram que o CtrlG (CEJ-PL 0,10 ± 0,00; CEJ-BC 0,34 ± 0,02) apresentaram os valores mais baixos (p<0,05). O grupo SG (CEJ-PL 0,90 ± 0,24; CEJ-BC 1,30 ± 0,28) apresentou valores mais elevados que foram significativamente diferentes (p<0,05) dos resultados do LG. Os outros grupos apresentaram resultados estatísticos semelhantes (p>0,05). Conclusão Os resultados deste estudo não permitem uma avaliação da susceptibilidade dos animais à periodontite induzida por ligadura. Sendo necessários, portanto, outros estudos que elucidem melhor a questão.

Abstract Introduction Contraceptives are widely used by women in much of the world. The stress associated with their use can lead adverse responses in the body. Objective The aim of this paper was to evaluate the effects of chronic stress associated with contraceptive use on the progression of ligature-induced periodontitis in female Lewis rats. Material and method Therefore, forty rats were randomly divided into 5 groups (n = 8): contraceptive and ligature group (CG); stress and ligature group (SG); contraceptive, stress and ligature group (CSG); ligature group (LG); and control group (CtrlG). An injectable contraceptive was administered to the CG and CSG groups at the beginning of the experiment. On the following day, periodontitis was induced in the CG, SG, LG and CSG groups by placing ligatures on the upper-right second molar. On the third day, the SG and the CSG were subjected to a chronic stress model using physical restraint and cold exposure. After 60 days, the animals were euthanized and submitted to histometric measurements. Two parameters were considered: histological attachment loss (CEJ-PL) and bone loss (CEJ-BC). Regarding CEJ-PL/CEJ-BC. Result The results indicated that the CtrlG (CEJ-PL 0.10 ± 0.00; CEJ-BC 0.34 ± 0.02) showed the lowest values (p<0.05). The SG group (CEJ-PL 0.90 ± 0.24; CEJ-BC 1.30 ± 0.28) presented higher values that were significantly different (p<0.05) from the results of the LG. The other groups exhibited similar statistical results (p>0.05). Conclusion The present results do not allow an assessment of the susceptibility of animals to ligature-induced periodontitis.

Resumo Introdução A sinvastatina é uma das várias estatinas utilizadas no tratamento da hipercolesterolemia e, na odontologia, alguns estudos têm buscado relacioná-la ao reparo ósseo. Objetivo Avaliar o efeito da sinvastatina na progressão da periodontite apical induzida em ratos. Material e método Para tanto, 36 ratos Wistar, previamente selecionados, foram divididos em 3 grupos (N=12). Grupo Controle (GC); Grupo Periodontite Apical (GPA); Grupo Periodontite Apical Associada à Sinvastatina (GPAS). No primeiro dia do ensaio o GPA e o GPAS foram anestesiados e submetidos à abertura coronária do primeiro molar inferior direito. Durante trinta dias, o GPAS recebeu diariamente 6mg de sinvastatina, através de gavagem. No trigésimo primeiro dia, todos os grupos foram submetidos à coleta de sangue e a eutanásia. As mandíbulas foram removidas e fixadas em formol. Para a mensuração das regiões periapicais, foram realizadas tomografias. Além disso, avaliou-se a massa corporal, glicemia e o lipidograma. Os dados foram submetidos à análise estatística ANOVA de uma via e teste Post Hoc de Tukey (p<0,05). Resultado Os resultados demonstram que o GPA (3,42±0,65) apresentou os maiores perímetros para espaço do ligamento periapical, seguido pelo GPAS (1,54±0,78) e GC (0,64±0,24), respectivamente (p<0,05). Em relação ao lipidograma percebe-se o efeito da sinvastatina avaliando-se a quantidade de glicose, triglicérides, HDL, VLDL (p<0,05). Para a massa corporal o GPA foi o que mais ganhou peso (264,75±44,11); seguido pelo GC (252,00±44,36); e GPAS (245,41±42,56). Os três grupos apresentaram diferenças estatísticas entre si, de forma decrescente (p<0,05). Conclusão O uso da sinvastatina diminuiu a progressão do aumento do espaço do ligamento periapical em ratos.

Abstract Introduction Simvastatin is one of several statins that are used to treat hypercholesterolemia, and in dentistry, few studies have attempted to associate the administration of this compound with bone repair. Objective To evaluate the effect of simvastatin on the progression of induced apical periodontitis in rats. Material and method To this end, 36 male Wistar rats were divided into 3 groups (N=12): Induced Apical Periodontitis Associated with Simvastatin Group (APSG N=12), Induced Periodontitis Apical Induced Group (APG N=12) and Negative Control Group (CG). On the first day, APG and APSG were anesthetized, and the coronal opening of the mandibular first molar was performed. For thirty days, the APSG received 6 mg of simvastatin daily via gavage. On the thirty-first day, all groups underwent blood collection and euthanasia. The jaws were removed and fixed in formalin. CT scans were performed to measure the periapical regions. In addition, the body mass and lipid profile were analyzed. The data were subjected to statistical analysis (ANOVA and Tukey’s test). Result The APG (3.42±0.65) showed the highest perimeters for the space periapical ligament, followed by APSG (1.54±0.78) and CG (0.64±0.24) (p<0.05). The lipid profile revealed the effect of simvastatin on the amount of glucose, triglycerides, HDL, and VLDL (p<0.05). Body mass APG showed the most weight gain (264.75±44.11), followed by CG (252.00±44.36) and APSG (245.41±42.56). The three groups showed significant differences in decreasing order (p<0.05). Conclusion The use of simvastatin decreased the progression of the increasing periapical ligament space in rats.

Osteopetrosis is characterized by a considerable increase in bone density resulting in defective remodeling, caused by failure in the normal function of osteoclasts, and varies in severity. It is usually subdivided into three types: benign autosomal dominant osteopetrosis; intermediate autosomal recessive osteopetrosis; and malignant autosomal recessive infantile osteopetrosis, considered the most serious type. The authors describe a case of chronic osteomyelitis in the maxilla of a 6-year-old patient with Malignant Infantile Osteopetrosis. The treatment plan included pre-maxilla sequestrectomy and extraction of erupted upper teeth. No surgical procedure was shown to be the best to prevent the progression of oral infection. Taking into account the patient's general condition, if the patient develops severe symptomatic and refractory osteomyelitis surgery should be considered. The patient and his family are aware of the risks and benefits of surgery and its possible complications.

La osteopetrosis se caracteriza por un aumento considerable de la densidad ósea que resulta en un remodelado defectuoso, causado por mal funcionamiento de los osteoclastos, de severidad variable. Usualmente se divide en 3 tipos: osteopetrosis dominante autosómica benigna, osteopetrosis recesiva autosómica intermedia y osteopetrosis infantil recesiva autosómica maligna, considerado el tipo de mayor gravedad. Los autores describen un caso de osteomielitis crónica en el maxilar superior de paciente de 6 años de edad con osteopetrosis infantil maligna. El plan de tratamiento incluyó secuestrectomía y exondoncia de los dientes superiores erupcionados. Ningún procedimento quirúrgico se ha comprobado que sea superior a otros en la prevención del avance de infecciones bucales. Tomando en cuenta las condiciones generales del paciente al desarrollar osteomielitis refractaria y sintomática severa, la cirugía debe ser considerada. El paciente y sus familiares deben ser conscientes de los riesgos y beneficios de la cirugía, así como de sus posibles complicaciones.

RESUMO Objetivo: Avaliar a capacidade de abertura bucal de pacientes submetidos a tratamento radioterápico de cabeça e as variáveis relacionadas à sua limitação. Métodos: Foram analisados 32 pacientes seis meses após o término das sessões de radioterapia para tratamento de câncer em região de cabeça e pescoço. A medida da abertura bucal máxima foi aferida por meio de um paquímetro digital e sua associação com as variáveis sexo, idade, tabagismo, etilismo, localização do tumor, realização de quimioterapia e cirurgia foram analisadas com os testes U de Mann-Whitney e Kruskal-Wallis no nível de significância de 95%. Resultados: A idade média dos pacientes foi de 60,44 anos; 87,5% eram do sexo masculino; 81,2% eram tabagistas; 65,6% eram etilistas. A média de abertura bucal foi de 43,17mm e sete pacientes (21,9%) apresentavam trismo. As localizações mais frequentes dos tumores foi a língua (31,3%), seguida da laringe e da prega vocal com cinco (15,6%) cada uma. Não foi encontrada associação entre a limitação de abertura bucal e as variáveis estudadas. Conclusão: Na amostra estudada, 21,9% dos pacientes apresentaram trismo seis meses após o término do tratamento radioterápico. As variáveis sexo, hábitos de etilismo e tabagismo, localização do tumor, cirurgia prévia e quimioterapia adjuvante não estiveram associados à limitação de abertura bucal.

ABSTRACT Objective: To evaluate the ability to open the mouth in patients undergoing radiotherapy for head and neck and the variables related to this limitation. Methods: 32 patients were evaluated six months after completion of radiotherapy sessions to treat cancer in the head and neck. The maximum mouth opening was measured using digital calipers and its association with gender, age, smoking, alcohol consumption, tumor location, chemotherapy and surgery were analyzed using the Mann-Whitney and Kruskal-Wallis tests at a level of significance of 95%. Results: The mean age of patients was 60.44 years; 87.5% were male; 81.2% were smokers; 65.6% regularly consumed alcohol. The average mouth opening was 43.17 mm and seven (21.9%) patients had trismus. The most common locations of the tumors were the tongue (31.3%) followed by the larynx and vocal folds with five (15.6%) each. No association was found between limited mouth opening and the other variables. Conclusion: In this sample, 21.9% of patients had trismus six months after completing radiotherapy. The variables gender, age, smoking habits and alcohol consumption, tumor location, previous surgery and adjunctive chemotherapy were not associated with limited mouth opening.

PURPOSE:To compare chronic physical stressed with normal tense animals regarding implant osseointegration in the rat mandible.METHODS:Thirty six Wistar rats were anesthesiaded and blunt instruments were used to expose and empty their alveolar inferior nerve. One implant (2.2 x 4mm) was installed into the mandibular canal. Following 72 hours, all rats were equally divided in: Control Group analyzed in 18 days (CG18); Control Group analyzed in 33 days (CG33); Stressed Group with stress during 18 days (SG18) and Stressed Group with stress during 33 days (SG33) - The animals from Stressed Groups (CG 18 and CG33) were placed individually in plastic pipes (PVC) during 12 hours daily to physical restraint. Histomorphometric analysis included bone-implant-contact (BIC) and bone area (BA).RESULTS: In relation to BIC - CG18 (49.8+20.3); SG18 (29.0+16.5) - and BA - CG18 (50.13+21.2); SG18 (23.8+7.8)-, there was a bone repair delayed in SG18 when compared with CG18 (p<0.05). After 33 days, BIC - CG33 (59.6+26.8); SG33 (49.52+17.3)- and BA - CG33 (41.90+17.4); SG33 (43.91+14.7)- showed no difference between groups (p>0.05).CONCLUSION: Chronic physical stress interfere with the initial stage of osseointegration in the rat mandible, but not the final process.

The aim of this study was to evaluate the in vitro antimicrobial activity of Brazilian brown propolis as an intracanal medication againstEnterococcus faecalis. Thirty dentin discs prepared from intact freshly extracted bovine maxillary central incisors were infected withE. faecalis for 21 days. The specimens were distributed into six groups according to the medicament used as follows: G1- calcium hydroxide paste; G2- Carbowax 400 (control group); G3- 20% brown propolis paste; G4- 40% brown propolis paste; G5- 20% brown propolis paste + calcium hydroxide paste; and G6- 40% brown propolis paste + calcium hydroxide paste. The experimental pastes were placed into the canal lumen and left for 14 days. After each period, irrigation was performed with sterile saline to remove the medicament, and the canals were dried with sterile paper points. The dentin chips were removed from the canals with sequential sterile round burs at low speed and were immediately collected in separate test tubes containing BHI broth. The tubes were incubated at 37°C, and microbial growth was analyzed by spectrophotometry after 15 days. All the experimental medications significantly reduced the number of viable bacteria. The G4 and G5 pastes were more effective than the G1 paste, with 35.8%, 41%, and 21.3% antibacterial activity, respectively. Brazilian brown propolis shows antibacterial capacity againstE. faecalis.

PURPOSE: To investigate the effect chronic stress in newborn rats on the progression of ligature-induced-periodontitis in adulthood. METHODS: Ten couples of adult Wistar rats were selected for mating. After birth, the female and their respective offsprings were allocated into two groups. Ligature Group (LG): offsprings were only watched during breast-feeding; Stress-ligature Group (SLG): after 24h of live birth, the offsprings were moved away from their mothers every day for four hours during breast-feeding for 20 days; in both approaches, after reaching ± 250g, ten rats were included in the groups. Periodontal disease was induced by a silk suture placed around the maxillary right second molar. The left side was used as control. After 15 days, the animals were subjected to euthanasia, maxillary bones were removed and stored in 10% formaldehyde. After 48h, radiographs were taken and revealed and were used for bone destruction analysis. Examiner was blind and calibrated for measurements. RESULTS: Stress-ligature group presented higher bone loss values in relation to ligature group (p<0.05). CONCLUSION: Exposure to chronic stress imposed on offsprings produced a greater progression of bone loss induced during adulthood.

OBJETO: Fusão dental é definida como sendo a união de dois germes dentais em algum momento do estágio de desenvolvimento. O objetivo desse artigo foi descrever o tratamento endodôntico de dois casos de fusão dental. DESCRIÇÃO DO CASO: No primeiro caso clínico, o paciente foi orientado pelo ortodontista a realizar tratamento endodôntico do dente 12, o qual estava fusionado ao dente 13. Foi realizada a separação cirúrgica dos elementos dentais e posterior reposicionamento no arco dental. No segundo caso clínico, o paciente procurou atendimento relatando dor espontânea na região anterior superior. Por meio do exame radiográfico, foi observado geminação do dente 11 e fusão do dente 21 com dente extranumerário. Em ambos os casos os dentes fusionados foram tratados endodônticamente e os pacientes encaminhados para restabelecimento da estética e função. CONCLUSÃO: O cirurgião dentista deve ter habilidade de diagnosticar, diferenciar e tratar adequadamente as anomalias dentárias, objetivando a manutenção da saúde oral dos pacientes.

PURPOSE: Dental fusion is defined as the union of two dental germs at some stage of their development. The aim of this article is to report the endodontic treatment of two clinical cases of dental fusion. CASE DESCRIPTION: In the first case, the patient was referred by an orthodontist for endodontic treatment of tooth 12, which was fused to 13. Surgical separation and later replacement of the involved elements in the dental arch was indicated. In the second case, the patient sought dental attendance due to spontaneous pain. In the radiographic exam, gemination in tooth 11 and fusion of 21 with a supernumerary tooth was observed. The fused teeth were endodontically treated, and patients were referred to other dental specialties to reestablish esthetics and function. CONCLUSION: The dentist must be able to diagnose, differentiate and treat these dental anomalies adequately, with the goal of maintaining patients' oral health.

OBJETIVO: Avaliar o efeito de dois modelos de estresse crônico - físico e variável - em ratos, associados à periodontite induzida, sobre parâmetros hematológicos: volume corpuscular médio (VCM), hemoglobina corpuscular média (HCM) e concentração hemoglobínica corpuscular média (CHCM) hematócrito (Ht), hemácias (Hm), hemoglobina (Hg) e leucó- citos (Lc). METODOLOGIA: Selecionaram-se 48 ratas adultas da linhagem Wistar divididas aleatoriamente em 4 grupos (n=12): estresse físico (GEF), estresse variável (GEV), ligadura (GL) e controle (GC). Iniciou-se o ensaio de estresse físico (contenção e exposição ao frio) e estresse variável (exposição à luz piscante, isolamento, exame da cavidade bucal, ambiente congestionado, odor de sangue e barulho). Decorridos 10 dias do início do ensaio de estresse, os animais dos Grupos EF, EV e L foram anestesiados e um fio de seda foi adaptado em volta do segundo molar superior direito, sendo o ensaio de estresse mantido por mais 50 dias. Os animais foram anestesiados e procedeu-se a incisão e visualização da veia cava posterior. Realizou-se a punção sanguínea a vácuo, em tubos com EDTA. Os dados foram coletados por examinadores cegos e treinados e analisados por ANOVA e teste de Bonferroni, ao nível de significância de 0,05. RESULTADOS: Os dois modelos de estresse alteraram todos os parâmetros hematológicos do estudo com exceção do VCM. CONCLUSÃO: O estresse associado à periodontite é capaz de modificar parâmetros sanguíneos em ratas.

PURPOSE: To evaluate the effect of two models of chronic stress in rats and their association with induced periodontitis on hematological parameters: mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), hematocrit (Ht), erythrocytes (Hm), hemoglobin (Hg) and leukocytes (Lk). METHODS: Forty-eight adult Wistar rats were randomly distributed into four groups (n=12): physical stress (PSG), variable stress (VSG), ligature (LG) and control (CG) and then started the test of physical stress (restraint and exposure to cold) and variable stress (exposure to flashing light, isolation, examination of the oral cavity, congested environment, the smell of blood and noise). After 10 days of the stress test, the animals in Groups PS, VS and L were anesthetized, and a silk thread was adapted around the upper right second molar; subsequently, the stress test continued for 50 days. The animals were anesthetized and held up the incision and visualization of the posterior vena cava for blood puncture vacuum in tubes containing EDTA. Data were collected by blinded and trained examiners and were statistically analyzed by means of ANOVA and Bonferroni's test at the significance level of 0.05. RESULTS: The two models of stress changed all of the hematological parameters tested, with the exception of VCM. CONCLUSION: The stress associated with periodontitis is able to modify blood parameters in rats.

This study evaluated the time efficiency of stress associated with ligature-induced periodontitis in rats. Sixty adult Wistar rats, housed in temperature-controlled rooms and receiving water and food ad libitum, were randomly separated into stress (n = 30) or control groups (n = 30). All animals were anesthetized, and nylon ligatures were placed at the gingival margin level of the maxillary right second molars. After the induction of periodontitis, rats in the stress group were subjected to physical restraint for 12 hours daily. The animals were euthanized after 7, 15 and 30 days by anesthetic overdose (10 animals per group per period). The right hemimaxillae were stored in formalin solution for 48 hours. Parallel radiographic images of the hemimaxillae were taken and processed following standard procedures. Radiographic examination was performed by a blinded and previously calibrated investigator. Bone height level was measured, and data were submitted to analysis of variance and post hoc Bonferroni tests (p < 0.05). Rats in the stress group had greater bone loss than those in the control group at 7 and 15 days post-induction (p < 0.05). After 30 days, there was no statistically significant difference between the groups (p > 0.05). Restraint stress modulates the short-term progression of periodontal disease in rats. Therefore, the 12-hour daily physical restraint stress model in rats applied for up to 15 days is suitable for the investigation of the combined effect of ligation and restraint stress on periodontal degradation.

The purpose of this study was to evaluate the hydrogenionic potential and electrical conductivity of Portland cements and MTA, as well as the amount of arsenic and calcium released from these materials. In Teflon molds, samples of each material were agitated and added to plastic flasks containing distilled water for 3, 24, 72 and 168 h. The results were analyzed with a Kruskal-Wallis non-parametric test for global comparisons and a Dunn-Tukey test for pairwise comparisons. The results revealed no significant differences in the pH of the materials (p > 0.05). The electrical conductivity of the cements were not statistically different (p > 0.05). White non-structural cement and MTA BIO released the largest amount of calcium ions into solution (p < 0.05), while arsenic release was insignificant in all of the materials (p > 0.05). The results indicated that the physico-chemical properties of Portland cements and MTA were similar. Furthermore, all materials produced an alkaline environment and can be considered safe for clinical use because arsenic was not released. The electrical conductivity and the amount of calcium ions released into solution increased over time.

OBJETIVO: O objetivo desse estudo in vitro foi de avaliar a ação antimicrobiana de enxaguatórios bucais com e sem álcool. METODOLOGIA: Usaram-se no estudo o Periogard®, o CEPACOL®, Plax Classic® e o ORAL-B®, anti-séptico sem álcool. Para a realização desse estudo foram utilizadas 40 placas de Petri com meio de cultura de Ágar Sangue para os seguintes microrganismos: Staphylococcus aureus, Candida albicans, Enterococcus faecalis, Pseudomonas aeruginosa. Para a mensuração dos halos de inibição, um único examinador treinado utilizou uma lupa estereoscópica e um paquímetro digital. Após a coleta dos dados, as médias foram comparadas utilizando-se do teste estatístico ANOVA (análise de variância) com teste corretivo de Bonferroni, para nível de significância de 5%. RESULTADOS: O Periogard® com álcool e o sem álcool apresentaram os melhores resultados. O Plax® sem álcool obteve os piores resultados. O Plax® com álcool foi melhor substância em relação ao S. aureus. Os demais resultados mantiveram-se com melhor efetividade em relação à substância controle. CONCLUSÃO: Os enxaguatórios sem álcool não têm a mesma eficácia antimicrobiana comparada aos enxaguatórios com álcool em relação aos microrganismos testados neste estudo.

PURPOSE: The aim of this in vitro study was to evaluate the effect of mouthwashes with and without alcohol on some microorganisms. METHODS: Periogard®, Cepacol®, Plax Classic® and Oral-B® were the substances tested. For this study, 40 plates of Petri with medium blood agar were used for the following microorganisms: Staphylococcus aureus, Candida albicans, Enterococcus faecalis, Pseudomonas aeruginosa. To measure the inhibition zones, a single trained examiner used a stereomicroscope and a digital caliper. After data collection, the medias were compared using the ANOVA (analysis of variance) with Bonferroni test post-hoc correction for 5% significance level. RESULTS: Periogard®, with and without alcohol, showed the best results. Plax® without alcohol presented the poorest results. Plax® with alcohol was the best substance in relation to S. aureus. The others results remained with better effectiveness in relation to control substance. CONCLUSION: The alcohol-free mouthwashes did not have the same efficacy of antimicrobial rinses with alcohol in relation to microorganisms tested in this study.