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Carlos Estrela - One of the best experts on this subject based on the ideXlab platform.

  • ethical aspects concerning endodontic ethical aspects concerning endodontic instrument fracture instrument fracture
    Brazilian Journal of Oral Sciences, 2016
    Co-Authors: Rhonan Ferreira Silva, Savio Domingos Da Rocha Pereira, Eduardo Daruge, Luiz Francesquini, Claudia Daniela Moreira Portilho, Carlos Estrela
    Abstract:

    Aim: The aim of this study was to address several ethical aspects concerning the behavior of Endodontists and general dentists regarding endodontic instrument fracture during root canal treatment. Methods: The responses of a group of professionals (Endodontists and general dentists) to a questionnaire were reviewed and analyzed statistically by Fisher’s Exact and chi-square tests at 5% significance level. Results: Forty-six percent of the interviewees responded that they would try to solve the problem without informing the patient about the accident. Only 28.1% of the participants affirmed that they would let the patient know right at the moment of occurrence. Conclusions: The outcomes of this survey demonstrate that most professionals are afraid of informing their patient about an accidental endodontic instrument breakage during treatment and might be subject to lawsuits.

  • sodium hypochlorite chemical burn in an Endodontist s eye during canal treatment using operating microscope
    Journal of Endodontics, 2014
    Co-Authors: Desiree Regalado C Farreras, Carlos Garcia Puente, Carlos Estrela
    Abstract:

    Abstract Introduction This study describes a case of eye burn induced by sodium hypochlorite used as an irrigant during root canal preparation. Methods A 24-year-old female Endodontist was using an operating microscope during root canal treatment, and as the root canal was irrigated, the pressure cannula burst and the irrigant (3.5% sodium hypochlorite) came into direct contact with her left eye. She immediately sought ophthalmologic emergency care for pain, redness of the cornea, burning sensation, photophobia, intraocular pressure, and blurred vision. The initial treatment consisted of washing the eye with saline solution and administering analgesic and anti-inflammatory (steroid) medications. One day after the accident, a topical demulcent and hydroxypropyl medication were applied to the eyeball (conjunctiva), the eye was bandaged for 24 hours, and rest was prescribed for 7 days. Eight days later, a corneal ulcer was diagnosed, and antibiotic and anti-inflammatory (steroid) medications were used. Results Vision was restored without any sequelae 4 weeks after the accident. The Endodontist was instructed to apply control medication (Lagricel; Sophia SA, Caracas, Venezuela) for 3 months and to return for ophthalmologic follow-up every 6 months. Conclusions Sodium hypochlorite is an effective antibacterial irrigant indicated for the treatment of root canal infections. The tissue cytotoxicity highlights the need to inform the patient of the risk factors of accidents and enhance care with individual protection equipment for the patient and the professional during clinical procedures.

  • procedural errors during root canal preparation using rotary niti instruments detected by periapical radiography and cone beam computed tomography
    Brazilian Dental Journal, 2010
    Co-Authors: Ana Helena Goncalves De Alencar, Jesus Djalma Pécora, P M H Dummer, Henrique Cesar Marcal Oliveira, Carlos Estrela
    Abstract:

    This study detected procedural errors created by rotary nickel-titanium (NiTi) instruments during root canal preparation by two imaging methods. Forty extracted human maxillary and mandibular molars were divided randomly into two groups and treated by two Endodontists (n=10) and two undergraduate dental students (n=10). The ProTaper UniversalTM Rotary System was used to shape the canals and then they were filled using AH PlusTM sealer and gutta-percha. Periapical radiographs (PR) and cone beam computed tomography (CBCT) images were obtained and two examiners, who evaluated them to verify the occurrence of procedural errors (fractured instruments, perforations, and canal transportation). The Chi-square test at 0.05 level of significance was used for statistical analyses. There were no significant differences (p>0.05) between the imaging methods. In the analysis of procedural errors, there was no significant difference (p>0.05) between the groups of operators (Endodontists vs. students) nor between tooth groups (maxillary molars vs. mandibular molars). In view of the low incidence of procedural errors during root canal preparation performed by students the introduction of rotary NiTi instruments has potential in undergraduate teaching. PR and CBCT permitted the detection of procedural errors, but the CBCT images offer more recourse for diagnosis.

  • ethical aspects concerning endodontic instrument fracture
    Brazilian Journal of Oral Sciences, 2009
    Co-Authors: Rhonan Ferreira Silva, Savio Domingos Da Rocha Pereira, Eduardo Daruge, Luiz Francesquini, Claudia Daniela Moreira Portilho, Carlos Estrela
    Abstract:

    Aim: The aim of this study was to address several ethical aspects concerning the behavior of Endodontists and general dentists regarding endodontic instrument fracture during root canal treatment. Methods: The responses of a group of professionals (Endodontists and general dentists) to a questionnaire were reviewed and analyzed statistically by Fisher s Exact and chi-square tests at 5% significance level. Results: Forty-six percent of the interviewees responded that they would try to solve the problem without informing the patient about the accident. Only 28.1% of the participants affirmed that they would let the patient know right at the moment of occurrence. Conclusions: The outcomes of this survey demonstrate that most professionals are afraid of informing their patient about an accidental endodontic instrument breakage during treatment and might be subject to lawsuits.

Daniel E Tira - One of the best experts on this subject based on the ideXlab platform.

  • use of cone beam computed tomography to identify root canal systems in vitro
    Journal of Endodontics, 2008
    Co-Authors: Rya P Matherne, James C Kulild, Christos Angelopoulos, Daniel E Tira
    Abstract:

    Abstract This study investigated the use of cone-beam computed tomography (CBCT) as a diagnostic tool for identifying root canal systems (RCSs) when compared with images obtained by using charged coupled device (CCD) and photostimulable phosphor plate (PSP) digital radiography in vitro. Seventy-two extracted teeth were exposed with CCD, PSP, and CBCT radiography. Specimens included 24 maxillary molars, mandibular premolars, and mandibular incisors each. Tooth-type selections were based on the greater possibility of multiple RCSs. Three board-certified Endodontists evaluated CCD and PSP images to determine the number of RCSs. CBCT images were used to establish “ground truth” for the comparisons and were evaluated by a board-certified oral and maxillofacial radiologist who determined the number of RCSs. Descriptive statistical analysis revealed that the Endodontists consistently agreed among themselves. When compared with CBCT evaluation, the Endodontists, on average, failed to identify 1 or more RCSs in 41% of the teeth with CCD and 40% of the time with PSP. CBCT evaluations identified an average of 3.58 RCSs per maxillary molar, 1.21 per mandibular premolar, and 1.5 per mandibular incisor. Evaluation of CCD images demonstrated an average number of 1.0 RCSs per mandibular incisor, 1.0 per mandibular first premolar, and 3.1 per maxillary molar. Evaluation of PSP images demonstrated an average number of 1.3 RCSs per mandibular incisor, 1.1 per mandibular first premolar, and 3.0 per maxillary molar. In summary, Endodontist evaluators with either CCD or PSP methods failed to identify at least 1 RCS in approximately 4 of 10 teeth, which can result in a less optimal healing outcome if a missed RCS is left uninstrumented and unobturated.

Kenneth M Hargreaves - One of the best experts on this subject based on the ideXlab platform.

  • epidemiological evaluation of the outcomes of nonsurgical root canal treatment in a large cohort of insured dental patients
    Journal of Endodontics, 2001
    Co-Authors: Michael P Lazarski, William A Walker, Christopher M Flores, William G Schindler, Kenneth M Hargreaves
    Abstract:

    Selected outcomes following initial nonsurgical root canal treatment (NSRCT) procedures were retrospectively assessed using an insurance company database of 110,766 nonsurgical root canal procedures that were completed by Endodontists and their referring general dentists. A subset of 44,613 cases, with a minimum required follow-up time of 2 yr, showed incidences of extraction, retreatment and periradicular surgery equal to 5.56%, 2.47%, and 1.41%, respectively. The incidence of subsequent extraction increased with patient age. Teeth that were not restored after root canal therapy were significantly more likely to undergo extraction than restored teeth. Although the practice pattern for Endodontists consisted of a significantly higher proportion of molars (48% more; p

Ivaldo Gomes De ,moraes - One of the best experts on this subject based on the ideXlab platform.

  • Radiographic analysis of root canal fillings : influence of two sealers on the perception of voids
    2014
    Co-Authors: Bodanezi Augusto, Munhoz, Etiene De Andrade, Bernardineli Norberti, Capelozza, Ana Lucia Alvares, Ivaldo Gomes De ,moraes, Bramante, Clovis Monteiro
    Abstract:

    O propósito deste estudo ex vivo foi investigar se dois cimentos obturadores de fórmulas diferentes influenciariam a percepção radiográfica de obturações de canais radiculares. Os canais radiculares de 48 caninos superiores extraídos foram preparados e divididos em 3 grupos. Em cada grupo os canais foram preenchidos através da condensação lateral da gutapercha e de um dos cimentos testados (Endométhasone, Sealer 26 e cimento não-radiopaco), e um defeito de ponta a ponta foi simulado em metade dos espécimes de cada grupo (n=8). As imagens radiográficas vestíbulo-linguais obtidas foram aleatoriamente interpretadas quanto à existência de defeitos por um radiologista e um Endodontista. As diferenças em sensibilidade e especificidade entre os grupos e examinadores foram comparadas respectivamente usando-se os testes Exato de Fisher e McNemar ajustados ao nível de significância de 5%. Ambos os cimentos radiopacos ocasionaram uma redução significativa da sensibilidade na parte cervical das obturações. O uso do Endométhasone aumentou os valores de especificidade para as porções cervical e apical das obturações dos canais radiculares. Concluiu-se que os cimentos testados influenciaram de maneira distinta a percepção radiográfica de obturações endodônticas executadas com condensação lateral.The aim of this ex vivo was to investigate if two radiopaque root canal sealers with different formulations would influence the radiographic perception of root canal fillings. The root canals of 48 extracted maxillary canines were prepared and randomly assigned to 3 groups of 16 specimens each. In each group, the root canals were filled by lateral condensation of gutta-percha and one of the tested sealers: Endométhasone, Sealer 26, or a non-radiopaque sealer. A through-and-through void was simulated in half of the specimens from each group (n=8). The buccolingual radiographic images obtained were randomly interpreted for voids existence by a radiologist and an Endodontist. The differences in sensitivity and specificity between groups and examiners were compared using, respectively, Fisher's Exact and McNemar tests at 5% significance level. Both radiopaque sealers caused a significant decrease in sensitivity at the coronal part of fillings. The use of Endométhasone increased specificity values for both coronal and apical portions of the root canal fillings. In conclusion, the tested sealers influenced the radiographic perceptions of laterally condensed root canal fillings in a different way

  • Influence of root canal sealer on the radiographic appearance of filling voids in maxillary single-rooted teeth
    2012
    Co-Authors: Bodanezi Augusto, Munhoz, Etiene De Andrade, Bernardineli Norberti, Capelozza, Ana Lucia Alvares, Ivaldo Gomes De ,moraes, Garcia, Roberto Brandão, Bramante, Clovis Monteiro
    Abstract:

    Objective: This study compared the infJuence of three epoxy resin-based sealers with distinct radiopacities on the observers' ability to detect root canal filling voids during radiographic analysis. Material and methods: The root canais of 48 extracted maxillary canines were prepared and divided into three groups. Each group was laterally condensed with one sea/er (AH P/us™, Acrosea/® o r a non-radiopaque sealer), and a longitudinal void was simulated in half of the specimens from each group (n=S). Buccolingual radiographs were obtained and randomly interpreted for voids by a radiologist and an Endodontist in a blinded fashion. Teeth were cut and inspected under a microscope to confirm the position of void. Differences in sensitivity and specificity between groups and examiners were compared using the Fisher's Exact and McNemar tests, respectively (a=O.OS). Results: Significantly lower sensitivity leveis (p

  • Eficácia dos métodos radiográficos convencional e digital no diagnóstico de reabsorções radiculares simuladas
    Faculdade De Odontologia De Bauru - USP, 2004
    Co-Authors: Westphalen, Vânia Portela Ditzel, Ivaldo Gomes De ,moraes, Westphalen, Fernando Henrique
    Abstract:

    This in vitro study evaluated and compared the efficacy of conventional (Kodak F-speed (Insight), Kodak) and a digital (DRS Gnatus System, Gnatus) radiographic imaging for diagnosis of simulated external root resorption cavities. Human mandibles containing teeth were covered with bovine muscle slices in order to simulate the soft tissues. Nine teeth out of each group of teeth were investigated. Initially, three periapical radiographs of each tooth were taken using a tube shift technique with mesial and distal angulations in both methods. All teeth were subsequently extracted and had 0.7 and 1.0-mm deep cavities prepared on their buccal, mesial and distal surfaces at the cervical, middle and apical thirds. Steel cylinder burs (DORMER® - HSS) with 0.7 and 1.0-mm diameter were used. Each tooth was replaced on its socket and new radiographs were taken. Three examiners, an Endodontist (1), a radiologist (2) and a general dentist (3), evaluated the images. Results were compared by z-test and showed a higher number of cavities detected by the digital method compared to the conventional, regardless of the deepness of the cavity. In decreasing order, examiners 2, 3 and 1 exhibited different potentials of detection of cavities with the conventional method. Examiners 1 and 3 exhibited superior potential than examiner 2 for detection of cavities of different sizes with the digital method.O presente estudo visou avaliar e comparar, in vitro, a eficácia dos métodos radiográficos convencional (filmes de grupos de sensibilidade E/F Kodak Insight) e digital (Sistema Gnatus DRS), no diagnóstico de cavidades simulando reabsorções radiculares externas, em dentes contidos em mandíbulas humanas secas com músculo bovino simulando o tecido mole. As variáveis consideradas foram: tamanhos das cavidades e examinadores envolvidos. Foram utilizadas nove unidades de cada grupo dentário, incisivos (central e lateral), caninos, pré-molares e molares, sem lesões periapicais, as quais foram radiografadas inicialmente, em três tomadas radiográficas periapicais (orto, mesio e distorradial) pelos métodos radiográficos convencional e digital. Extraíram-se os dentes com o auxílio de fórceps e as cavidades de reabsorção foram confeccionadas com brocas cilíndricas DORMER® - HSS - Aço rápido, de 0,7 e 1,0 mm de diâmetro, nas profundidades 0,7 e 1,0 mm, para simular cavidades pequenas e médias, respectivamente, distribuídas nos terços radiculares cervical, médio e apical e nas faces vestibular, mesial e distal. Após a realização das cavidades os dentes eram reposicionados nos alvéolos e então, radiografados novamente pelos métodos convencional e digital, sendo esses passos comuns a ambos os diâmetros e profundidades das cavidades. As radiografias convencionais e digitais foram avaliadas por três cirurgiões-dentistas, sendo um radiologista, um Endodontista e um clínico geral. Os resultados da investigação mostraram que, pelo método radiográfico digital o número de cavidades observadas foi maior do que pelo convencional, tanto para as cavidades pequenas (p

  • Efficacy of conventional and digital radiographic imaging methods for diagnosis of simulated external root resorption
    Universidade de São Paulo. Faculdade de Odontologia de Bauru, 2004
    Co-Authors: Westphalen, Vânia Portela Ditzel, Ivaldo Gomes De ,moraes, Westphalen, Fernando Henrique
    Abstract:

    This in vitro study evaluated and compared the efficacy of conventional (Kodak F-speed (Insight), Kodak) and a digital (DRS Gnatus System, Gnatus) radiographic imaging for diagnosis of simulated external root resorption cavities. Human mandibles containing teeth were covered with bovine muscle slices in order to simulate the soft tissues. Nine teeth out of each group of teeth were investigated. Initially, three periapical radiographs of each tooth were taken using a tube shift technique with mesial and distal angulations in both methods. All teeth were subsequently extracted and had 0.7 and 1.0-mm deep cavities prepared on their buccal, mesial and distal surfaces at the cervical, middle and apical thirds. Steel cylinder burs (DORMER® - HSS) with 0.7 and 1.0-mm diameter were used. Each tooth was replaced on its socket and new radiographs were taken. Three examiners, an Endodontist (1), a radiologist (2) and a general dentist (3), evaluated the images. Results were compared by z-test and showed a higher number of cavities detected by the digital method compared to the conventional, regardless of the deepness of the cavity. In decreasing order, examiners 2, 3 and 1 exhibited different potentials of detection of cavities with the conventional method. Examiners 1 and 3 exhibited superior potential than examiner 2 for detection of cavities of different sizes with the digital method.O presente estudo visou avaliar e comparar, in vitro, a eficácia dos métodos radiográficos convencional (filmes de grupos de sensibilidade E/F Kodak Insight) e digital (Sistema Gnatus DRS), no diagnóstico de cavidades simulando reabsorções radiculares externas, em dentes contidos em mandíbulas humanas secas com músculo bovino simulando o tecido mole. As variáveis consideradas foram: tamanhos das cavidades e examinadores envolvidos. Foram utilizadas nove unidades de cada grupo dentário, incisivos (central e lateral), caninos, pré-molares e molares, sem lesões periapicais, as quais foram radiografadas inicialmente, em três tomadas radiográficas periapicais (orto, mesio e distorradial) pelos métodos radiográficos convencional e digital. Extraíram-se os dentes com o auxílio de fórceps e as cavidades de reabsorção foram confeccionadas com brocas cilíndricas DORMER® - HSS - Aço rápido, de 0,7 e 1,0 mm de diâmetro, nas profundidades 0,7 e 1,0 mm, para simular cavidades pequenas e médias, respectivamente, distribuídas nos terços radiculares cervical, médio e apical e nas faces vestibular, mesial e distal. Após a realização das cavidades os dentes eram reposicionados nos alvéolos e então, radiografados novamente pelos métodos convencional e digital, sendo esses passos comuns a ambos os diâmetros e profundidades das cavidades. As radiografias convencionais e digitais foram avaliadas por três cirurgiões-dentistas, sendo um radiologista, um Endodontista e um clínico geral. Os resultados da investigação mostraram que, pelo método radiográfico digital o número de cavidades observadas foi maior do que pelo convencional, tanto para as cavidades pequenas (

  • Efficacy of conventional and digital radiographic imaging methods for diagnosis of simulated external root resorption Eficácia dos métodos radiográficos convencional e digital no diagnóstico de reabsorções radiculares simuladas
    University of São Paulo, 2004
    Co-Authors: Vânia Portela Ditzel Westphalen, Ivaldo Gomes De ,moraes, Fernando Henrique Westphalen
    Abstract:

    This in vitro study evaluated and compared the efficacy of conventional (Kodak F-speed (Insight), Kodak) and a digital (DRS Gnatus System, Gnatus) radiographic imaging for diagnosis of simulated external root resorption cavities. Human mandibles containing teeth were covered with bovine muscle slices in order to simulate the soft tissues. Nine teeth out of each group of teeth were investigated. Initially, three periapical radiographs of each tooth were taken using a tube shift technique with mesial and distal angulations in both methods. All teeth were subsequently extracted and had 0.7 and 1.0-mm deep cavities prepared on their buccal, mesial and distal surfaces at the cervical, middle and apical thirds. Steel cylinder burs (DORMER® - HSS) with 0.7 and 1.0-mm diameter were used. Each tooth was replaced on its socket and new radiographs were taken. Three examiners, an Endodontist (1), a radiologist (2) and a general dentist (3), evaluated the images. Results were compared by z-test and showed a higher number of cavities detected by the digital method compared to the conventional, regardless of the deepness of the cavity. In decreasing order, examiners 2, 3 and 1 exhibited different potentials of detection of cavities with the conventional method. Examiners 1 and 3 exhibited superior potential than examiner 2 for detection of cavities of different sizes with the digital method.O presente estudo visou avaliar e comparar, in vitro, a eficácia dos métodos radiográficos convencional (filmes de grupos de sensibilidade E/F Kodak Insight) e digital (Sistema Gnatus DRS), no diagnóstico de cavidades simulando reabsorções radiculares externas, em dentes contidos em mandíbulas humanas secas com músculo bovino simulando o tecido mole. As variáveis consideradas foram: tamanhos das cavidades e examinadores envolvidos. Foram utilizadas nove unidades de cada grupo dentário, incisivos (central e lateral), caninos, pré-molares e molares, sem lesões periapicais, as quais foram radiografadas inicialmente, em três tomadas radiográficas periapicais (orto, mesio e distorradial) pelos métodos radiográficos convencional e digital. Extraíram-se os dentes com o auxílio de fórceps e as cavidades de reabsorção foram confeccionadas com brocas cilíndricas DORMER® - HSS - Aço rápido, de 0,7 e 1,0 mm de diâmetro, nas profundidades 0,7 e 1,0 mm, para simular cavidades pequenas e médias, respectivamente, distribuídas nos terços radiculares cervical, médio e apical e nas faces vestibular, mesial e distal. Após a realização das cavidades os dentes eram reposicionados nos alvéolos e então, radiografados novamente pelos métodos convencional e digital, sendo esses passos comuns a ambos os diâmetros e profundidades das cavidades. As radiografias convencionais e digitais foram avaliadas por três cirurgiões-dentistas, sendo um radiologista, um Endodontista e um clínico geral. Os resultados da investigação mostraram que, pelo método radiográfico digital o número de cavidades observadas foi maior do que pelo convencional, tanto para as cavidades pequenas (p

G C Dietz - One of the best experts on this subject based on the ideXlab platform.

  • the Endodontist and the general dentist
    Dental Clinics of North America, 1992
    Co-Authors: G C Dietz
    Abstract:

    As the title suggests, most of this article has discussed the relationship between the general dentist and the endodontic specialist. In attempting to shed some light on this very intricate referral process, one should not lose sight of the fact that it is ultimately the dental patient needing the root canal treatment who should be the recipient of any improvement that develops in this referral process. General dentists have always, and, most probably, will always provide the great majority of root canal treatments done in the United States. Many factors, however, will, from time to time, cause the thoughtful general dentist to refer at least some cases to endodontic specialists. Patients have very little to say in this process; however, we must all realize that they place a great deal of trust in both the general dentist and the Endodontist to work together to come to the best resolution of their endodontic problems. The primary concerns of most patients seem to fall into the areas of fear of the treatment and fear of the cost. Costs are driven by expenses, insurance tables, and market factors. Although it cannot be said that endodontic treatment is inexpensive, it can usually be stated that there is good value received for the treatment given. This is particularly true if the end result is a quality job done with long-term retention of the problem tooth. As to the patient's fear concerning pain, it is incumbent on both the generalist and the specialist to develop the skills necessary to render modern endodontic treatment in a pain-free manner. This is within the standard of care, and is something the patients should not only expect but, in fact, demand. The other concerns that patients have are quite standard in the profession. They are, primarily, the desire for pleasant surroundings, pleasant staff, confident doctors, convenient pay arrangements, understanding of the procedure, and a perception of value for time and money spent. Working together, the endodontic specialist and the general dentist should certainly be able to provide these wishes for all patients.