Syfte: Att beskriva vilka faktorer som uttryckt i generella termer har betydelse för tandläkarens beslut gällande koronal restaurering av en rotfylld tand.    Material och metod: Fjorton allmäntandläkare (27–64 år) valdes ut strategiskt med avseende på kön, ålder, utbildningsort i Sverige, verksamhet (privat/folktandvård) och yrkeserfarenhet. Semistrukturerade djupintervjuer genomfördes där informanterna ombads att beskriva de två senaste fallen där en direkt restaurering valdes efter rotbehandling av en tand och de två senaste fallen då en indirekt restaurering valdes. Intervjuerna spelades in digitalt och transkriberades ordagrant. Det insamlade materialet analyserades enligt kvalitativ innehållsanalys.    Resultat: Ett mönster identifierades och, för att åskådliggöra det manifesta innehållet, klassificerade dessa i tre kategorier, inklusive två subkategorier för respektive kategori. Den första kategorin var Professionens inflytande med subkategorierna (i) individuella preferenser och (ii) klinisk erfarenhet. Den andra kategorin var Klinisk situation med subkategorierna (i) iakttagbart status och (ii) bedömning inför framtiden. Den tredje kategorin Ekonomiska förutsättningar hade subkategorierna (i) patientrelaterade och (ii) samhällsrelaterade.    Konklusion: Beslutet vid val av koronal restaurering på rotfyllda tänder, och uttryckt i generella termer, påverkades av tandläkarens preferenser och teoretiska kunskap samt kliniska erfarenhet tillsammans med olika kliniska faktorer och ekonomiska förutsättningar, där stödet från både Försäkringskassan och patientens privata ekonomi också ingick. / Aim: To describe which factors expressed in general terms that are important for the dentist's decision regarding coronal restoration of a root-filled tooth.   Material and method: Fourteen general dental practitioners (27-64 years old) were strategically selected according to gender, age, location of undergraduate education in Sweden, professional activities (private/public dental care) and professional experience. Semi-structured in-depth interviews were conducted where the informants were asked to describe the last two cases where a direct restoration was chosen after a root canal treatment of a tooth and the last two cases when an indirect restoration was chosen. The interviews were recorded digitally and transcribed verbatim. The interviews were analyzed according to qualitative content analysis.   Results: A pattern was identified and, to illustrate the manifest content, these were classified into three categories, including two subcategories for each category. The first category was the Influence of the Profession with subcategories individual preferences and clinical experience. The second category was Clinical situation with subcategories observable status and assessment for the future. The third category Economic conditions had subcategories patient-related and community-related.     Conclusion: The decision to choose coronal restoration on root-filled teeth, and expressed in general terms, was influenced by the dentist’s preferences and theoretical knowledge as well as clinical experience together with various clinical factors and financial conditions, where the support from both the Swedish Social Insurance Agency and the patient’s private finances were also included.

Introduction: Pulp necrosis in immature permanent teeth stops root development and may lead to higher risk of cervical fractures and a challenging treatment. Regenerative endodontic treatment (RET) aims to continue tooth development and implies the use of calcium silicate-based cements, such as Mineral trioxide aggregate (MTA) and Biodentine to seal the root canal. However, its effect on stem cells has been poorly explored.  Aims: Examine the effect of two different calcium silicate-based cements on the viability and the odonto-/osteogenic potential of Stem Cells from Apical Papilla (SCAP). Material and method:  Isolated SCAPs from three healthy donors (donor I, II and III) were used and exposed for different concentration extracts of ProRoot® MTA and BiodentineTM for 21 days. Cell viability was studied using the neutral red cytotoxicity test. Osteogenic differentiation was analyzed by the alkaline phosphatase test (ALP). Results:  No difference in SCAPs viability was detected by the type of cements used, Biodentine or ProRoot MTA. However, material concentration could be associated with cells cytotoxicity.  Osteogenic differentiation was not based on the type of cement used but the environment conditions (aerobic/anaerobic) and the genetical background. Conclusions: The type of cement used in RET, Biodentine or MTA, showed similar effect on SCAPs viability and differentiation potential in vitro. Further studies should be performed to analyze their effect -in -vivo.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Dentinal defects are characterized by cracks in the root dentin that can develop into a vertical root fractures (VRF), thus leading to tooth loss. Endodontic procedures may generate these defects and between these steps, the biomechanical preparations with NiTi rotary instruments are associated with the incidence of these amendments dentinal. A new concept in minimally invasive preparation was introduced, along with a new reciprocating movement, using a single instrument for root canal instrumentation. This allows less root dentin is removed, thus avoiding the weakening of tooth structure. The aim of this study was evaluate the incidence of dentinal defects after root canal preparation by three single-file systems. One hundred forty mesial roots of mandibular molars were selected and randomly assigned to 4 groups (n= 35 mesial roots per group). One group was left unprepared as control. In two groups, the root canals were instrumented by using the reciprocating single-file systems WaveOne (Dentsply-Maillefer) and Reciproc (VDW), while other group was prepared with single-file of continuous rotation One Shape (Micro-Mega). The specimens were sectioned in 03, 06 and 09 mm from the apex with a low-speed saw under water cooling (IsoMet 1000 Precision Saw) and observed through a stereomicroscope (Zeiss Stemi SV6, Carl Zeiss) at a magnification of 20×. The pictures were recorded and evaluated by two blinded calibrated observers. The slices were categorized in: 0- No defects; 1- Others defects and 2 vertical root fracture. The dates were statistically analyzed with a significance level set at α = 0.05. The chi-square and Fisher exact tests were used to assess the differences between groups. No defects were observed in control group. All the experimental groups showed dentinal defects. The reciprocating files were associated with more defects than the continuous rotary file and control group (P < 0.05), but no significant difference between them (P = .115). VRF was observed only in the One Shape group. The results of this study suggest that the biomechanical preparation could cause damage in the root dentin and that the continuous rotary has a tendency to result in fewer defects compared to reciprocating files. / Defeitos dentinários são caracterizados por trincas na dentina radicular que podem evoluir para uma Fratura Vertical da Raiz (FVR), levando assim a perda do elemento dentário. O preparo biomecânico com o uso de sistemas rotatórios está associado com a incidência dessas alterações dentinárias. Atualmente, o uso de um único instrumento para a instrumentação dos canais radiculares juntamente com uma cinemática reciprocante tem sido introduzido. Desse modo, o objetivo desse estudo foi avaliar a incidência de defeitos dentinários causado por três sistemas de instrumento único. Cento e quarenta raízes mesiais de molares inferiores foram selecionadas e aleatoriamente divididas em quatro grupos (n= 35 por grupo). Um grupo não sofreu intervenção e serviu como controle. As demais raízes foram preparadas pelos instrumentos reciprocantes WaveOne (Dentsply-Maillefer) e Reciproc (VDW) e por um instrumento de rotação contínua One Shape (Micro-Mega). As raízes foram seccionadas horizontalmente com auxílio de uma máquina de corte de precisão (IsoMet 1000 Precision Saw) em 03, 06 e 09 mm a partir do ápice e observadas em um estereomicroscópio (Zeiss Stemi SV6, Carl Zeiss) sob um aumento de 20×. Imagens das fatias foram gravadas e avaliadas por dois observadores cegos, previamente calibrados. As fatias foram categorizadas em: 0 - Ausência de defeitos; 1- Outros defeitos; 2- Fratura Vertical da Raiz. Os resultados obtidos foram submetidos à análise estatística com nível de significância fixado em α= 0.05. Os testes Qui-quadrado e Exato de Fisher foram utilizados para analisar e comparar as diferenças entre os grupos. O grupo controle não apresentou defeito. Todos os grupos experimentais apresentaram defeitos dentinários e foram diferentes estatisticamente do grupo controle (P < 0.05). Os grupos reciprocantes foram associados à presença de mais defeitos do que o grupo One Shape, mas não houve diferença significante entre eles (P = .115). O grupo One Shape foi o único que apresentou FVR. Os resultados obtidos nesse estudo sugerem que o preparo biomecânico com instrumentos rotatórios e/ou de reciprocidade podem causar danos na dentina radicular.

Syftet var att med kvalitativ metodik analysera den process som föregår allmäntandläkares beslut att avstå revisionsbehandling på en tidigare rotfylld tand med kvarstående apikal parodontit. Fem allmäntandläkare valdes strategiskt ut på grundval av att tandläkaren inom de senaste tre månaderna fattat beslutet att avstå från revisionsbehandling av minst en tidigare rotfylld tand med kvarstående apikal parodontit. Urvalet syftade också till en variation av informanternas kön, ålder, utbildningsort, yrkeserfarenhet och offentlig/privat verksamhet. Fem semistrukturerade djupintervjuer utfördes om händelseförloppet mellan patient och tandläkare som resulterat i att tandläkaren valde att avstå från revisionsbehandling. Samtliga intervjuer dokumenterades med en digital bandspelare, transkriberades ordagrant och analyserades med kvalitativ innehållsanalys. Ett tema som åskådliggör det latenta innehållet identifierades: ”Pragmatisk avvägning mellan teori och verklighet” med två huvudkategorier. Den första var ”Balanserat utnyttjande av makt”, med subkategorierna ”Kunskap som maktfaktor”, ”Patientens behov som maktfaktor” och ”Maktinfluerad information”. Den andra huvudkategorin var ”Erfarenheten som beslutsstöd” med subkategorierna ”Ifrågasatt hälsovinst” och ”Uttalad aktiv strategi”. Beslutet att avstå revisionsbehandling på tand med kvarstående apikal parodontit innebar för informanterna en praktisk kliniskt fungerande balansgång mellan inlärd teori och den kliniska verkligheten. Beslutet fattades i ett sammanhang där patienten hade inflytande och där man tog hänsyn till den egna kliniska erfarenheten. / The aim was to analyse the process that precedes the general dentist's decision to waive retreatment of a previously root-filled tooth with persistent apical periodontitis, using a qualitative approach.Five general dentists were strategically selected according to during the past three months having made a decision to waive retreatment of at least one previously root-filled tooth with persistent apical periodontitis. The selection further aimed at a variation concerning gender, age, location of undergraduate education, work experience duration and service affiliation. Five semi-structured interviews were conducted on the events between patient and dentist that resulted in the dentist´s choice to waive retreatment. All interviews were digitally recorded, verbatim transcribed and analysed using qualitative content analysis.A theme illustrating the latent content was identified: “A pragmatic balance between theory and reality” with two main categories. The first was “A balanced utilization of authority”, with the subcategories “Expertise as power-factor”, “Patient´s needs as power-factor” and “Power-influenced information”. The second category was “Experience as support to decision”, with the subcategories “Disputed health improvement” and “Established active strategy”. For the informants, the decision to waive retreatment meant a practical clinically workable balance between the learned theoretical knowledge and clinical practice. This decision is made in a context where the patient had influence and where the dentists´ own clinical experience was taken into account.