Introdução: Retratamentos endodônticos apresentam maior complexidade técnica e piores prognósticos quando comparados ao tratamento endodôntico inicial. Nesse contexto, uma investigação mais detalhada em relação aos fatores que afetam a exiquibilidade de se obter qualidade técnica satisfatória e reparo periapical é necessária. Técnicas empregadas para mineração de dados são pouco exploradas na área da Odontologia, ainda que apresentem potencial em contribuir com a descoberta do conhecimento. No presente estudo, padrões e fatores de risco relacionados à qualidade técnica e ao reparo periapical de retratamentos endodônticos foram investigados. Árvores de decisão foram geradas, sendo essa técnica complementada pela análise estatística convencional. Metodologia: Este estudo observacional incluiu 321 indivíduos com indicação de retratamento endodôntico atendidos por alunos de especialização em Endodontia. Foram coletados dados demográficos, referentes a história médica, ao diagnóstico, ao tratamento e a controles pós-operatórios, os quais foram transferidos para uma base de dados eletrônica. Após o preparo e pré-processamento de dados, foram selecionadas 32 variáveis independentes e 2 variáveis dependentes, as quais compreenderam os desfechos qualidade técnica do retratamento e reparo periapical. Estatísticas descritivas foram conduzidas a fim de determinar a frequência de dados ausentes, a distribuição das variáveis categóricas e a média e desvio-padrão de variáveis numéricas. Foram geradas árvores de decisão para a determinação de padrões relacionados aos desfechos, através do software de mineração de dados Weka (Waikato Environment of Knowledge Analysis, University of Waikato, New Zealand). Análises estatísticas convencionais foram conduzidas com auxílio do Software SPSS (SPSS Inc., Chicago, IL, USA), a fim de determinar fatores que poderiam interferir nos referidos desfechos. Resultados: Após o retratamento endodôntico, qualidade técnica satisfatória e reparo periapical foram obtidos em 65,20% e em 80,50% dos casos, respectivamente. A qualidade técnica do retratamento endodôntico foi afetada por vários fatores de risco, incluindo curvatura radicular severa (p < 0,001) e alterações na morfologia do canal radicular (p = 0,002). As árvores de decisão sugeriram padrões que combinam a ocorrência simultânea de raízes retas e reabsorções radiculares apicais com resultados tecnicamente insatisfatórios. O diâmetro da lesão periapical (p = 0,018), o grupo dentário (p = 0,015) e a presença de reabsorções apicais (p = 0,024) apresentaram associação significativa com o insucesso de retratamentos endodônticos. A análise de mineração de dados sugeriu que lesões periapicais extensas e qualidade da obturação insatisfatória no tratamento endodôntico inicial, apresentam mecanismos de interação entre a infecção intracanal e a resposta do hospedeiro que não foram totalmente elucidados, sendo necessários estudos complementares. Conclusão: Qualidade técnica satisfatória é afetada por diversos fatores de risco, entre eles, a presença de curvaturas radiculares severas e alterações na morfologia do canal radicular. A localização dos acidentes de procedimento exerce influência na obtenção da qualidade técnica. Fatores como o diâmetro da lesão periapical, o grupo dentário e as reabsorções radiculares apicais mostraram-se significativamente associados ao insucesso de retratamentos endodônticos. / Introduction: Non-surgical root canal retreatment presents higher technical complexity and poor prognosis compared to primary endodontic treatment. Within this context, a more detaild investigation on the factors affecting the feasibilty of achieving technical quality and periapical healing in teeth presenting secondary root canal infection is needed. Data mining approach is still little explored in the dentistry field, regardless of its potential to contribute to knowledge discovery. In the present study decision trees were complemented by conventional statistical analysis aiming to investigate patterns and risk factors related to technical quality and healing outcomes in non-surgical root canal retreatment. Methods: This observational study included 321 consecutive patients presenting for non-surgical root canal retreatment. Patients were treated by postgraduate students, following standard protocols. Data concerning demographic, medical, diagnostic, treatment and follow-up variables were transferred to an eletronic chart database (ECD). After data preprocessing and preparation a total of 32 independent variables and 2 dependent variables were defined. Basic statistics were tabled and provided the frequency of missing values, the distribution of categorical attributes and the mean and standard deviation values of numeric attributes. Decision trees were generated to predict patterns related to technical quality (satisfactory/unsatisfactory) and periapical healing (healed /failure), using J48 classification algorithm in Weka data mining software (Waikato Environment of Knowledge Analysis, University of Waikato, New Zealand). Statistical tests were performed using SPSS software (SPSS Inc., Chicago, IL, USA). Univariate and multivariate analytic methods were used to determine factors affecting endodontic retreatment technical quality and periapical healing. Results: After endodontic retreatment, technical outcome was satisfactory in 65.20%, and periapical healing was observed in 80.50% of the cases. Technical quality of endodontic retreatment was affected by several risk factors, including severity of root curvature (p < 0.001) and altered root canal morphology (p = 0.002). The decision trees suggested that patterns that combine straight root curvature and apical root resorption may prevent satisfactory technical outcomes. Periapical lesion area (p = 0.018), tooth type (p = 0.015) and apical resorption (p = 0.024) were shown to be significantly associated with endodontic retreatment failure. Data mining analysis suggested that large periapical lesions, as well as poor root filling quality in the initial endodontic treatment, present mechanisms that are not fully understood with regards to the interaction between intracanal infection and host response, which should be further investigated. Conclusions: Technical quality of endodontic retreatment is affected by several risk factors, including severity of root curvature and altered root canal morphology. The occurence of procedure accidents is especially relevant in the apical third of the roots, affecting the technical quality. Periapical lesion area, tooth type and apical resorption were shown to be significantly associated with endodontic retreatment failure.

Este estudo teve como objetivo avaliar a citotoxicidade, biocompatibilidade e perfil osteoindutor de um novo material a base de MTA (MTA Flow) comparado ao AH plus e MTA fillapex. A viabilidade celular foi avaliada em células-tronco do ligamento periodontal pelo teste MTT. A resposta inflamatória e o perfil osteoindutor foram avaliados em tecido conjuntivo de 24 ratos machos (Rattus norvegicus albinus, Rodentia, Mammalia da linhagem Wistar), pesando entre 300 e 350g. Os animais foram divididos em 4 grupos experimentais. Foram implantados 4 tubos de polietileno no dorso de cada animal, sendo um vazio e outros três preenchidos com um dos materiais. Após 7, 30 e 60 dias, 8 animais foram mortos com anestésico inalatório. O tubo e o tecido subcutâneo adjacente foram removidos e fixados em solução de formalina a 10%. O material foi analisado histológicamente quanto ao processo inflamatório, condensação fibrosa e presença de abscesso. Posteriormente, realizou-se a análise imunoistoquímica para identificação de colágeno I, osteopontina, sialoproteina óssea e proteína morfogentica óssea-4 (BMP-4). Os dados foram analisados estatisticamente pela ANOVA, complementado pelo teste de Tukey usando SPSS 15.0. O MTA Flow mostrou não ser citotóxico e ter excelente biocompatibilidade com menor reação inflamatória no tecido subcutâneo de ratos em comparação com AH Plus e MTA Fillapex. Além disso, o MTA Flow mostrou ser capaz de estimular o processo mineralização, sendo uma vantagem em relação aos outros materiais testados. / This study aimed to evaluate the cytotoxicity, biocompatibility and osteoinductive profile of a new MTA based material (MTA Flow) compared to AH plus and MTA fillapex. Cell viability was evaluated in periodontal ligament stem cells by the MTT test. The inflammatory response and the osteoinductive profile were evaluated in the connective tissue of 24 male rats (Rattus norvegicus albinus, Rodentia, Mammalia of the Wistar line) weighing between 300 and 350g. The animals were divided into 4 experimental groups. Four polyethylene tubes were implanted on the back of each animal, one empty and another three filled with one of the materials. After 7, 30 and 60 days, 8 animals were killed with inhaled anesthetic. The tube and adjacent subcutaneous tissue were removed and fixed in 10% formalin solution. The material was analyzed histologically for the inflammatory process, fibrous condensation and presence of abscess. Subsequently, the immunohistochemical analysis was performed to identify collagen I, osteopontin, bone sialoprotein and bone morphogenetic protein-4 (BMP-4). Data were analyzed statistically by ANOVA, complemented by the Tukey test using SPSS 15.0. MTA Flow was shown to be non-cytotoxic and to have excellent biocompatibility with lower inflammatory reaction in rat subcutaneous tissue compared to AH Plus and MTA Fillapex. In addition, the MTA Flow showed to be able to stimulate the mineralization process, being an advantage over the other materials tested.

Orientador: Gisele Faria / Resumo: BiodentineTM (BD) apresenta bioatividade, biocompatibilidade e propriedades físico-químicas adequadas; no entanto, não possui radiopacidade adequada. Os objetivos foram avaliar (1) a radiopacidade de BD e BD associado com 15% de tungstato de cálcio (BDCaWO4) ou óxido de zircônio (BDZrO2), empregando sistemas de radiografia convencional e digital; e (2) as propriedades físico-químicas de tempo de presa, pH e solubilidade, e as propriedades biológicas de citocompatibilidade e potencial para induzir mineralização desses cimentos. Para a avaliação da radiopacidade, cada corpo de prova foi radiografado ao lado de uma escada de alumínio usando filme oclusal, placa de fósforo ou sensores digitais. As radiografias convencionais foram digitalizadas por câmera fotográfica ou scanner. Os valores médios de cinza dos materiais foram expressos em milímetros de alumínio (mm Al). A solubilidade foi avaliada após 7 dias de imersão dos espécimes em água destilada e expressa em percentagem de perda de massa. O tempo de presa foi avaliado empregando a agulha de Gillmore (105 ± 0,5 g) e o pH foi mensurado com um medidor de pH. A citocompatibilidade e a bioatividade celular foram avaliadas em células de linhagem osteoblástica (Saos-2) utilizando os ensaios de metiltetrazólio (MTT), vermelho neutro (NR), atividade de fosfatase alcalina (ALP) e coloração de vermelho de alizarina. Os dados foram avaliados utilizando ANOVA de um fator e pós-teste Tukey ou ANOVA de dois fatores e pós-teste de Bonferron... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: BiodentineTM (BD) presents bioactivity, biocompatibility and suitable physicochemical properties; however, it does not have adequate radiopacity. The objectives were to evaluate (1) the radiopacity of BD and BD associated with 15% calcium tungstate (BDCaWO4) or zirconium oxide (BDZrO2), employing conventional and digital radiography systems; and (2) the physicochemical properties of setting time, pH and solubility, and biological properties of cytocompatibility and potential to induce mineralization of these cements. For radiopacity evaluation, each cement specimen was radiographed alongside an aluminum step-wedge using occlusal film, photostimulable phosphor plates or digital sensors. The conventional radiographies were digitized by digital photographic camera or scanner. Mean grey values of materials were expressed in millimeters of aluminum (mm Al). Solubility was evaluated after 7 days of specimens' immersion in distilled water and expressed as percentage of mass loss. Setting time was evaluated employing a Gillmore needle (105 ± 0.5 g) and pH was evaluated with pH meter. The cytocompatibility and cell bioactivity were evaluated in osteoblasts-like cells (Saos-2) using methyl-thiazol-tetrazolium (MTT), neutral red (NR), alkaline phosphatase (ALP) activity and alizarin red staining assays. The data were evaluated using one-way ANOVA and Tukey post-test or two-way ANOVA and Bonferroni post-test (α=0.05). BD radiopacity was below 3 mm Al and BDZrO2 and BDCaWO4 was above 3 mm... (Complete abstract click electronic access below) / Mestre

Depuis une dizaine d’années, la thérapeutique de pulpotomie totale est proposée dans la littérature pour le traitement pérenne de l’inflammation pulpaire des dents permanentes matures. De nombreuses publications de type essai clinique, étude de cohorte, série de cas ou revue systématique rapportent des résultats convergents qui placent la pulpotomie totale comme une alternative au traitement endodontique conventionnel. Cependant, la procédure reste peu enseignée, la variabilité méthodologique des études, les influences potentielles des fabricants de matériaux et les interprétations dogmatiques peuvent constituer un frein à la diffusion de cette thérapeutique. Des arguments complémentaires semblent nécessaires pour que les cliniciens, les enseignants et les chercheurs puissent appuyer leurs pratiques de soins, d’enseignements et de recherches selon la démarche fondée sur la preuve. Cette thèse constitue une démarche réflexive essentielle à la compréhension des phénomènes qui régissent la guérison à long terme de l’inflammation pulpaire et aux choix méthodologiques qui permettront d’évaluer cette guérison. Ce travail interroge les données bibliographiques pour argumenter les trois questions suivantes : 1°) Pourquoi et comment la pulpotomie totale peut-elle être considérée comme une thérapeutique de l’inflammation pulpaire ; 2°) Quelles procédures doit-on respecter et quels matériaux peut-on utiliser pour considérer la pulpotomie totale comme une thérapeutique à part entière ? 3°) Quels critères peut-on utiliser pour évaluer le succès d’une pulpotomie totale sur dents permanentes ? Ce travail bibliographique est complété par une étude expérimentale au cours de laquelle la fiabilité et la stabilité d’un guide de lecture des images radiologiques ont été vérifiées afin de proposer un outil de formation susceptible d’être appliqué lors de l’évaluation des résultats de la pulpotomie totale. / Full pulpotomy is a therapeutic in which the coronal pulp portion is removed surgically followed by the capping of the remaining radicular pulp. During the last decade, this therapeutic has been reinvestigated as a definitive treatment of pulp pathologies in mature permanent teeth. Converging datas from published studies suggested that full pulpotomy could be recognized as an alternative to root canal treatment. Furthermore, few clinical trials and a meta analysis aimed to evaluate the effect of initial pulp state or pulp capping material on the success of this treatment. However, large variations in the methodology of the studies, potential influence of laboratories of materials and endodontic dogmas are the major obstacles to the promotion of this therapeutic. An evidence-based approach is necessary because incorporates the best evidence in making decisions. This strategy will help clinicians, teachers and researchers to include full pulpotomy in a daily practice This thesis consists to question the scientific literature in order to answer three following questions: 1) Why and how the full pulpotomy should be considered as a treatment of pulp pathologies ? 2) Which procedures could be applied for full pulpotomy ? 3) Which criteria’s could be used to evaluate the outcomes of full pulpotomy ? These literature reviews are completed with an experimental study about an enriched version of a practical guide for the interpretation of PAI score. Its reliability and reproducibility were verified among French undergraduate students. This practical guide will be a useful tool in evaluation of outcomes in endodontics.

Orientador: Milton Carlos Kuga / Resumo: Os objetivos do presente estudo foram avaliar os efeitos dos solventes para remoção de resíduos de cimento endodôntico à base de resina epóxi (Sealer Plus) da dentina da câmara pulpar e a repercussão sobre a interface adesiva, com o sistema adesivo Universal (Single Bond Universal e Ambar Universal). Foram selecionados 90 incisivos bovinos com coroa dental similar, os quais foram seccionados, obtendo-se fragmentos da câmara pulpar, na proporção de 5x5x5mm para avaliação da microscopia eletrônica de varredura (MEV), e seus efeitos sobre a dentina da câmara pulpar, por meio de microscopia EDX e mensuração da microdureza dentinária, após o uso dos protocolos de limpeza contendo acetato de amila (AA), acetona pura (AC) ou etanol a 95% (ET) e combinações entre cada um destes protocolos (soluções experimentais AA-AC, AA-ET, AC-ET e AA-AC-ET), além dos controles positivo (PC) e negativo (NC). Além disso, quarenta fragmentos de dentina foram impregnados com cimento endodôntico e removidos com os protocolos de limpeza: etanol a 95% (ET), xilol (XI), acetato de amila (AA) ou ação mecânica (PC) e dez espécimes não receberam tratamento (NC) para avaliação também da persistência de resíduos e a repercussão sobre a interface adesiva. A avaliação da persistência de resíduos foi realizada em MEV (500x) e após, foram obtidos 100 espécimes, onde 80 foram impregnados e submetidos aos protocolos de limpeza e 20, não. Em cada protocolo, os espécimes foram divididos em 2 subgrupos (n=10), de acord... (Resumo completo, clicar acesso eletrônico abaixo) / Mestre

Orientador: Juliane Maria Guerreiro Tanomaru / Resumo: Cimentos à base de silicatos de cálcio são desenvolvidos para obturação de canais radiculares. Publicação 1: Este estudo avaliou propriedades biológicas dos cimentos experimentais (CE-1 e CE-2) compostos por silicatos de cálcio e com adição de hipoclorito de cálcio (CE-2), em comparação ao AH Plus (AHP) e TotalFill BC Sealer (TBC). A reação tecidual provocada pelos materiais no subcutâneo de ratos foi avaliada por meio da implantação de tubos de polietileno nos períodos de 7, 15, 30 e 60 dias. Cortes foram corados com hematoxilina e eosina (HE) para análises morfológica e do número de células inflamatórias/mm2(CI) e cortes foram utilizados para detecção de interleucina-6 (IL-6) e osteocalcina. Método de von Kossa foi realizado para identificação de depósitos de cálcio. Os dados foram submetidos aos testes ANOVA e Tukey, com significância de 5%. Aos 7 dias, CE-1, CE-2 e AHP apresentaram maior número de CI. AHP apresentou maior marcação para IL-6. Após 15 dias não houve diferença entre CE-2 e o grupo controle para IL-6. Aos 30 dias, AHP exibiu maior número de CI (p<0,0001) e CE-2 e o grupo controle os menores valores de CI e IL-6. Após 60 dias CE-2, TBC e controle apresentaram os menores valores (p<0,05). Os cimentos CE-1, CE-2 e TBC apresentaram estruturas positivas ao método von Kossa em todos os períodos observados e marcação positiva para osteocalcina. CE-2 apresentou quantidade de células positivas superior em todos os períodos quando comparado aos cimentos CE-1 e TBC (p< ... (Resumo completo, clicar acesso eletrônico abaixo) / Mestre

Introduction: Socioeconomically disadvantaged children have limited access to orthodontic services not only because of their families’ competing needs for limited resources, but also because of the limited availability of orthodontists in their communities and a shortage of orthodontists who are willing to treat patients enrolled in Medicaid. We will systematically explore the hypothesis that an early interceptive treatment protocol using removable appliances provides the same treatment outcome but better cost-effectiveness than a traditional fixed-appliance protocol. Methods: Interim data on a prospective study with patients being treated either in private practice with rational fixed Phase I orthodontic treatment (n=11) or in a community clinic with removable interceptive orthodontic treatment (n=10). Initial and post treatment study models were acquired along with pretreatment PAR and clinical photos. PAR and ICON scores were assessed on all initial and final casts. Cost effective analyses were performed comparing the two treatment groups as well as comparing the removable group to no treatment. Sensitivity analyses were performed to assess the robustness of our data while manipulating certain treatment outcome variables. Results: For the fixed group the average PAR score at T2 was 7.6 with a 68% reduction from T1 to T2, while the ICON average score was 16.2 with a 67% reduction. In the removable group the average PAR score at T2 was 13.4 with a lesser reduction from T1 to T2 than the fixed group at 48% (p=0.20), while the ICON average score was 25.3 with a significantly lower reduction of 39% when compare to the fixed group (p=0.037). Cost effectiveness analyses showed that the removable appliance treatment protocol was cost effective when compared to no treatment but not cost effective when compared to 3 the traditional fixed Phase I treatment using the studies measured probabilities of success. Conclusion: The removable appliance protocol used at the Fruitvale community clinic can effectively reduce the severity of malocclusions. However, in order for this treatment to be cost effective when compared to a traditional fixed Phase I protocol it needs to demonstrate consistent clinical results and minimize the probability of “No Improvement”.

ABSTRACT Introduction: Medical imaging continues to play an increasing role in health care and is an integral part of medicine and dentistry. Recent technological advancements have led to the development of fully automated landmark identification (ALI) systems capable of tracing Cone-Beam Computed Tomography (CBCT). The purpose of this study was to evaluate the accuracy and reliability of an ALI system as a tool for automatic landmark location compared to human judges. Methods: One hundred subjects’ CBCT volumes from multiple imaging centers were traced by two human judges who were calibrated and had an ICC close to 1. Fifty-three landmarks were identified in the x, y, and z coordinate planes using Checkpoint Software (Stratovan Corporation, Davis, CA). The ground truth was created by calculating the mean values of the x, y, and z coordinates for each landmark across both judges’ landmark identification. To evaluate the accuracy of ALI, the mean absolute error at each coordinate and mean error distance (mm) between the human landmark identification (ground truth) and the ALI were determined, and a successful detection rate (SDR) was calculated. Results: Overall, the ALI system was as successful at landmarking as the human judges with the exception of a few landmarks. The mean error distance for all 53 landmarks was 4.04 mm ± 6.5. Forty-nine out of 53 landmarks were located within a mean error of 4mm when the average for the coordinates of human judges was considered as a ground truth. Conclusion: Across all three coordinate planes, 96% of the landmarks had a mean absolute error of less than 4mm when compared to the ground truth. The ALI was more precise than humans when identifying landmarks on the same image at different times. This study demonstrates the promise of ALI in aiding orthodontists with landmark identification on CBCTs in the future.

No description available.

Non-Surgical Root Canal Treatment (NSRCT) is performed to save the teeth with infected root canal system. A number of factors affect the long term survival of NSRCT. There is limited evidence correlating the survival rate of NSRCT in older adults with existing comorbid conditions and comparing them with the survival rate of NSRCT in younger adults. The primary objective of this study was to analyze the survival of non-surgical root canal therapy in older adults with comorbid conditions. Data was collected from patients' charts retrospectively to analyze the factors affecting the survival rate of NSRCT in permanent teeth in patients aged 18 and above and analyzed to compare the comorbid conditions in older adults and young adults. Factors including gender, prevailing coronary heart disease, diabetes, cancer, cancer therapy, and tobacco habits that may influence the long-term survival of endodontically treated teeth were analyzed statistically using a follow up data for five years. Survival analysis was the statistical method of choice to analyze the results given the focus of the clinical question on failure of endodontic treatment. Kaplan-Meier survival estimates were calculated for 5-year survival of endodontically treated teeth (with 95% confidence intervals). Teeth that had been retreatment, periapical surgery or extraction were considered as having had a complication, i.e., a failure. Analysis using the Kaplan-Meier method requires that actual date of failure (as indicated in description of project) as well as the date of initial endodontic treatment were available in the data set. The dates of re-treatment were considered as the date of failure for the purpose of statistical analysis. The statistical analysis showed that there was no significant association between age and root canal survival but there was a possible association between NSRCT failure and the presence of diabetes and tobacco habits.