Browsing by Author "Loureiro, Sara Manuela Marinho"
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- Controlo do tratamento endodôntico não-cirúrgico de dentes com diagnóstico de necrose pulpar associada ou não a lesão apicalPublication . Loureiro, Sara Manuela Marinho; Teles, Ana MouraIntrodução: De forma a se poder pronunciar o grau de recuperação de uma lesão com Necrose Pulpar e/ou Periodontite Apical Crónica, o Tratamento Endodôntico Não-Cirúrgico deve ser sujeito a uma avaliação do sucesso, tendo em conta diversos critérios. O trabalho agora apresentado, pretende esclarecer os conceitos de sucesso e insucesso do TENC, enumerar os critérios de avaliação do sucesso e insucesso desta opção terapêutica, relatar os factores inerentes ao procedimento clínico condicionantes da taxa de sucesso, analisar as taxas de sucesso actualmente prevalentes e mostrar os dados do acompanhamento, até ao momento, do protocolo desenvolvido num projecto de investigação intitulado “Analysis of endodontic pathogens by classical microbiological and nucleic acid approaches”, na Universidade Fernando Pessoa. Materiais e métodos: Num estudo de controlo randomizado (“Analysis of endodontic pathogens by classical microbiological and nucleic acid approaches”) iniciado em 2011, foram seleccionados 71 pacientes de ambos os sexos, possuidores de um dente monorradicular, com diagnósticos de Necrose Pulpar ou de Periodontite Apical Crónica, (com imagem radiolúcida associada, indicativa de lesão periapical, sem exposição pulpar e sem sinais de doença periodontal). Nesse estudo, o tratamento foi realizado de acordo com um protocolo clínico que propõe testar a eficácia da pasta de hidróxido de cálcio e do gel de digluconato de clorhexidina a 2%, como medicação intracanalar. O controlo dos resultados, realizado de forma longitudinal num período estimado de 4 anos (6 em 6 meses, no primeiro ano, e 12 em 12 meses, nos seguintes anos), foi efectuado por examinador duplo. Por questões temporais, neste trabalho, fez-se análise dos resultados aos 6 meses para 44 doentes e aos 12 meses para 16 doentes. A análise dos resultados foi realizada por aplicação do IBM© SPSS© Statistics, vs. 19.9, considerando um nível de significância de 0,05 nos procedimentos de inferência estatística. Resultados e discussão de resultados: Aos 6 meses, 59,1% (26 casos) dos controlos foram classificados como bem-sucedidos, 27.3% (12 casos) como questionáveis e 13.60% (6 casos) como mal-sucedidos. Aos 12 meses, 25% (11 casos) dos controlos foram classificados como bem-sucedidos, 9.10% (4 casos) como questionáveis e 2.3% (1 caso) como mal-sucedidos. Factores tais como a medicação intracanalar, o extravasamento de material obturador, a realização da restauração definitiva no mesmo dia que o selamento intracanalar, o índice de higiene oral, a perda da restauração definitiva, os pontos de contacto, a oclusão, o tamanho da lesão e a clasificação do Índice Periapical, prevêm alguma interferência na recuperação a curto prazo. Conclusão: Os resultados sugerem que é possível atingir taxas de sucesso elevadas para o TENC quando as causas intrarradiculares e/ou extrarradiculares, de origem endodôntica, são bem controladas. Contudo, não se pode considerar como terminado o tratamento na fase de obturação do canal radicular. O retorno do dente às suas funções, só fica concluído com a execução da restauração definitiva o mais próxima possível da data de conclusão do TENC. Introduction: In order to be able to pronounce the degree of recovery from injury with Pulp Necrosis or Chronic Apical Periodontitis, the Root Canal Treatment should be subject to an assessment of success, taking into account several criteria. The work presented is intended to clarify the concepts of success and failure SRCT, enumerate the criteria for assessing the success and failure of this therapeutic option, reporting factors inherent constraints of the clinical procedure success rate, analyze success rates currently prevalent and show the data monitoring, until the moment, the protocol developed in a research project titled: “Analysis of endodontic pathogens by classical microbiological and nucleic acid approaches”, at the University Fernando Pessoa. Materials and methods: In a randomized control study (“Analysis of endodontic pathogens by classical microbiological and nucleic acid approaches”) started in 2011, were selected 71 patients of both sexes, possessed of a tooth monorradicular with diagnoses of Pulp necrosis or Chronic Apical Periodontitis (associated with radiolucent image, indicative of apical lesions, without pulp exposure and without signs of periodontal disease). In this study, treatment was conducted according to a clinical protocol which proposes test the effectiveness of calcium hydroxide paste and 2% digluconate chlorhexidine gel, as intracanalar dressing. The control of the results, carried out in a longitudinal form in an estimated period of 4 years (6 in 6 months, in the first year, and 12 in 12 months, in the following years), was effected by double examiner. In temporal matters, this work was done analyzing the results at 6 months for 44 patients and 12 months for 16 patients. The analysis was performed by application of IBM© SPSS© Statistics, vs. 19.9, assuming a significance level of 0.05 in procedures of statistical inference. Results and discussion: At 6 months, 59.1% (26 cases) of controls were classified as successful, 27.3% (12 cases) as questionable and 13.60% (6 cases) as unsuccessful. At 12 months, 25% (11 cases) of controls were classified as successful, 9.10% (4 cases) as questionable and 2.3% (1 case) as unsuccessful. Factors such as intracanalar dressing, extravasation of filling material, realization of the final restoration at the same day that the filling, the oral hygiene index, loss of final restoration, points of contact, occlusion, lesion size and PAI, provide some interference in short-term recovery. Conclusion: The results suggest that it is possible to achieve high success rates for endodontic treatment, when the intracanalar and extrarradiculars causes of endodontic failure are well controlled. However, it cannot be considered as completed the treatment phase of root canal filling. The return of the tooth to its functions, is only finished with the execution of the definitive restoration as close as possible to the date of conclusion of SRCT.
- Identification of yeast and non-pigmented cultivable endodontic bacteria in adult portuguese patientsPublication . Teles, Ana Moura; Manso, M. Conceição; Loureiro, Sara Manuela Marinho; Silva, Ricardo; Madeira, Inês; Pina, Cristina Maria San Román Gomes de; Cabeda, José ManuelIntroduction This study has focused on the identification of the yeasts and non-pigmented bacteria present on adult patients with necrosis or apical periodontitis and the ones who resisted chemomechanical preparation and intracanal dressing with calcium hydroxide paste (Ca(OH)2) or 2% chlorohexidine digluconate gel (CHX). Methods 69 single-rooted teeth of adult patients with necrosis associated or not with apical periodontitis were selected (strict inclusion criteria); CHX group: 34 teeth; Ca(OH)2 group: 35 teeth. Bacteria samples were taken at baseline (S1), after chemo-mechanical preparation (S2) and after 14 days of intracanal dressing (S3). Bacteria and fungal presence was evaluate by means of culture in three atmospheres (aerobic, anaerobic, microaerofilic) in appropriate culture broads. Strict techniques were used for serial dilution, plating, incubation and identification. Results The most represented, abundant and prevalent strains of non-pigmented bacteria were Propionibacterium acnes (detected in S1, S2 and S3), Gemella morbillorum and Clostridium difficile. Candida albicans was found in 9 patients. The higher number of isolates proceeded from S1, being S2 the moment with lowest number of isolates. CHX had a worst performance in disinfection of the root canal system; consequently the number of isolates from S3 samples was bigger compared to Ca(OH)2. The number of identified bacterial species per canal/moment of sampling, varied from zero till 5, including yeasts (Candida albicans). Conclusions: Our findings confirm that the microbiota from primary endodontic infections is polymicrobial, and the anaerobes Gram-positive non-pigmented bacteria are well represented. CHX performed worse, consequently the number of isolates from S3 samples was bigger when compared to Ca(OH)2 as well as with diagnosis of necrosis.