Marius Bud

Acest articol ar putea fi incadrat la categoria ” Pierdut la spate…..regasit la fatza” Mai precis, cercetarea in sine am comis-0 chiar dupa absolvirea facultatii in cadrul unei burse guvernamentale la Facultatea de Stomatologie din Amsterdam la catedra de endodontie condusa de profesorul Wesselink, un nume sonor al endodontiei mondiale. Am facut cercetarea si am redactat  o schema de articol care a ramas uitata pe laptopul meu pana anul asta cand am reinviat-o si trimis-o la o revista sa publice articolul.

Cu stagiul meu la facultatea asta ar fi o poveste de jungla  )in care eu ma miram de ce-mi aratau ei (eu nici nu vazusem diga sau alte jumbuslucuri endodontice pe la facultatea noastra din cluj ) iar ei se mirau de ce auzeu de la mine (cum lasam noi dinti deschisi si cum infigem un con de gutaperca in endometazona din canal). Dupa trecerea mirarii am pornit la treaba si impreuna cu profesorul si cu Min Kai Wu, mana lui dreapta in cercetare, am pus la punct un protocol care avea ca scop sa analizeze cum e mai bine sa obturam canalele inguste si curbe de molari inferiori: cu ce sigilant si, respetiv, daca punem un con sau mai multe conuri de GP si le compactam lateral la rece. Pe cand credeau dumnealor ca m-au dat pe brazda, tanarul cercetator roman loveste din nou: le explic eu ca in Romanica majoritatea medicilor pun pe canale endometazona si un con de GP si ca eu as vrea sa includ in studiu si o grupa obturata ….ca la noi. In final oamenii accepta si mi-au comadat special pentru mine endometazona de la septodont.

Zis si facut: preparat cum se cuvine 80 de molari extrasi cu radacini curbate, mai mult sau mai putin, media curburii a fost de 38grade. facut 4 grupe de cate 20 fiecare, si obturat cu AH, Ez Fill si GP ( o grupa cu compactare laterala si una cu un singur con) si grupa mioritica cu endometazana si conul singuratic.

Partea practica a fost pe cat de greu de realizat si minutioasa in unele faze pe atat de haioasa in altele. Haiosenia a rezultat din montarea specimenelor in dispozitivul pentru testarea transportului fluid unde nici daca eream instalator sau angajat la regia de apa canal nu cred ca m-as fi descurcat  mai bine. 

dispozitiv de testare a transportului fluid prin obturatia endodontica

Am pus dintelelui cate un furtun cu apa la fiecare capat ( coroana + radacina) si printr-un capat bagam presiune de 0.6 atmosfere iar la celallalt capat punem o pipeta cu o bula de aer. Daca la presiunea trimisa prin furtun si implicit prin dintele obturat pe canal, bula de aer din pipeta se deplaseaza inseamna ca ….bingo….prin obturatia endo lichidul trece fara probleme, deci la fel si bacteriile. Prin urmare, asadar, si in concluzie daca inchiderea coronara a dintelui nu e buna, bacteriile din saliva zburda direct spre apex si ridica sus stegurile pe care scrie mare ” esec endodontic” . Dispozitivul asta e patentat de Min kai Wu si nu e deloc complicat insa permite sa analizezi o chestie de importanta majora in endodontie:  poate trece sau nu ceva de-a lungul obturatiei facute de tine? asa ca traiasca cel care l-a inventat!

Min Kai Wu de la ACTA Amsterdam

Am tras si un photo session radiografic din incidenta mezio-distala si vestibulu orala, asta in ideea ca molarii inferiori au canalele ovale si pe incidenta V-O pe care o facem clinic toata obturatiile par superbe pentru ca se suprapun multe planuri fiind diametrul mare al canalului. Confimat si pe studiu.

Concluzia e clara: grupa obturata mioritic a dat rezultate mai slabe pentru am descoperit mai multe goluri pe radiografii. iar proportia specimenelor care au permis scurgeri la testarea transportului fluid a fost mult mai mare decat la celelalte grupe.

Cam asta ar fi pe scurt. daca aveti chef de mai multe detalii, articolul e publicat in Oral Surgery, Oral Medicine, oral pathology, Oral radiology and endodontology, vol 108, issue 6, pag 946. December 2009

http://www.ooooe.net/article/S1079-2104(09)00530-7/abstract

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The quality of single cone and laterally compacted gutta-percha fillings in small and curved root canals as evidenced by bidirectional radiographs and fluid transport measurements

Received 20 April 2009; accepted 24 July 2009. published online 29 October 2009.

Objective

The aim of this study was to examine the quality of root fillings in small and curved root canals using bidirectional radiographs and fluid transport (FT) measurements.

 

Study design

Root canals in eighty 38°-curved mesial roots of mandibular molars were prepared using a balanced force technique. Samples were divided into 4 groups of 20 each and obturated by either the cold lateral compaction (LC) or the single cone (SC) technique, using either epoxy resin–based or zinc oxide–eugenol sealers. Bidirectional (buccolingual and mesiodistal) radiographs were acquired from each root. The voids along the root filling were assessed. The FT along the root filling was measured using an FT monitoring device. The differences between the groups regarding FT and the bidirectional radiographic score were analyzed by means of a Kruskal-Wallis test. The correlation between the FT values and the radiographic scores were analyzed using a Spearman test.

 

Results

Three groups of LC or SC fillings containing epoxy resin–based sealers exhibited similar radiographic scores and FT values (P > .05). The group of SC fillings that contained zinc oxide–eugenol sealer had worse radiographic scores than the other groups (P = .047). The bidirectional radiographic scores and the FT values for the 80 filled roots were strongly correlated (r2 = 0.519; P = .00001).

 

Conclusion

Root fillings of similar quality were confirmed in small and curved root canals filled using either a single cone or laterally compacted gutta-percha and epoxy resin–based sealers.

 

 

 

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Cam la asta ma gandeam eu cand cei din Leuven, unde eram cu o bursa, m-au intrebat de ce-am batut eu atat cale de la Cluj! Curiozitatea mea era cat de mare trebuie sa fie un gol din obturatie astfel incat sa-l putem observa pe radiografii si, respectiv, de la ce dimensiuni in jos el nu mai este vizibil.

Stabilirea protocolului de cercetare a fost o adevarata hernie cerebrala la care toti cinci din echipa incercam sa gasim cea mai simpla cale de crea in obturatia endo goluri de marime cunoscuta astfel incat sa stim care este marimea maxima vizibila pe radiografii! atunci mi-am amintit ce m-a invatat un unchi de-al meu electrician: mereu o litza de sarma salveaza situatia!  Asa ca acest studiu l-am realizat inserand in obturatia endo diferite diametre de sarme pe care le-am scos dupa priza sigilantului pentru a crea golurile. 

Articolul a aparut in numarul din august  2009 al International Endodontic Journal si se numste “Void detection in root fillings using intraoral analogue, intraoral digital and cone beam CT images”

http://www3.interscience.wiley.com/journal/122504554/abstract 

 

Aim To compare void detection in root fillings using different radiographic imaging techniques: intraoral analogue, intraoral digital and cone beam CT (CBCT) images and to assess factors influencing small void detection.

Methodology Two straight root canals in canine teeth were prepared. Calibrated steel wires of five different diameters (200, 300, 350, 500, 800 μm) were inserted respectively in the canal after the injection of a sealer. To simulate filling voids of known dimensions, the wires were removed after the sealer had set. Each sample was imaged, using a Minray X-ray tube (Soredex, Helsinki, Finland) at optimal clinical settings combined with Vistascan PSP (Dürr Dental, Bietigheim-Bissingen, Germany), Digora Optime PSP (Soredex), Sigma CCD (Instrumentarium, Tuusula, Finland) and E-speed films (Agfa-Gevaert, Mortsel, Belgium). The teeth were also imaged using CBCT (3D Accuitomo, Morita, Japan). A generalized mixed model and anova analysis were used on the acquired data (Tukey–Kramer correction).

Results There was no evidence that the factor ‘root level’ affected void detection in root fillings. ‘Void size’ was a main determining factor as all voids larger than 300 μm were determined with all techniques. For the smaller voids, there were significant differences between the 5 imaging techniques at different void sizes and different root levels.

Conclusions Void size and imaging technique were main determining factors. Voids larger than 300 μm were determined with all imaging techniques. For small void detection, all digital intraoral techniques performed better than intraoral analogue and CBCT images.

Nici nu s-a incheiat bine vacanta si concediul ca stiinta ne bate la usa, defapt noi batem la usa ei! Am trimis si eu un articol spre publicare in urma cu ceva vreme la Clinical Oral Investigations! Este una dintre cercetarile facute in Leuven  la care eu tin foarte mult deoarece face parte din teza mea de doctorat iar la momentul realizarii ei a fost singurul studiu care analiza vizibilitatea acelor K de marimi  ISO #6 #8 si #10 pe mai multe tipuri de imagini digitale (PSI, CCD!)

o singura problema insa!  Nu stim scrie articole! Este intr-un fel ca si la proiectele UE, trebuie sa stii sa scrii! Abia atunci am inteles de ce din Romania nu se prea vad articole in reviste internationale serioase de Stomatologie (radiologie orala sau endodontie…..aici cunosc mai bine literatura). NU stim …..dar stim sa invatam! Coautorii mei Bart Vandenberghe si Prof. Reinhilde Jacobs m-au incurajat foarte mult sa nu lasam totul balta ci  sa exprimam aceasta cercetare in cuvinte, adica sa construim articolul astfel incat sa fie acceptat de Clinical Oral Investigations. Si a fost….

Articolul se numeste ” The use of high-resolution digital imaging technology for small diameter K-file length determination in endodontics” si il puteti accesa aici:

http://www.springerlink.com/content/702782592qm63m63/

Abstract

To assess the reliability of high resolution intra-oral photostimulable storage phosphor (PSP) and complementary metal-oxide semiconductor (CMOS) imaging systems for working length (WL) assessment of small K-files in narrow and curved root canals. Eleven narrow and curved canals from extracted molars were used as pre-test for sample-size calculation. Nineteen canals from four cadavers were used for endodontic length assessment in the final study. Small K-files (ISO size 6, 8, and 10) were introduced into the canals at prepared length. Digital intra-oral radiographs were obtained using high-resolution Vistascan^® PSP plates and Sigma M CMOS active pixel sensor with a DC X-ray tube at 70 kV, 7 mA, and 0.16 s. Both image series were assessed with and without use of a dedicated endodontic filter. Three observers measured WLs for comparison to the gold standards of a digital millimeter ruler. Multiple regression analysis of the dependent measurements revealed no significant influence of imaging sensor (PSP or CMOS, p = 0.34) and image processing (p = 0.97). For ISO file size, however, there was a significant difference (p = 0.08) at a level of 10%. Observers mostly underestimated lengths using PSP but overestimated them on CMOS. Almost all radiographic measurements (96–98%) were within 2-mm deviation, while 71% to 82% deviated within 1 mm. Dedicated filtering and sensor type did not influence the outcome of WL determination of small file sizes when using high-resolution imaging sensors. WL determination with ISO file 6 did show a significant difference compared to ISO 8 and 10 but mostly for deviations <1.5 mm.

Keywords Photostimulable storage phosphor (PSP) plates - CMOS - Endodontics - Working length - Small K-files - Intra-oral radiography