Endo 1

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\cols2\colno1\colw7546\colsr-0\colno2\colw3546\pard\li466\ri0\sl-186\slmult0
\fs16\cf0\f0\charscalex100\i {Brazilian Dental Journal (2014) 25(1): 3-11}\i0
\par\pard\li466\ri0\sl-200\slmult0 \fs16\cf0\f0\charscalex100\i
{http://dx.doi.org/10.1590/0103-6440201302356}\i0 \par\pard\li466\ri0\sl-
586\slmult0 \fs36\cf0\f0\charscalex100\b {Characterization of Successful }\b0
\par\pard\li466\ri0\sl-440\slmult0 \fs36\cf0\f0\charscalex100\b {R o o t C a n a
l T r e a t m e n t}\b0 \par\pard\li466\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li466\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li466\ri0\sl-
213\slmult0 \fs18\cf0\par\pard\li466\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li466\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {Carlos
Estrela}\fs12\cf0\f0\charscalex100 {1}\fs20\cf0\f0\charscalex100 {, Roberto
Holland}\fs12\cf0\f0\charscalex100 {2}\fs18\cf0\f0\charscalex100 {, Cyntia
Rodrigues de Ara�jo Estrela}\fs12\cf0\f0\charscalex100
{3}\fs20\cf0\f0\charscalex100 {, Ana }\par\pard\li466\ri0\sl-226\slmult0
\fs20\cf0\f0\charscalex100 {Helena Gon�alves Alencar}\fs12\cf0\f0\charscalex100
{1}\fs20\cf0\f0\charscalex100 {, Manoel Dami�o Sousa-
Neto}\fs12\cf0\f0\charscalex100 {1}\fs20\cf0\f0\charscalex100 {, Jesus
Djalma }\par\pard\li466\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100
{P�cora}\fs12\cf0\f0\charscalex100 {1}\par\pard\li466\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li466\ri0\sl-306\slmult0 \fs18\cf0\f0\charscalex100 {Knowing the
outcome of root canal treatment (RCT) is determinant to substantiate
the}\par\pard\li466\ri0\sl-213\slmult0 \fs16\cf0\f0\charscalex100 {clinical
decision making process, especially when RCT is weighed against the
extraction}\par\pard\li466\ri0\sl-213\slmult0 \fs16\cf0\f0\charscalex100 {of
natural teeth or replacement by prosthetic elements. The ideal scenario in all
clinical}\par\pard\li466\ri0\sl-213\slmult0 \fs16\cf0\f0\charscalex100 {situations
should combine healing/prevention of disease (apical periodontitis) and
the}\par\pard\li466\ri0\sl-213\slmult0 \fs16\cf0\f0\charscalex100 {functional
retention of the tooth. Understanding the risk factors associated with
endodontic }\par\pard\li466\ri0\sl-213\slmult0 \fs18\cf0\f0\charscalex100 {failure
is a key factor to increase the chances of success. The logical action is to
reverse}\par\pard\li466\ri0\sl-213\slmult0 \fs18\cf0\f0\charscalex100 {the existing
disease, which requires intervention to neutralize the bacterial invasion
and}\par\pard\li466\ri0\sl-213\slmult0 \fs18\cf0\f0\charscalex100 {disrupt the
bacterial biofilm within the complex anatomy. Success is more
predictable}\par\pard\li466\ri0\sl-213\slmult0 \fs18\cf0\f0\charscalex100 {when the
immune host defenses are favorable. However, success has different
meanings}\par\pard\li466\ri0\sl-213\slmult0 \fs18\cf0\f0\charscalex100 {to the
dentist, to the patient and to the tooth itself. The life of an endodontically
treated}\par\pard\li466\ri0\sl-213\slmult0 \fs18\cf0\f0\charscalex100 {tooth
depends on the accuracy of the diagnosis and planning, excellence of
disinfection,}\par\pard\li466\ri0\sl-213\slmult0 \fs18\cf0\f0\charscalex100
{instrumentation and filling procedures (antimicrobial strategies, root canal
shaping and}\par\pard\li466\ri0\sl-213\slmult0 \fs18\cf0\f0\charscalex100 {coronal
and apical seal) and finally the rehabilitation management. The
interpretation}\par\pard\li466\ri0\sl-213\slmult0 \fs18\cf0\f0\charscalex100 {of
constant or intermittent pain and/or discomfort associated with apical
periodontitis}\par\pard\li466\ri0\sl-213\slmult0 \fs16\cf0\f0\charscalex100 {(AP)
in endodontically treated tooth may be suggestive of endodontic failure. The
success}\par\pard\li466\ri0\sl-213\slmult0 \fs16\cf0\f0\charscalex100 {features of
RCT, namely absence of pain, regression of AP, tight seal of canal and
coronal}\par\pard\li466\ri0\sl-213\slmult0 \fs18\cf0\f0\charscalex100 {spaces, and
recovery of tooth function, must be reevaluated over time. In case of
doubt}\par\pard\li466\ri0\sl-213\slmult0 \fs16\cf0\f0\charscalex100 {between
success and failure, cone beam computed tomography (CBCT) could be
indicated}\par\pard\li466\ri0\sl-213\slmult0 \fs18\cf0\f0\charscalex100 {for
detection and precise localization of AP. The possibility of map reading on
CBCT}\par\pard\li466\ri0\sl-213\slmult0 \fs18\cf0\f0\charscalex100 {images
characterizes the real multidimensional structure, providing accurate
information}\par\pard\li466\ri0\sl-213\slmult0 \fs18\cf0\f0\charscalex100 {on the
presence, absence or regression of AP. The survival of an endodontically
treated}\par\pard\li466\ri0\sl-213\slmult0 \fs18\cf0\f0\charscalex100 {tooth
implies understanding the biological and mechanical outcomes as
multifactorial}\par\pard\li466\ri0\sl-213\slmult0 \fs16\cf0\f0\charscalex100
{events over the individual\uc1\u8217Xs life span. The objective of this review of
literature is to discuss}\par\pard\li466\ri0\sl-213\slmult0
\fs18\cf0\f0\charscalex100 {relevant factors associated with patient\uc1\u8217Xs
health, tooth and dentist that could account}\par\pard\li466\ri0\sl-213\slmult0
\fs16\cf0\f0\charscalex100 {for a successful RCT.}\par\column\pard\li1480\ri0\sl-
186\slmult0 \fs16\cf0\f0\charscalex100 {ISSN 0103-6440}\par\pard\li0\ri0\sl-
213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-346\slmult0 \fs10\cf0\f0\charscalex100
{1}\fs16\cf0\f0\charscalex100 {Department of Stomatologic }\par\pard\li0\ri0\sl-
200\slmult0 \fs16\cf0\f0\charscalex100 {Sciences, School of
Dentistry, }\par\pard\li0\ri0\sl-200\slmult0 \fs16\cf0\f0\charscalex100 {UFG -
Federal University of }\par\pard\li0\ri0\sl-200\slmult0 \fs16\cf0\f0\charscalex100
{Goi�s, Goi�nia, GO, Brazil}\par\pard\li0\ri0\sl-200\slmult0
\fs10\cf0\f0\charscalex100 {2}\fs16\cf0\f0\charscalex100 {Department of Restorative
Dentistry, }\par\pard\li0\ri0\sl-200\slmult0 \fs16\cf0\f0\charscalex100 {School of
Dentistry, UNESP - Univ }\par\pard\li0\ri0\sl-200\slmult0
\fs16\cf0\f0\charscalex100 {Estadual Paulista, Ara�atuba, SP,
Brazil}\par\pard\li0\ri0\sl-200\slmult0 \fs10\cf0\f0\charscalex100
{3}\fs16\cf0\f0\charscalex100 {Department of Endodontics, }\par\pard\li0\ri0\sl-
200\slmult0 \fs16\cf0\f0\charscalex100 {School of Dentistry,
University }\par\pard\li0\ri0\sl-200\slmult0 \fs16\cf0\f0\charscalex100 {of Cuiab�,
Cuiab�, MT, Brazil}\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-
213\slmult0 \fs16\cf0\f0\charscalex100 {Correspondence: Prof. Dr.
Carlos }\par\pard\li0\ri0\sl-186\slmult0 \fs16\cf0\f0\charscalex100 {Estrela, Pra�a
Universit�ria s/n, Setor }\par\pard\li0\ri0\sl-186\slmult0
\fs16\cf0\f0\charscalex100 {Universit�rio, 74605-220,
Goi�nia, }\par\pard\li0\ri0\sl-186\slmult0 \fs16\cf0\f0\charscalex100 {GO, Brasil.
Tel: +55-62-3209-6254. }\par\pard\li0\ri0\sl-186\slmult0 \fs16\cf0\f0\charscalex100
{e-mail: estrela3@terra.com.br }\par\pard\li13\ri0\sl-213\slmult0
{Key Words: success, }\par\pard\li13\ri0\sl-213\slmult0 \fs18\cf0\f0\charscalex100
{failure, outcome, apical }\par\pard\li13\ri0\sl-213\slmult0
\fs18\cf0\f0\charscalex100 {periodontitis,
healing.}\par\pard\sect\sectd\sbknone\cols2\colno1\colw5573\colsr-
0\colno2\colw5520\pard\li466\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li466\ri0\sl-
360\slmult0 \fs28\cf0\f0\charscalex100\b {Introduction}\b0 \par\pard\li746\ri0\sl-
226\slmult0 \fs20\cf0\f0\charscalex100 {Success is the expected outcome after root
canal}\par\pard\li466\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100 {treatment
(RCT), regardless of the clinical conditions. }\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {However, predicting success usually
requires adopting a}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{referential or criteria, and presupposes that the patient}\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {is healthy. It is estimated that RCT should
be considered}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{completed when the tooth is permanently restored and in}\par\pard\li466\ri0\sl-
266\slmult0 \fs18\cf0\f0\charscalex100 {function (1). RCT clinical success can be
analyzed based on}\par\pard\li466\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100
{different points of view, with specific values that involve
the }\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {dentist, the
patient or the tooth itself. References for the}\par\pard\li466\ri0\sl-
266\slmult0 \fs18\cf0\f0\charscalex100 {dentist are the value of symptom (clinical
silence - absence}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {of
pain), the value of image (root canal space completely}\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {filled with no evidence of periapical
inflammation), and the }\par\pard\li466\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100
{value of clinical condition (a well-restored and
functioning }\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {tooth).
The dentist\uc1\u8217Xs skills are crucial to interpret
correctly}\par\pard\li466\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100 {the
radiographic features and establish a diagnostic }\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {hypothesis. For the patient, the value of
symptom (no pain)}\par\pard\li466\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100 {is
essential. Apart from this, RCT success is associated
with}\par\column\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-
\fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-306\slmult0
\fs20\cf0\f0\charscalex100 {predictive aspects that eliminate the need of
interventions}\par\pard\li0\ri0\sl-280\slmult0 \fs20\cf0\f0\charscalex100 {and
establishes treatment conclusion. The success for the}\par\pard\li0\ri0\sl-
253\slmult0 \fs18\cf0\f0\charscalex100 {tooth itself is associated with absence of
disease (root canal }\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{infection or periapical inflammation).}\par\pard\li280\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {The life of an endodontically treated tooth
implies}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {understanding
that biological and mechanical events have}\par\pard\li0\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {a multifactorial nature and cannot be viewed
separately.}\par\pard\li0\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100 {Ideally,
it is expected to preserve the largest possible number }\par\pard\li0\ri0\sl-
266\slmult0 \fs18\cf0\f0\charscalex100 {of teeth until the end of life. Successful
RCT prevents pain,}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{apical periodontitis (AP) and tooth loss, but it is a real}\par\pard\li0\ri0\sl-
266\slmult0 \fs18\cf0\f0\charscalex100 {challenge because several clinical
conditions can contribute, }\par\pard\li0\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {alone or in combination, for a poor prognosis, namely
root}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {canal
perforation, overfilling, endodontic and periodontal}\par\pard\li0\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {lesion, root fracture, periapical biofilm,
traumatic dental}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{injury, fracture of instrument, AP, root resorption, etc.}\par\pard\li280\ri0\sl-
266\slmult0 \fs18\cf0\f0\charscalex100 {Systemic and periodontal conditions should
be carefully }\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {examined
before RCT. Preoperative diagnosis of dental}\par\pard\li0\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {pulp and/or periapical tissues is an important
reference}\par\pard\sect\sectd\sbknone\pard\sect\sectd\sbkpage
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1}}}}\pgwsxn11893\pghsxn15866\marglsxn666\margrsxn133\margtsxn533\margbsxn120\cols2
\colno1\colw5573\colsr-0\colno2\colw5520\pard\li466\ri0\sl-186\slmult0
\fs16\cf0\f0\charscalex100\i {Braz Dent J 25(1) 2014 }\i0 \par\pard\li466\ri0\sl-
\fs18\cf0\par\pard\li466\ri0\sl-293\slmult0 \fs20\cf0\f0\charscalex100 {to
establish case prognosis. The dentist\uc1\u8217Xs health
represents}\par\pard\li466\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100 {a human
aspect that is frequently neglected and can}\par\pard\li466\ri0\sl-266\slmult0
\fs18\cf0\f0\charscalex100 {also be a risk factor for the occurrence of
intraoperative}\par\pard\li466\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100
{procedural errors. Human error may be associated with}\par\pard\li466\ri0\sl-
266\slmult0 \fs18\cf0\f0\charscalex100 {stress, working conditions, and lack of
attention, adequate}\par\pard\li466\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100
{planning and sufficient knowledge of new technologies.}\par\pard\li466\ri0\sl-
266\slmult0 \fs18\cf0\f0\charscalex100 {Renouard and Charrier (2) discussed some
human factors}\par\pard\li466\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100 {that
could induce accidents and reported that as far as}\par\pard\li466\ri0\sl-
266\slmult0 \fs18\cf0\f0\charscalex100 {the interactions between the individual and
the working}\par\pard\li466\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100
{environment, errors could be related to other people (life}\par\pard\li466\ri0\sl-
266\slmult0 \fs18\cf0\f0\charscalex100 {ware), technology (hardware), documentation
(software)}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {and
environment.}\par\pard\li746\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100 {The
objective of this review of literature is to discuss}\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {relevant factors associated with
patient\uc1\u8217Xs health, tooth and }\par\pard\li466\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {dentist that could account for a successful RCT. Table
1}\par\pard\li466\ri0\sl-280\slmult0 \fs16\cf0\f0\charscalex100 {enumerates
determinant aspects associated with the health }\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {of the individual, the tooth and the
professional that must}\par\pard\li466\ri0\sl-266\slmult0
\fs18\cf0\f0\charscalex100 {be carefully observed for a successful
RCT.}\par\pard\li466\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li466\ri0\sl-320\slmult0
\fs22\cf0\f0\charscalex100\i {The Value of Diagnosis}\i0 \par\pard\li746\ri0\sl-
266\slmult0 \fs18\cf0\f0\charscalex100 {Establishing a correct diagnosis is
essential for planning }\par\pard\li466\ri0\sl-266\slmult0
\fs18\cf0\f0\charscalex100 {clinical procedures. A favorable prognosis in RCT
relies on}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {the
endodontist\uc1\u8217Xs scientific experience level and skills.
The}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {challenge is to
overcome the complex canal morphology,}\par\pard\li466\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {neutralize the microbial pathogenicity regardless of
the}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {type and
duration of infection, and disrupt the bacterial}\par\pard\li466\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {biofilm. Host\uc1\u8217Xs defense (immune response) is
fundamental}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {in this
process.}\par\column\pard\li280\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li280\ri0\sl-
\fs18\cf0\par\pard\li280\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {Pulpal or
periapical inflammatory diseases are usually}\par\pard\li0\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {identified by the consequences of tissue
aggressions. }\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {The main
purpose of canal therapy is the removal of the}\par\pard\li0\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {causative - bacterial, chemical, mechanical and
physical}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {etiological -
agents. During the diagnosis, it is essential}\par\pard\li0\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {to recognize the clinical conditions that could have
led to}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {tissue
response, such as dental caries, pain, inflammation,}\par\pard\li0\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {primary infection, secondary infection,
symptomatic/}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{asymptomatic AP, periapical abscess with/without sinus}\par\pard\li0\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {tract, open/closed cavity, history of
traumatic dental injury.}\par\pard\li280\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {Knowing the clinical factors associated with
pulpal}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {and periapical
pain may provide important information}\par\pard\li0\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {for planing the therapeutic strategies and predicting
RCT}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {outcomes. The most
frequent diagnosis of pulpal pain has}\par\pard\li0\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {been associated with symptomatic pulpitis and
hyper-}\par\pard\li0\ri0\sl-280\slmult0 \fs20\cf0\f0\charscalex100 {reactive
pulpalgia, and the most frequent periapical pain is}\par\pard\li0\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {symptomatic AP of infectious origin.
Endodontic diagnosis}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{and local factors associated with pulpal and periapical
pain }\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {suggest that the
important clinical factor in pulpal pain is}\par\pard\li0\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {closed pulp chamber and caries, and is periapical pain
is}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {open pulp chamber
(3).}\par\pard\li280\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {Understanding
the general clinical condition (patient\uc1\u8217Xs}\par\pard\li0\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {systemic health) and local (clinical
conditions of the tooth)}\par\pard\li0\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {favors the first impression to predict a possible
outcome}\par\pard\li0\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100 {of RCT. The
impact of patient\uc1\u8217Xs age, smoking status, initial}\par\pard\li0\ri0\sl-
266\slmult0 \fs18\cf0\f0\charscalex100 {treatment versus retreatment, root canal
system exposed to }\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{salivary contamination prior to treatment, and the type of}\par\pard\li0\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {instrumentation on RCT outcome were
recently
evaluated}\par\pard\sect\sectd\sbknone\pgwsxn11893\pghsxn15866\marglsxn666\margrsxn
133\cols2\colno1\colw1026\colsr-0\colno2\colw10066\pard\li573\ri0\sl-213\slmult0
{4}\par\column\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-
{Table 1. Determinant factors associated with health of individual, tooth and
professional that must be carefully observed for RCT
success. }\par\pard\li80\ri0\sl-400\slmult0 \fs16\cf0\f0\charscalex100
{Determinants associated with the individual}\par\pard\li80\ri0\sl-280\slmult0
\fs16\cf0\f0\charscalex100 {- Patient\uc1\u8217Xs age}\par\pard\li80\ri0\sl-
200\slmult0 \fs16\cf0\f0\charscalex100 {- Oral health (periodontal
disease)}\par\pard\li80\ri0\sl-200\slmult0 \fs16\cf0\f0\charscalex100 {- Systemic
health (systemic diseases)}\par\pard\li80\ri0\sl-200\slmult0
\fs16\cf0\f0\charscalex100 {- Patient\uc1\u8217Xs collaboration (level of
patient\uc1\u8217Xs knowledge about the importance of health and of the
RCT)}\par\pard\li80\ri0\sl-266\slmult0 \fs16\cf0\f0\charscalex100 {Determinants
associated with the tooth}\par\pard\li80\ri0\sl-280\slmult0
\fs16\cf0\f0\charscalex100 {- Diagnosis of dental pulp and/or periapical tissue
previously to RCT}\par\pard\li80\ri0\sl-200\slmult0 \fs16\cf0\f0\charscalex100 {-
Dental morphology (dental group - anterior, premolar and molar; dental development
disturbances)}\par\pard\li80\ri0\sl-200\slmult0 \fs16\cf0\f0\charscalex100 {- RCT
planning}\par\pard\li80\ri0\sl-200\slmult0 \fs16\cf0\f0\charscalex100
{- Time, extension and type of the infectious process}\par\pard\li80\ri0\sl-
200\slmult0 \fs16\cf0\f0\charscalex100 {- Understanding the disinfection process,
the selection of the antimicrobial agents (irrigant solution, intracanal dressing,
filling}\par\pard\li80\ri0\sl-200\slmult0 \fs16\cf0\f0\charscalex100 {material,
quality of coronary restoration)}\par\pard\li80\ri0\sl-200\slmult0
\fs14\cf0\f0\charscalex100 {- RCT (root canal space completely filled, with filling
material ending 1-2 mm from the radiograph apex, overfilling, root
perforation,}\par\pard\li80\ri0\sl-200\slmult0 \fs16\cf0\f0\charscalex100 {fracture
of instrument, endoperiodontal lesion, traumatic dental
injury)}\par\pard\li80\ri0\sl-200\slmult0 \fs16\cf0\f0\charscalex100 {- Type of
restoration (composite resin, metallic restoration, unitary prosthesis with or
without intraradicular post, extensive dental}\par\pard\li80\ri0\sl-200\slmult0
\fs16\cf0\f0\charscalex100 {rehabilitation)}\par\pard\li80\ri0\sl-200\slmult0
\fs16\cf0\f0\charscalex100 {- Control and longevity of the
RCT}\par\pard\li80\ri0\sl-200\slmult0 \fs16\cf0\f0\charscalex100 {- Selection of
the cases and gumption}\par\pard\li80\ri0\sl-266\slmult0 \fs16\cf0\f0\charscalex100
{Determinants associated with the professional}\par\pard\li80\ri0\sl-266\slmult0
\fs16\cf0\f0\charscalex100 {- Stress}\par\pard\li80\ri0\sl-200\slmult0
\fs16\cf0\f0\charscalex100 {- Work environment}\par\pard\li80\ri0\sl-200\slmult0
\fs16\cf0\f0\charscalex100 {- Lack of attention}\par\pard\li80\ri0\sl-
200\slmult0 \fs16\cf0\f0\charscalex100 {- Lack of planning}\par\pard\li80\ri0\sl-
200\slmult0 \fs16\cf0\f0\charscalex100 {- Domain of new
technologies}\par\pard\li80\ri0\sl-200\slmult0 \fs16\cf0\f0\charscalex100 {-
Technical ability and knowledge (academic level - student, general clinician,
specialist, experienced specialist,
professor)}\par\pard\sect\sectd\sbknone\pgwsxn11893\pghsxn15866\marglsxn666\margrsx
n133
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{(4). The integrity of a patient\uc1\u8217Xs nonspecific immune
system,}\par\pard\li466\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100 {which has
been neglected in earlier investigations, is a}\par\pard\li466\ri0\sl-
266\slmult0 \fs18\cf0\f0\charscalex100 {significant predictor for endodontic
treatment outcome,}\par\pard\li466\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100
{and should receive more attention. The immune status}\par\pard\li466\ri0\sl-
266\slmult0 \fs18\cf0\f0\charscalex100 {of the patient, and the quality of the root
filling showed}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {a
great influence on RCT outcome in a cohort study (4).}\par\pard\li746\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {Several non-endodontic diseases suggest a
typical }\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {case of AP.
The differential diagnosis of diseases of non-}\par\pard\li466\ri0\sl-
266\slmult0 \fs18\cf0\f0\charscalex100 {endodontic and endodontic origin should
always be }\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {made
carefully. Radiolucent or radiopaque images in the}\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {mandibular or maxillary areas surrounding
the root apexes}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {may
be a sign of non-endodontic disease, and may be}\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {misdiagnosed as AP (5-
7).}\par\pard\li466\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li466\ri0\sl-
333\slmult0 \fs22\cf0\f0\charscalex100\i {Root Canal Infection and its
Consequences}\i0 \par\pard\li746\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100 {The
periapical inflammation represents a natural }\par\pard\li466\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {biological defense response, caused by several
etiologic}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {agents.
The model of the inflammatory response is similar}\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {in other parts of the organism. The
intensity of periapical}\par\pard\li466\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {inflammation and/or infection can suggest the
diagnosis}\par\pard\li466\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100 {and the
treatment option. The traumatic or infectious injury }\par\pard\li466\ri0\sl-
266\slmult0 \fs18\cf0\f0\charscalex100 {of the dental pulp is able to produce
harmful consequences }\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{in the periapical region. The infection of the dental pulp}\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {mobilizes microorganisms to develop in
apical direction, to}\par\pard\li466\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100
{invade and colonize the periapical tissues. The period of
time }\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {of an
infection process is unpredictable. Microorganisms}\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {with different characteristics (structural,
metabolic and}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{pathogenic) reaching the periapical region stimulate the}\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {inflammatory and immunologic responses. The
organic}\par\pard\li466\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100 {defenses and
the degree of virulence of the microorganisms }\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {establish several types of periapical
alterations and its}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{infection potential (8,9).}\par\pard\li746\ri0\sl-266\slmult0
\fs18\cf0\f0\charscalex100 {Some signs are solid evidence of the
pathogenic }\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{potential to be neutralized by therapeutic strategies,
like}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {a tooth with
root canal that remained open for some time}\par\pard\li466\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {and favored the invasion and colonization by
different}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {bacterial
species, or the presence of a sinus tract, which}\par\pard\li466\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {collaborates with the invasion and development of
a}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {structured
bacterial biofilm.}\par\pard\li746\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{The participation of a bacterial complex in the process}\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {of pulp and periapical aggression has been
thoroughly}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {discussed
in several studies (8-17).}\par\pard\li746\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {Sundqvist and Figdor (13) reported that infection of
the }\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {root canal is
not a random event. The type and mix of the}\par\pard\li466\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {bacterial microbiota develop in response to the
surrounding }\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{environment. Species that establish a persistent root
canal}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {infection are
selected by the phenotypic traits that they}\par\pard\li466\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {share and that are suited to the modified
environment.}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {Nair
(8) has defined pathogenicity as the ability of a}\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {microbe to produce disease and virulence;
it is the relative}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{capacity of a microbe to cause damage in a host (17). Any}\par\pard\li466\ri0\sl-
266\slmult0 \fs18\cf0\f0\charscalex100 {metabolically active microbe living in the
root canal has the }\par\column\pard\li2986\ri0\sl-186\slmult0
\fs16\cf0\f0\charscalex100\i {Braz Dent J 25(1) 2014}\i0 \par\pard\li0\ri0\sl-
\fs18\cf0\par\pard\li0\ri0\sl-293\slmult0 \fs18\cf0\f0\charscalex100 {potential to
participate in the inflammation of periapical}\par\pard\li0\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {tissues. Individual species in the endodontic
microbiota}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {may be of
low virulence, but their survival in the necrotic}\par\pard\li0\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {root canal and pathogenic properties are
influenced by a}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{combination of several factors. They include the ability to}\par\pard\li0\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {build biofilms, interact with other
microorganisms in the}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{biofilm and develop synergistically beneficial
partnerships, }\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {the
capability to interfere with and evade host defenses,}\par\pard\li0\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {the release of lipopolysaccharides and
other microbial}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{modulins, and the synthesis of enzymes that damage host}\par\pard\li0\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {tissues (8,10-
12,16,17).}\par\pard\li280\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {The
etiology of disease post-treatment in endodontics}\par\pard\li0\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {has been associated with microbial
etiologic factors }\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{(intraradicular and extraradicular infection \uc1\u8211X
bacteria,}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {fungi); and
nonmicrobial etiologic factors (endogenous \uc1\u8211X}\par\pard\li0\ri0\sl-
280\slmult0 \fs20\cf0\f0\charscalex100 {true cysts; exogenous \uc1\u8211X foreign-
body reaction) (9-12,16).}\par\pard\li0\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {According to Nair (8,10-12,16), it is important to
consider}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {the
extraradicular infections occuring by: (a) exacerbating}\par\pard\li0\ri0\sl-
266\slmult0 \fs18\cf0\f0\charscalex100 {AP lesions, (b) periapical actinomycosis,
(c) association with }\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{pieces of infected root dentin displaced into the periapex}\par\pard\li0\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {during root canal instrumentation or cut
off from the rest}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {of
the root by massive apical resorption and (d) infected}\par\pard\li0\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {periapical cysts, particularly in
periapical pocket cysts with}\par\pard\li0\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {cavities open to the root
canal.}\par\pard\li280\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {Other
etiologic agents should also be correlated as}\par\pard\li0\ri0\sl-266\slmult0
\fs18\cf0\f0\charscalex100 {potential periapical aggressors. The periapical
inflammation }\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {may
occur due to a natural defense response against over-}\par\pard\li0\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {instrumentation, over-irrigation or
overfilling (18-22). The }\par\pard\li0\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100
{root canal preparation and obturation should be restricted}\par\pard\li0\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {to the main root canal if there is no
evidence contrary to}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{this therapeutic protocol.}\par\pard\li0\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li0\ri0\sl-320\slmult0 \fs22\cf0\f0\charscalex100\i {Operational
Strategies that May Interfere On Success}\i0 \par\pard\li0\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li0\ri0\sl-320\slmult0 \fs20\cf0\f0\charscalex100 {Apical Limit,
Apical Enlargement}\par\pard\li280\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{The quality of root canal preparation and filling and}\par\pard\li0\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {coronal sealing are essential factors to
achieve high rates}\par\pard\li0\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100 {of
success, even in infected root canals. This fact reinforces}\par\pard\li0\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {the concept of eliminating empty spaces
that can harbor}\par\pard\li0\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100
{microorganisms (8,9,23,24). The RCT excellency is
associated }\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {with the
disinfection process, which involves removing}\par\pard\li0\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {microorganisms from the root canal system by
emptying,}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {cleaning and
enlarging/shaping, combined with the use of}\par\pard\li0\ri0\sl-266\slmult0
\fs18\cf0\f0\charscalex100 {antibacterial therapies (8,9,16,23,25,26). Based on the
need }\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {to control the
microbiota of infected root canals, some}\par\pard\li0\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {aspects are necessary in a therapeutic protocol. Thus,
the}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {apical limit of
instrumentation and obturation must be}\par\pard\li0\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {discussed, the determination of apical enlargement
level}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {(anatomical
diameter) and the antibacterial efficacy of}\par\pard\li0\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {intracanal medicaments in root canal
infections.}\par\pard\li280\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100 {Several
studies reported that root canal preparation and }\par\pard\li0\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {obturation short of the radiographic apex
were associated}\par\pard\li4346\ri0\sl-293\slmult0 \fs16\cf0\f0\charscalex100
{5}\par
{\shp{\*\shpinst\shpleft10973\shptop6840\shpright11173\shpbottom8853\shpfhdr0\shpbx
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\fs16\cf0\f0\charscalex100\i {Successful root canal
treatment}\i0 }}}\pard\sect\sectd\sbkpage
\fs18\cf0\par\pard\li466\ri0\sl-293\slmult0 \fs18\cf0\f0\charscalex100 {with a
better prognosis (18-22). The clinical characterization }\par\pard\li466\ri0\sl-
266\slmult0 \fs18\cf0\f0\charscalex100 {of apical morphology is extremely complex.
The root level of }\par\pard\li466\ri0\sl-266\slmult0 \fs16\cf0\f0\charscalex100
{isthmuses and their frequency do not represent as
standard }\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {(9,27).
The apical constriction and the apical foramen are}\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {not reliable anatomic landmarks for the
obturation length}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {at
the apical end, and their use to calculate obturation}\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {length may result in injury to apical and
periapical tissues}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{(28). On the basis of biologic and clinical principles, }\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {instrumentation and obturation should not
extend beyond }\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {the
apical foramen (18-22,27-33).}\par\pard\li746\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {A frequent discussion in endodontic therapy,
reported}\par\pard\li466\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100 {by Ricucci
(30) and Ricucci and Langeland (31) concerns the }\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {apical limit of instrumentation and
obturation. The results}\par\pard\li466\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {of longitudinal studies, basic anatomical knowledge of
the}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {apical third of
the root canal, and the histological pulp}\par\pard\li466\ri0\sl-280\slmult0
\fs20\cf0\f0\charscalex100 {reaction to caries progression, demonstrated the
presence}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {of a vital
apical pulp remnant, even in the presence of a}\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {periapical lesion. Wu et al. (29) reported
that the biologic}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{and clinical principles after vital pulpectomy that
attained}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {highest
success rates were achieved when procedures}\par\pard\li466\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {ended 2\uc1\u8211X3 mm short of the radiographic apex.
When there}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {is pulp
necrosis, bacteria and their by-products as well}\par\pard\li466\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {as infected dentin debris may remain in the most
apical}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {portion of
the root canal, and these irritants jeopardize}\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {apical healing. In these cases, highest
success rates were}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{achieved when obturation ended at 0\uc1\u8211X2 mm short
of}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {the radiographic
apex. When shorter than 2 mm from or}\par\pard\li466\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {beyond the radiographic apex, success rates for
infected}\par\pard\li466\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100 {canals were
approximately 20% lower than those found for }\par\pard\li466\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {root filling ending 0-2 mm short of the apex.
Systematic}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {reviews
(32,33) also showed that higher success rates are}\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {achieved when obturation is short of the
apex (root canal}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{obturation 1-2 mm short of apex).}\par\pard\li746\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {Thus, the filling material should remain confined
to}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {the root canal
and in no way its presence beyond the apex}\par\pard\li466\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {is justified. It is appropriate to remind that many
injuries}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {seem AP,
but it does not mean they really are.}\par\pard\li746\ri0\sl-266\slmult0
\fs18\cf0\f0\charscalex100 {The level of enlargement of the root canal and the
action }\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {potential of
disinfection process reflect the effectiveness}\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {of antimicrobial strategies. The estimate
of the anatomic}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{diameter of the root canal before enlargement should be}\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {considered (34,35). Many instruments do not
touch all}\par\pard\li466\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100 {canal
walls (36). Thus, root canal emptying and enlargement }\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {represent essential actions for
antimicrobial control (35).}\par\pard\li466\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li466\ri0\sl-320\slmult0 \fs20\cf0\f0\charscalex100
{Sanitization Process}\par\pard\li746\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{One of the challenges in RCT is to discover how to}\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {sanitize the isthmus areas that harbor
microorganisms,}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{which in turn prevents the action of the instruments on}\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {bacterial biofilm.}\par\pard\li746\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {The antimicrobial efficacy of intracanal
medicaments}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {on
bacterial biofilm is still not confirmed (24,26,37,38).}\par\pard\li573\ri0\sl-
293\slmult0 \fs16\cf0\f0\charscalex100 {6}\par\column\pard\li0\ri0\sl-
\fs20\cf0\f0\charscalex100 {Nair et al. (37) reported the importance and necessity
of}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {stringent
application of non-antibiotic chemomechanical}\par\pard\li0\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {measures in order to disrupt the biofilm and reduce
the}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {intraradicular
microbial load to the lowest possible level}\par\pard\li0\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {to ensure the most favorable long-term prognosis for
the}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {treatment of
infected root canals.}\par\pard\li280\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{The selection of effective microbial control in }\par\pard\li0\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {infected root canals requires detailed
knowledge of }\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {the
microorganisms responsible for pulp and periapical}\par\pard\li0\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {pathology associated with understanding the
action }\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {mechanism of
the antimicrobial substances (39,40). The}\par\pard\li0\ri0\sl-266\slmult0
\fs18\cf0\f0\charscalex100 {success of infected RCT may be influenced by some
clinical}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {environments,
as the planktonic suspension, presence of}\par\pard\li0\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {biofilm, time and type of infection, host response,
and}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {effective
antibacterial therapeutic protocol.}\par\pard\li280\ri0\sl-280\slmult0
\fs18\cf0\f0\charscalex100 {Irrigant solutions are necessary during root
canal }\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {preparation
because they help to clean the root canal,}\par\pard\li0\ri0\sl-266\slmult0
\fs18\cf0\f0\charscalex100 {lubricate the files, flush out debris, and have an
antimicrobial }\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {and
tissue dissolution effect, without damaging periapical}\par\pard\li0\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {tissues. The selection of an ideal irrigant
depends on its}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {action
against the root canal microbiota and the biological}\par\pard\li0\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {effect on periapical tissue (24,25,40).
Several irrigating}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{solutions have been considered in order to decrease }\par\pard\li0\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {endodontic infection and contribute to
canal disinfection,}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{including: halogenated compounds (sodium hypochlorite), }\par\pard\li0\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {chlorhexidine, detergents (anionic,
cationic), chelating }\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{agents (EDTA, citric acid), MTAD, ozonated water, apple}\par\pard\li0\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {vinegar. However, up to now, sodium
hypochlorite and}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{chlorhexidine are the most often indicated antimicrobial}\par\pard\li0\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {agents for treatment protocols against
endodontic and}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{periodontal infections (24,25,40).}\par\pard\li280\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {The antimicrobial effect of sodium hypochlorite
by}\par\pard\li0\ri0\sl-280\slmult0 \fs20\cf0\f0\charscalex100 {direct contact
with}{ }\fs18\cf0\f0\charscalex100\i {E. faecalis}\i0 \fs18\cf0\f0\charscalex100
{ occurs after 2 min (25). The}\par\pard\li0\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {positive culture of microorganisms following the
application }\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {of the
irrigating solutions (ozonated water, gaseous ozone,}\par\pard\li0\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {2.5% sodium hypochlorite, 2% chlorhexidine)
for 20 min}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {confirmed
their inability to sterilize an infected human}\par\pard\li0\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {root canal (24). Thus, when a medicament does not
reach}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {the target
microorganism, its killing potential cannot be}\par\pard\li0\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {recognized. Therefore, it cannot be stated whether
the}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {microbial strains
were resistant to one or other medication. }\par\pard\li0\ri0\sl-266\slmult0
\fs18\cf0\f0\charscalex100 {In this case, it is likely that the microorganisms were
able to}\par\pard\li0\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100 {survive, adapt
and tolerate the critical ecological conditions.}\par\pard\li280\ri0\sl-266\slmult0
\fs18\cf0\f0\charscalex100 {In the same direction, the properties of
calcium }\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {hydroxide
stem from its dissociation into calcium and}\par\pard\li0\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {hydroxyl ions and the action of these ions on tissues
and}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {bacteria explains
biological and antimicrobial properties}\par\pard\li0\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {of this substance (39). Thus, it was shown that
calcium}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {hydroxide
induces the deposition of a hard tissue bridge}\par\pard\li0\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {on pulpal and periodontal connective tissue (41-
44). }\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {Its action on
connective tissue (pulpal and periodontal}\par\pard\li0\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {tissues) revealed the ability to stimulate
mineralization,}\par
2;12;16384;45824;1;45824;1;45824;1;45824;1;45824;24577;32768}}
{from the significant involvement of alkaline phosphatase}\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {and fibronectin (39-
46).}\par\pard\li746\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100 {There is a
great release of hydroxyl ions from calcium}\par\pard\li466\ri0\sl-266\slmult0
\fs18\cf0\f0\charscalex100 {hydroxide, which are able of altering the integrity of
the}\par\pard\li466\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100 {bacterial
cytoplasmic membrane through the toxic effects}\par\pard\li466\ri0\sl-
266\slmult0 \fs18\cf0\f0\charscalex100 {generated during the transfer of nutrients
or by the}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{destruction of the phospholipids of unsaturated fatty
acids. }\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {The
influence of pH alters the integrity of the cytoplasmic}\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {membrane by biochemical injury to organic
components}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{(proteins, phospholipids) and transport of nutrients. The}\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {maintenance of a high concentration of
hydroxyl ions can}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{change the enzymatic activity and provide its inactivation}\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {(39). In addition, the healing process in
teeth with AP after}\par\pard\li466\ri0\sl-266\slmult0 \fs16\cf0\f0\charscalex100
{RCT in two appointments with the use of calcium hydroxide }\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {paste showed a better status of periapical
tissue (with}\par\pard\li466\ri0\sl-280\slmult0 \fs20\cf0\f0\charscalex100
{mineralized barrier)(43-44).}\par\pard\li746\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {The presence of biofilm in the root canal system
is}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {a challenge to
the outcome of RCT (26,37). The active}\par\pard\li466\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {participation of mechanical action of
endodontic }\par\pard\li466\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100
{instruments combined with antimicrobial strategies }\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {appears to be crucial for decreasing root
canal infection.}\par\pard\li466\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li466\ri0\sl-320\slmult0 \fs22\cf0\f0\charscalex100\i {Criteria
for the RCT success}\i0 \par\pard\li746\ri0\sl-266\slmult0
\fs18\cf0\f0\charscalex100 {The estimation of the RCT prognosis must be related
to}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {criteria for
understanding the success. This aspect implies}\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {in evaluating results based on longitudinal
monitoring,}\par\pard\li466\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100 {which
requires a standard. The RCT success criteria and its}\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {prevalence should be routinely reevaluated.
Among the}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {clinical
and radiographic characteristics of the RCT failure}\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {there is often observed the presence of
symptoms (pain)}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{and/or the presence of a periapical radiolucent area.}\par\pard\li746\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {AP is a consequence of root canal system
infection,}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {which can
involve progressive stages of inflammation}\par\pard\li466\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {and changes of periapical bone structure, resulting
in}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {resorptions
identified as radiolucencies in radiographs (12).}\par\pard\li746\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {RCT failures may involve microbial and non-
microbial}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {factors,
as discussed previously (9-12,16). A high rate of}\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {failure is associated with endodontically
treated teeth}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{associated with AP, overfilling, and teeth that were not}\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {properly restored after RCT (18-22,27,47-
49).}\par\pard\li746\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {Thus, utmost
care must be taken to establish criteria}\par\pard\li466\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {to define success. On this account, the life of a
tooth}\par\pard\li466\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100 {endodontic
treatment may be rely on the time and }\par\pard\li466\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {the age of the individual. In a prospective analysis,
an}\par\pard\li466\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100 {endodontically
treated tooth is expected to remain }\par\pard\li466\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {throughout the individual\uc1\u8217Xs life. The
analysis of the RCT}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{success involves reversion of the inflammatory/infectious}\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {process, no symptoms, well restored, in
function and no}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{evidence of periapical radiolucency. It is important to}\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {recognize that along people\uc1\u8217Xs
life, some diseases may}\par\pard\li466\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {develop and impact their health. Incidentally, an
infection}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {or re-
infection may arise some time after RCT.}\par\column\pard\li2986\ri0\sl-186\slmult0
\fs16\cf0\f0\charscalex100\i {Braz Dent J 25(1) 2014}\i0 \par\pard\li280\ri0\sl-
\fs18\cf0\par\pard\li280\ri0\sl-293\slmult0 \fs18\cf0\f0\charscalex100 {To
characterize the outcomes of endodontically treated }\par\pard\li0\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {teeth with vital pulp (healthy or inflamed
pulp), infected}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {pulp,
AP and periapical abscess, must be considered the}\par\pard\li0\ri0\sl-
266\slmult0 \fs18\cf0\f0\charscalex100 {time since RCT conclusion and the definite
restoration. The}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{previous status of pulp and periapical tissue may aid in the}\par\pard\li0\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {interpretation of actual clinical
conditions.}\par\pard\li280\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{Strindberg (50) described important clinical and }\par\pard\li0\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {radiographic factors associated with RCT success
and }\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {failure. A
considerable number of clinical studies have}\par\pard\li0\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {discussed the causes of failure of endodontically
treated}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {teeth and
prospects for prognosis in retreatment (50-75).}\par\pard\li0\ri0\sl-266\slmult0
\fs18\cf0\f0\charscalex100 {The correlation of RCT failure with infected root canal
was}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {evident in several
conditions (1,3,8-20,24-27,35-40,47-75).}\par\pard\li280\ri0\sl-266\slmult0
\fs18\cf0\f0\charscalex100 {Traditionally, three aspects are associated in the
analysis }\par\pard\li0\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100 {of RCT
success \uc1\u8211X the clinical, radiographic and
microscopic}\par\pard\li0\ri0\sl-280\slmult0 \fs18\cf0\f0\charscalex100
{characteristics. In the clinical context, two of these
aspects}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {normally guide
the decision-making process: clinical }\par\pard\li0\ri0\sl-266\slmult0
\fs18\cf0\f0\charscalex100 {history (symptoms \uc1\u8211X absence; sensitivity,
discomfort and/or }\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{pain; physical exam \uc1\u8211X normality; edema, fistula,
excessive}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {mobility)
and interpretation of images (signs of periapical}\par\pard\li0\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {health; periapical bone
radiolucency).}\par\pard\li280\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100
{Clinical and radiographic aspects conventionally }\par\pard\li0\ri0\sl-266\slmult0
\fs18\cf0\f0\charscalex100 {associated with the RCT failure include pain, AP and/or
sinus }\par\pard\li0\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100 {tract,
swelling. The cases of doubt on the success or failure}\par\pard\li0\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {involve a transition phase and definition
of criteria may be}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{imposed by the limitations of the used clinical or imaging}\par\pard\li0\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {exams. Clinical success and clinical
silence are different}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{aspects to be analyzed. Clinical failure may present or not}\par\pard\li0\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100
{a symptomatic (pain) condition.}\par\pard\li280\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {In this sense, AP cannot be correctly identified
by}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {periapical
radiography only. The experienced professional}\par\pard\li0\ri0\sl-266\slmult0
\fs18\cf0\f0\charscalex100 {has many resources to identify the agent responsible
for the }\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {failure.
Notwithstanding the dentist\uc1\u8217Xs skills, the diagnosis}\par\pard\li0\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {of odontogenic pain should always follow an
accurate}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {protocol,
since the pain felt by the patient may not have}\par\pard\li0\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {a direct association with a well or bad
endodontically}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {treated
tooth.}\par\pard\li280\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100 {Various
factors may affect tooth survival, such as dental }\par\pard\li0\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {caries, periodontal disease and RCT. The prevalence
of}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {endodontically
treated teeth associated or not with AP has}\par\pard\li0\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {been examined in several populations
(1,48,49,61,72,73).}\par\pard\li280\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{Regarding the prevalence of endodontically treated}\par\pard\li0\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {teeth in Brazilian adults, a previous study
showed that}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {in a
sample of 29,467 teeth, only 6,313 (21.4%) received}\par\pard\li0\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {treatment (73). RCT was most frequent in
maxillary }\par\pard\li0\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100 {premolars
and molars, whereas mandibular incisors showed }\par\pard\li0\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {the lowest prevalence. Most endodontically treated
teeth}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {were found in
people aged 46 to 60 years (47.6%) and}\par\pard\li0\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {the prevalence increased with age in this range.
Females}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {(61.9%) showed
a higher prevalence of teeth with root}\par\pard\li0\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {fillings than males.}\par\pard\li280\ri0\sl-266\slmult0
\fs18\cf0\f0\charscalex100 {A total of 1,372 periapical radiographs of
endodontically }\par\pard\li4346\ri0\sl-293\slmult0 \fs16\cf0\f0\charscalex100
{7}\par
\fs18\cf0\par\pard\li466\ri0\sl-293\slmult0 \fs20\cf0\f0\charscalex100 {treated
teeth by postgraduate students were evaluated}\par\pard\li466\ri0\sl-266\slmult0
\fs18\cf0\f0\charscalex100 {(1). AP prevalence was significantly higher in teeth
with}\par\pard\li466\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100 {poor endodontic
treatment (66.3%) than in teeth with}\par\pard\li466\ri0\sl-266\slmult0
\fs18\cf0\f0\charscalex100 {adequate root canal filling (16.5%). Prevalence of AP
was}\par\pard\li466\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100 {also higher in
teeth with poor coronal restoration (52.1%)}\par\pard\li466\ri0\sl-266\slmult0
\fs18\cf0\f0\charscalex100 {than in teeth with adequate coronal restoration
(30.1%).}\par\pard\li466\ri0\sl-266\slmult0 \fs16\cf0\f0\charscalex100 {Based on
periapical radiographs, the prevalence of AP was}\par\pard\li466\ri0\sl-266\slmult0
\fs18\cf0\f0\charscalex100 {low when associated with a high technical quality of
RCT.}\par\pard\li746\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {In health
sciences, such as endodontics, various }\par\pard\li466\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {advances were applied to clinical practice. The
therapeutic}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{assessment of dental treatment by computed tomography}\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {characterizes a sensible advance of
information in health}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{(76,77). This contribution may be applied to planning,}\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {diagnosis, therapeutic process and
prognosis of several}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{diseases. The continuous advance of technology enabled}\par\pard\li466\ri0\sl-
280\slmult0 \fs20\cf0\f0\charscalex100 {the development of cone beam computed
tomography}\par\pard\li466\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100 {(CBCT)
(78,79), which has widen numerous perspectives for}\par\pard\li466\ri0\sl-
266\slmult0 \fs18\cf0\f0\charscalex100 {application in different research areas and
clinical dentistry }\par\pard\li466\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100
{(80-89). Imaging resources have been routinely used }\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {before, during and after dental treatment.
Conventional}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{radiographic images provide a two-dimensional rendition}\par\pard\li466\ri0\sl-
266\slmult0 \fs18\cf0\f0\charscalex100 {of a three-dimensional structure, which may
lead to }\par\pard\li466\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100
{interpretation errors. Periapical lesions of endodontic }\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {origin may be present but not visible on
conventional 2D}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{radiographs (80-84).}\par\pard\li746\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{The accuracy of diagnosis is a critical factor for the}\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {success. The correct management of CBCT
images may}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {reveal
abnormalities unable to be detected in periapical}\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {radiography and may enhance a more
predictable planning }\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{and treatment (80-84). The possibility of a map-reading}\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {approach with CBCT images reduces the
problems related}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {to
difficult evaluation conditions that require special care}\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {during diagnosis
(84).}\par\pard\li746\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {Estrela et al.
(82) evaluated the accuracy of CBCT}\par\pard\li466\ri0\sl-266\slmult0
\fs18\cf0\f0\charscalex100 {compared with periapical and panoramic radiography in
the }\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {identification
of AP. In view of the limitations of periapical}\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {radiography to visualize AP, a review of
epidemiologic}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{studies should be undertaken considering the quality of}\par\pard\li466\ri0\sl-
266\slmult0 \fs18\cf0\f0\charscalex100 {periapical aspects provided by CBCT images.
It will certainly }\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{reduce the influence of radiographic interpretation, with}\par\pard\li466\ri0\sl-
266\slmult0 \fs18\cf0\f0\charscalex100 {less possibility for false-negative
diagnoses. AP prevalence}\par\pard\li466\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {in endodontically treated teeth, when comparing
the}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {panoramic and
periapical radiographs and CBCT images,}\par\pard\li466\ri0\sl-266\slmult0
\fs18\cf0\f0\charscalex100 {was 17.6%, 35.3% and 63.3%, respectively. A
considerable}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{discrepancy can be observed among the imaging methods}\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {used to identify AP. AP was correctly
identified in 54.5%}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{of the cases with periapical radiographs and in 27.8% of}\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {the cases with panoramic radiographs. Minor
changes in}\par\pard\li466\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100
{sensitivity were found for different teeth groups, except
for }\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {incisors in
panoramic radiographs. ROC analysis suggests}\par\pard\li466\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {that AP is correctly identified with conventional
methods}\par\pard\li466\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100 {in an
advanced stage. CBCT was proved an accurate }\par\pard\li573\ri0\sl-293\slmult0
\fs16\cf0\f0\charscalex100 {8}\par\column\pard\li0\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {diagnostic
method to identify AP. Wu et al. (85) discussed}\par\pard\li0\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {the limitations of previously published systematic
reviews}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {assessing the
RCT outcomes. A high percentage of cases}\par\pard\li0\ri0\sl-266\slmult0
\fs18\cf0\f0\charscalex100 {confirmed as healthy by radiographs revealed AP on
CBCT}\par\pard\li0\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100 {and by histology.
In teeth where the small size of the existing }\par\pard\li0\ri0\sl-266\slmult0
\fs18\cf0\f0\charscalex100 {radiolucency was diagnosed by radiographs and
considered }\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {to
represent periapical healing, enlargement of the lesion}\par\pard\li0\ri0\sl-
266\slmult0 \fs18\cf0\f0\charscalex100 {was frequently confirmed by CBCT. In
clinical studies, two}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{additional factors may have further contributed to the}\par\pard\li0\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {overestimation of successful outcomes after
root canal}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {treatment:
(i) extractions and re-treatments were rarely}\par\pard\li0\ri0\sl-266\slmult0
\fs18\cf0\f0\charscalex100 {recorded as failures and (ii) the recall rate was often
lower}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {than 50%. The
outcomes of root canal treatment should}\par\pard\li0\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {be re-evaluated in long-term longitudinal studies
using}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {CBCT and
stricter evaluation criteria.}\par\pard\li280\ri0\sl-280\slmult0
\fs20\cf0\f0\charscalex100 {Characteristics of the clinical and imaging
outcomes}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {from RCT
include: success (clinical aspects - absence of}\par\pard\li0\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {pain; tooth with definitive restoration and in
masticatory}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {function;
imaging aspects - absence of periapical }\par\pard\li0\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {radiolucency); failure (clinical aspects - presence of
pain,}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {discomfort;
tooth with temporary or definitive restoration; }\par\pard\li0\ri0\sl-
266\slmult0 \fs18\cf0\f0\charscalex100 {presence of swelling; sinus tract; imaging
aspects - presence }\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {of
periapical radiolucency); doubt (intermediate clinical}\par\pard\li0\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {situations\uc1\u8211X in these cases may or
not present a history}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{involving pain or discomfort, associated with inconclusive}\par\pard\li0\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {image of AP
regression).}\par\pard\li280\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {In case
of doubt, it is essential to discuss the clinical}\par\pard\li0\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {case
with a more experienced professional, as in some}\par\pard\li0\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {cases it is not easy to determine the
differential diagnosis}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{of diseases of non-endodontic and endodontic origin.}\par\pard\li0\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {Various radiolucent images may be
associated with the }\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{apex, without being diseases of microbial origin and }\par\pard\li0\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {could be misinterpreted as AP (5-7). The
time to start}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {the
treatment is also a key factor to determine success}\par\pard\li0\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {or failure. The possibility of map-reading
in CBCT images}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{minimizes several problems related to complex diagnosis,}\par\pard\li0\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {particularly in dubious cases. Bueno et al.
(84) suggested}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {a map-
reading strategy to diagnose root perforations}\par\pard\li0\ri0\sl-266\slmult0
\fs18\cf0\f0\charscalex100 {near metallic intracanal posts by using CBCT. A
strategy to}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {minimize
metallic artifact in root perforation associated}\par\pard\li0\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {with intracanal post is to obtain
sequential axial slices}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{of each root, with an image navigation protocol from}\par\pard\li0\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {coronal to apical (or from apical to
coronal), with 0.2}\par\pard\li0\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100
{mm/0.2 mm axial slices. This map reading provides valuable }\par\pard\li0\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {information showing dynamic visualization
toward the}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {point of
communication between the root canals and}\par\pard\li0\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {the periodontal space, associated with radiolucent
areas,}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {suggesting root
perforation.}\par\pard\li280\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100
{Operative procedural errors (OPE) may occur and }\par\pard\li0\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {they represent risk factors able to
compromise a tooth}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{(86,87). Errors characterize disability, non-observance }\par\pard\li0\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {of therapeutic protocol and low level of
knowledge }\par
2;12;16384;45824;1;45824;1;45824;1;45824;1;45824;24577;32768}}
{involving the endodontic principles. Deficient attendance}\par\pard\li466\ri0\sl-
266\slmult0 \fs18\cf0\f0\charscalex100 {may be responsible for severe consequences
and sequels,}\par\pard\li466\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100 {which
impairs the prognosis, and may result in serious}\par\pard\li466\ri0\sl-266\slmult0
\fs18\cf0\f0\charscalex100 {judicial questions (89). Silva et al. (89) detected the
OPE}\par\pard\li466\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100 {in
endodontically treated teeth and dental implants, using}\par\pard\li466\ri0\sl-
266\slmult0 \fs18\cf0\f0\charscalex100 {CBCT images. In endodontically treated
teeth, OPE included }\par\pard\li466\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100
{underfilling, overfilling, and root perforation; OPE in
dental }\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {implants
were thread exposures, contact with anatomical}\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {structures, and contact with adjacent
teeth. Underfilling,}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{overfilling, and root perforations were detected in 33.5%,}\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {8% and 4.5% of the teeth, respectively.
Dental implants}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {with
thread exposures, contact with important anatomical}\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {structures and contact with adjacent teeth
were seen}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {in 37.5%,
13% and 6.5% of the cases, respectively. OPE}\par\pard\li466\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {were detected in endodontically treated teeth and
dental}\par\pard\li466\ri0\sl-280\slmult0 \fs20\cf0\f0\charscalex100 {implants, and
underfilling and thread exposures were the}\par\pard\li466\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {most frequent occurrences,
respectively.}\par\pard\li746\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {The
extension of treatment in a tooth with indication}\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {for extraction can be a dental implant. The
problem of}\par\pard\li466\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100 {replacing
a biological structure by biocompatible materials }\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {requires care and precise indication.
Information about}\par\pard\li466\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100
{criteria and rates of success in endodontically treated
teeth }\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {and dental
implants are of utmost importance.}\par\pard\li746\ri0\sl-266\slmult0
\fs18\cf0\f0\charscalex100 {Torabinejad et al. (90) analyzed by a systematic
review}\par\pard\li466\ri0\sl-266\slmult0 \fs16\cf0\f0\charscalex100 {clinical
articles addressing success and failure of nonsurgical }\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {RCT, and assigned levels of evidence to
these studies. It}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{appears that few high-level studies have been published in}\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {the past four decades related to the
success and failure of}\par\pard\li466\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {nonsurgical root canal therapy. The data generated by
this}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {search can be
used in future studies to specifically answer}\par\pard\li466\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {questions and test hypotheses relevant to the outcome
of}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {nonsurgical root
canal treatment.}\par\pard\li746\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100 {The
current moment of endodontic science is promising }\par\pard\li466\ri0\sl-
266\slmult0 \fs16\cf0\f0\charscalex100 {in view of all the knowledge acquired over
the last few years }\par\pard\li466\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100
{(91). New technologies such as CBCT influenced the quality}\par\pard\li466\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {of diagnosis, planning, therapy and
longitudinal control. A}\par\pard\li466\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {wide array of endodontic instruments for safer root
canal}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {preparation
was introduced in endodontics. Some of these}\par\pard\li466\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {advances contributed to the revision of concepts, and
to}\par\pard\li466\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100 {determine
adjustments to the treatment protocol. Estrela et }\par\pard\li466\ri0\sl-
266\slmult0 \fs18\cf0\f0\charscalex100 {al. (82) suggested a review of
epidemiologic studies in view}\par\pard\li466\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {of the limits of periapical radiography and the
accuracy to}\par\pard\li466\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100
{visualize AP by CBCT imaging. Wu et al. (85) in function
of}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {the limitations
of previous systematic reviews evaluating}\par\pard\li466\ri0\sl-266\slmult0
\fs16\cf0\f0\charscalex100 {the RCT outcomes, considered the need of re-evaluating
the }\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {outcome in
longitudinal studies using CBCT with rigorous}\par\pard\li466\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {evaluation criteria. One concern discussed at meetings
in}\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {endodontics and
in several recent studies (80-86) relates}\par\pard\li466\ri0\sl-266\slmult0
\fs18\cf0\f0\charscalex100 {to overestimated numbers of success in
RCT.}\par\pard\li746\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {Depending on
the dentist\uc1\u8217Xs knowledge and skills for}\par\pard\li466\ri0\sl-266\slmult0
\fs16\cf0\f0\charscalex100 {interpreting CBCT images, higher percentages of errors
and }\par\pard\li466\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {failures in RCT
may be identified. The possibility of map-}\par\column\pard\li2986\ri0\sl-
186\slmult0 \fs16\cf0\f0\charscalex100\i {Braz Dent J 25(1) 2014}\i0
\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li0\ri0\sl-293\slmult0 \fs16\cf0\f0\charscalex100 {reading on
the CBCT scans can characterize the reality of a}\par\pard\li0\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {multidimensional structure, aiding with
precise information }\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{the presence, absence or regression of AP. The life of an}\par\pard\li0\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {endodontically treated tooth implies
understanding the}\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100
{biological and mechanical results as a multifactorial event,}\par\pard\li0\ri0\sl-
266\slmult0 \fs20\cf0\f0\charscalex100 {over the life span of the
individual.}\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-
400\slmult0 \fs28\cf0\f0\charscalex100\b {Resumo}\b0 \par\pard\li0\ri0\sl-
186\slmult0 \fs14\cf0\f0\charscalex100 {O sucesso do tratamento endod�ntico deve
sempre ser o principal objetivo }\par\pard\li0\ri0\sl-200\slmult0
\fs16\cf0\f0\charscalex100 {em todas as situa��es cl�nicas, evitando-se dentro do
poss�vel a perda}\par\pard\li0\ri0\sl-200\slmult0 \fs14\cf0\f0\charscalex100 {do
dente. O entendimento dos fatores de riscos associados aos
fracassos}\par\pard\li0\ri0\sl-200\slmult0 \fs16\cf0\f0\charscalex100 {alerta para
a import�ncia terap�utica. A l�gica � reverter o quadro de}\par\pard\li0\ri0\sl-
200\slmult0 \fs16\cf0\f0\charscalex100 {doen�a presente, o que demanda interven��o
para neutralizar a agress�o}\par\pard\li0\ri0\sl-200\slmult0
\fs16\cf0\f0\charscalex100 {e romper biofilme bacteriano presente no complexo
anat�mico. Quando}\par\pard\li0\ri0\sl-200\slmult0 \fs16\cf0\f0\charscalex100 {as
defesas imunol�gicas do hospedeiro s�o favor�veis, o sucesso �
mais}\par\pard\li0\ri0\sl-200\slmult0 \fs16\cf0\f0\charscalex100 {previs�vel. A
�ptica do sucesso para o profissional, para o paciente e}\par\pard\li0\ri0\sl-
200\slmult0 \fs16\cf0\f0\charscalex100 {para o dente � distinta. A vida �til do
dente tratado endodonticamente}\par\pard\li0\ri0\sl-200\slmult0
\fs16\cf0\f0\charscalex100 {(DTE) depende da qualidade do processo de sanifica��o
(estrat�gias}\par\pard\li0\ri0\sl-200\slmult0 \fs16\cf0\f0\charscalex100
{antimicrobianas, alargamento e selamento), cujo referencial
apresenta}\par\pard\li0\ri0\sl-200\slmult0 \fs16\cf0\f0\charscalex100 {como base o
diagn�stico, o planejamento e a excel�ncia da t�cnica}\par\pard\li0\ri0\sl-
200\slmult0 \fs16\cf0\f0\charscalex100 {operat�ria (endod�ntica e reabilitadora). A
presen�a de dor cont�nua,}\par\pard\li0\ri0\sl-200\slmult0
\fs16\cf0\f0\charscalex100 {espor�dica, e/ou desconforto, associada ao aspecto de
uma imagem}\par\pard\li0\ri0\sl-200\slmult0 \fs14\cf0\f0\charscalex100 {radiol�cida
em DTE pode ser sugestivo de fracasso. As caracter�sticas de}\par\pard\li0\ri0\sl-
200\slmult0 \fs16\cf0\f0\charscalex100 {sucesso do tratamento (aus�ncia de dor,
regress�o de periodontite apical}\par\pard\li0\ri0\sl-200\slmult0
\fs16\cf0\f0\charscalex100 {(PA), espa�o do canal radicular e coron�rio
completamente obturado, e}\par\pard\li0\ri0\sl-200\slmult0
\fs16\cf0\f0\charscalex100 {dente em fun��o) devem ser avaliadas ao longo do tempo.
Nos casos}\par\pard\li0\ri0\sl-200\slmult0
\fs16\cf0\f0\charscalex100 {de d�vida, entre sucesso ou fracasso, a correta
localiza��o ou detec��o}\par\pard\li0\ri0\sl-200\slmult0 \fs16\cf0\f0\charscalex100
{da PA pode ser feita por tomografia computadorizada de feixe
c�nico}\par\pard\li0\ri0\sl-200\slmult0 \fs14\cf0\f0\charscalex100 {(TCFC). A
possibilidade de uma navega��o pela imagem da TCFC pode}\par\pard\li0\ri0\sl-
200\slmult0 \fs16\cf0\f0\charscalex100 {caracterizar a realidade de uma estrutura
multidimensional, auxiliando}\par\pard\li0\ri0\sl-200\slmult0
\fs16\cf0\f0\charscalex100 {com informa��o precisa sobre a presen�a, aus�ncia ou
regress�o da PA.}\par\pard\li0\ri0\sl-200\slmult0 \fs16\cf0\f0\charscalex100 {A
vida �til do DTE implica no entendimento de resultados biol�gicos
e}\par\pard\li0\ri0\sl-200\slmult0 \fs16\cf0\f0\charscalex100 {mec�nicos como um
evento multifatorial ao longo da vida do indiv�duo.}\par\pard\li0\ri0\sl-
213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-373\slmult0 \fs28\cf0\f0\charscalex100\b
{Acknowledgements}\b0 \par\pard\li0\ri0\sl-226\slmult0 \fs14\cf0\f0\charscalex100
{The authors deny any conflicts of interest related to this study. This
study}\par\pard\li0\ri0\sl-200\slmult0 \fs14\cf0\f0\charscalex100 {was supported in
part by grants from the National Council for Scientific}\par\pard\li0\ri0\sl-
200\slmult0 \fs14\cf0\f0\charscalex100 {and Technological Development (CNPq grant
306394/2011-1 to C.E.).}\par\pard\li0\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li0\ri0\sl-533\slmult0 \fs28\cf0\f0\charscalex100\b
{References}\b0 \par\pard\li0\ri0\sl-173\slmult0 \fs12\cf0\f0\charscalex100 { 1.
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\fs12\cf0\f0\charscalex100 {91. Estrela C, Alencar AHG, Kitten GT, Vencio EF, Gava
E. Mesenchymal stem }\par\pard\li346\ri0\sl-200\slmult0 \fs14\cf0\f0\charscalex100
{cells in the dental tissues: perspectives for tissue regeneration.
Braz }\par\pard\li346\ri0\sl-200\slmult0 \fs12\cf0\f0\charscalex100 {Dent J 2011;
22:91-98.}\par\pard\li2840\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2840\ri0\sl-
\fs16\cf0\f0\charscalex100\i {Received August 7, 2013}\i0 \par\pard\li2506\ri0\sl-
186\slmult0 \fs16\cf0\f0\charscalex100\i {Accepted November 11, 2013}\i0
\par\pard\li4280\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li4280\ri0\sl-213\slmult0
333\slmult0 \fs16\cf0\f0\charscalex100 {11}\par
\fs16\cf0\f0\charscalex100\i {Successful root canal treatment}\i0 }}}}

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