Efficacy of NiTi rotary instruments in removing calcium hydroxide dressing residues from root canal walls

The aim of this study was to evaluate the efficacy of three rotary instrument systems (K3, Pro Taper and Twisted File) in removing calcium hydroxide residues from root canal walls. Thirty-four human mandibular incisors were instrumented with the Pro Taper System up to the F2 instrument, irrigated with 2.5% NaOCl followed by 17% EDTA, and filled with a calcium hydroxide intracanal dressing. After 7 days, the calcium hydroxide dressing was removed using the following rotary instruments: G1. - NiTi size 25, 0.06 taper, of the K3 System; G2 - NiTi F2, of the Pro Taper System; or G3 - NiTi size 25, 0.06 taper, of the Twisted File System. The teeth were longitudinally grooved on the buccal and lingual root surfaces, split along their long axis, and their apical and cervical canal thirds were evaluated by SEM (x1000). The images were scored and the data were statistically analyzed using the Kruskall Wallis test. None of the instruments removed the calcium hydroxide dressing completely, either in the apical or cervical thirds, and no significant differences were observed among the rotary instruments tested (p > 0.05).

Effect of Ultrasonic Activation on pH and Calcium Released by Calcium Hydroxide Pastes in Simulated External Root Resorption

Introduction: The purpose of this study was to analyze the influence of ultrasonic activation of calcium hydroxide (CH) pastes on pH and calcium release in simulated external root resorptions. Methods: Forty-six bovine incisors had their canals cleaned and instrumented, and defects were created in the external middle third of the roots, which were then used for the study. The teeth were externally made impermeable, except for the defected area, and divided into the following 4 groups containing 10 samples each according to the CH paste and the use or not of the ultrasonic activation: group 1: propylene glycol without ultrasonic activation, group 2: distilled water without ultrasonic activation, group 3: propylene glycol with ultrasonic activation, and group 4: distilled water with ultrasonic activation. After filling the canals with the paste, the teeth were restored and individually immersed into flasks with ultrapure water. The samples were placed into other flasks after 7, 15, and 30 days so that the water pH level could be measured by means of a pH meter. Calcium release was measured by means of an atomic absorption spectrophotometer. Six teeth were used as controls. The results were statistically compared using the Kruskal-Wallis and Mann-Whitney U tests (P < .05). Results: For all periods analyzed, the pH level was found to be higher when the CH paste was activated with ultrasound. Calcium release was significantly greater (P < .05) using ultrasonic activation after 7 and 30 days. Conclusions: The ultrasonic activation of CH pastes favored a higher pH level and calcium release in simulated external root resorptions. (J Endod 2012;38:834-837)

Antimicrobial activity of calcium hydroxide and chlorhexidine on intratubular Candida albicans

This study investigated the efficacy of calcium hydroxide and chlorhexidine gel for the elimination of intratubular Candida albicans (C. albicans). Human single-rooted teeth contaminated with C. albicans were treated with calcium hydroxide, 2% chlorhexidine gel, calcium hydroxide plus 2% chlorhexidine gel, or saline (0.9% sodium chloride) as a positive control. The samples obtained at depths of 0–100 and 100–200 µm from the root canal system were analyzed for C. albicans load by counting the number of colony forming units and for the percentage of viable C. albicans using fluorescence microscopy. First, the antimicrobial activity of calcium hydroxide and the 2% chlorhexidine gel was evaluated by counting the number of colony forming units. After 14 days of intracanal medication, there was a significant decrease in the number of C. albicans colony forming units at a depth of 0–100 µm with chlorhexidine treatment either with or without calcium hydroxide compared with the calcium hydroxide only treatment. However, there were no differences in the number of colony forming units at the 100–200 µm depth for any of the medications investigated. C. albicans viability was also evaluated by vital staining techniques and fluorescence microscopy analysis. Antifungal activity against C. albicans significantly increased at both depths in the chlorhexidine groups with and without calcium hydroxide compared with the groups treated with calcium hydroxide only. Treatments with only chlorhexidine or chlorhexidine in combination with calcium hydroxide were effective for elimination of C. albicans

Antimicrobial activity of triantibiotic paste, 2% chlorhexidine gel, and calcium hydroxide on an intraoral-infected dentin biofilm model

Introduction: The purpose of this study was to evaluate the antimicrobial activity of calcium hydroxide, 2% chlorhexidine gel, and triantibiotic paste (ie, metronidazole, minocycline, and ciprofloxacin) by using an intraorally infected dentin biofilm model. Methods: Forty bovine dentin specimens were infected intraorally using a removable orthodontic device in order to induce the biofilm colonization of the dentin. Then, the samples were treated with the medications for 7 days. Saline solution was used as the control. Two evaluations were performed: immediately after the elimination of the medication and after incubation in brain-heart infusion medium for 24 hours. The Live/Dead technique (Invitrogen, Eugene, OR) and a confocal microscope were used to obtain the percentage of live cells. Nonparametric statistical tests were performed to show differences in the percentage of live cells among the groups (P < .05). Results: Calcium hydroxide and 2% chlorhexidine gel did not show statistical differences in the immediate evaluation. However, after application of the brain-heart infusion medium for 24 hours, 2% gel chlorhexidine showed a statistically lesser percentage of live cells in comparison with calcium hydroxide. The triantibiotic paste significantly showed a lower percentage of live cells in comparison with the 2% chlorhexidine gel and calcium hydroxide groups in the immediate and secondary (after 24 hours) evaluations. Conclusions: The triantibiotic paste was most effective at killing the bacteria in the biofilms on the intraorally infected dentin model in comparison with 2% chlorhexidine gel and calcium hydroxide

Healing of a tooth with an overinstrumented apex, extensive transportation and periapical lesion using a 5 mm calcium hydroxide apical plug: an 8-year follow-up report

Besides the risk of filling material extrusion throughout the apex, a satisfactory apical seal can be difficult to achieve in canals with open apices or iatrogenic enlargements of the apical constriction. These situations pose a challenge to root canal filling. This paper describes the root canal filling of a maxillary right canine with an overinstrumented apex, complete loss of the apical stop, extensive canal transportation and apical periodontitis. A 5 mm calcium hydroxide apical plug was placed before root canal filling. The plug was made by soaking paper points with saline, dipping the points in calcium hydroxide powder and then applying it to the apex several times, until a consistent apical plug was obtained. The canal was then irrigated with saline in order to remove any residual calcium hydroxide from the root canal walls, dried with paper points and obturated with an inverted #80 gutta-percha cone and zinc oxide-eugenol based sealer by the lateral condensation technique. An 8-year radiographic follow-up showed formation of mineralized tissue sealing the apical foramen, apical remodeling and no signs of apical periodontitis.

In vitro and in vivo evaluation of the biocompatibility of a calcium phosphate/poly(lactic-co-glycolic acid) composite

This study assess the effects of bioceramic and poly(lactic-co-glycolic acid) composite (BCP/PLGA) on the viability of cultured macrophages and human dental pulp fibroblasts, and we sought to elucidate the temporal profile of the reaction of pulp capping with a composite of bioceramic of calcium phosphate and biodegradable polymer in the progression of delayed dentine bridge after (30 and 60 days) in vivo. Histological evaluation of inflammatory infiltrate and dentin bridge formation were performed after 30 and 60 days. There was similar progressive fibroblast growth in all groups and the macrophages showed viability. The in vivo study showed that of the three experimental groups: BCP/PLGA composite, BCP and calcium hydroxide (Ca(OH)(2)) dentin bridging was the most prevalent (90 %) in the BCP/PLGA composite after 30 days, mild to moderate inflammatory response was present throughout the pulp after 30 days. After 60 days was observed dentine bridging in 60 % and necrosis in 40 %, in both groups. The results indicate that understanding BCP/PLGA composite is biocompatible and by the best tissue response as compared to calcium hydroxide in direct pulp capping may be important in the mechanism of delayed dentine bridge after 30 and 60 days.

Characterization of calcium oxide in root perforation sealer materials

Root perforation represents an undesirable complication that may lead to an unfavorable prognosis. The aims of this study were to characterize and to compare the presence of calcium oxide (CaO) on the chemical composition of materials used for root perforation therapy: gray and white mineral trioxide aggregate (MTA) and Portland cement (PC), gray MTA+5%CaO and gray MTA+10%CaO. The last two materials were analyzed to evaluate the increase of CaO in the final sample. CaO alone was used as a standard. Eighteen polyethylene tubes with an internal diameter of 3 mm and 3 mm in length were prepared, filled and then transferred to a chamber with 95% relative humidity and a temperature of 37ºC. The chemical compounds (particularly CaO) and the main components were analyzed by energy-dispersive X-ray microanalysis (EDX). EDX revealed the following concentrations of CaO: gray MTA: 59.28%, white MTA: 63.09%; PC: 72.51%; gray MTA+5%CaO: 63.48% and gray MTA+10%CaO: 67.55%. The tested materials presented different concentrations of CaO. Even with an increase of 5 and 10% CaO in gray MTA, the CaO levels found in the MTA samples were lower than those found in PC.

Antimicrobial activity and enterococcus faecalis biofilm formation on chlorhexidine varnishes

Objective: To evaluate, in vitro, the antimicrobial activity and biofilm formation of three chlorhexidine varnishes in four Enterococcus faecalis strains: E. faecalis ATCC 29212, E. faecalis EF-D1 (from failed endodontic treatment), E. faecalis 072 (cheese) and E. faecalis U-1765 (nosocomial infection), and one Enterococcus durans strain (failed endodontic treatment). Study Design: The direct contact test was used to study the antimicrobial activity. Bacterial suspensions were exposed for one hour to EC40, Cervitec (CE) and Cervitec Plus (CEP) varnishes. "Eradication" was defined as 100% bacterial kill. The formation of enterococci biofilms was tested on the surface of the varnishes after 24 hours of incubation and expressed as percentage of biofilm reduction. Results: EC40 eradicated all strains except E. faecalis ATCC 29212, where 98.78% kill was achieved. CE and CEP showed antimicrobial activity against all the strains, but most clearly against E. durans and E. faecalis 072. EC40 completely inhibited the formation of biofilm of E. faecalis ATCC 29212, E. faecalis 072 and E. durans. CE and CEP led to over 92% of biofilm reduction, except in the case of E. faecalis U-1765 on CEP (76.42%). Conclusion: The three varnishes studied were seen to be effective in killing the tested strains of enterococci and in inhibiting the formation of biofilm, the best results being observed with EC40.

Response of mice connective tissue to intracanal dressings containing chlorhexidine

Substances containing chlorhexidine (CHX) have been studied as intracanal medicaments. The aim of the present study was to characterize the response of mouse subcutaneous connective tissue to CHX-containing medications by conventional optical microscopy. The tissue response was evaluated by implanting polyethylene tubes containing one of the substances evaluated: Calen paste + 0.5% CHX, Calen + 2% CHX, 2% CHX gel, and Calen paste (control). After experimental periods of 7, 21, and 63 days, the implants (n = 10) were removed along with the subcutaneous connective tissue. Tissue samples were subjected to histological processing, and sections were stained with hematoxylin and eosin. Qualitative and quantitative analyses of the number of inflammatory cells, blood vessels, and vascularized areas were performed. Results were analyzed by ANOVA and Tukey tests with the significance level set at 5%. We concluded that Calen + 0.5% CHX led to reparative tissue response in contrast with Calen + 2% CHX and 2% CHX gel, which induced persistent inflammatory response, pointing to the aggressive nature of this mixture. When Calen + 2% CHX and 2% CHX gel were compared, the latter induced more intense inflammatory response. Microsc. Res. Tech., 2012. (C) 2012 Wiley Periodicals, Inc.

Clinical, radiographic and histologic analysis of the effects of pulp capping materials used in pulpotomies of human primary teeth

Aim: To compare the clinical, radiographic and histological responses of the pulp to mineral trioxide aggregate (MTA), calcium hydroxide (CH) and Portland cement (PC) when used as a pulpotomy agent in human primary teeth. Study design: Forty-five mandibular primary molar teeth were randomly assigned to CH, MTA or PC groups and treated by pulpotomy technique. Methods: The teeth were treated by conventional pulpotomy technique, differing only in the capping material for each group. Clinical and radiographic evaluations were recorded at 6-, 12- and 24-month follow-up. Teeth in the regular exfoliation period were further processed for histologic analysis. Statistics: The teeth were treated by conventional pulpotomy technique, differing only in the capping material for each group. Clinical and radiographic evaluations were recorded at 6-, 12- and 24-month follow-up. Teeth in the regular exfoliation period were further processed for histologic analysis. Statistics: Clinically and radiographically, the MTA and PC groups showed 100 % success rates at 6, 12 and 24 months. In CH group, several teeth presented clinical and radiographic failures detected throughout the follow-up period, and internal resorption was a frequent radiographic finding. Histologic analysis revealed the presence of dentine-like mineralised material deposition obliterating the root canal in the PC and MTA groups. CH group presented, in most of the sections, necrotic areas in the root canals. Conclusions: MTA and PC may serve as effective materials for pulpotomies of primary teeth as compared to CH. Although our results are very encouraging, further studies and longer follow-up assessments are needed in order to determine the safe clinical indication of Portland cement.

Avaliação clínica e radiográfica do extravasamento da pasta de hidróxido de cálcio em dentes com lesões periapicais

It has been evaluated clinically and radiographically the effect of the extrusion of calcium hydroxide paste in teeth with periapical lesions. Twenty-five patients with teeth showing pulp necrosis and periapical lesions were submitted to endodontic treatment. Dressing calcium hydroxide paste, iodoform and propylene glycol were used. Clinically, the symptoms were evaluated after treatment and, radiographically, the reabsorption of extravasated paste and repair process of the periapical lesion. Only three patients had symptoms severe in the first 24 hours, the paste was completely reabsorbed within 15 days and no interference in the repair process.

Cytocompatibility of Porous Biphasic Calcium Phosphate Granules With Human Mesenchymal Cells by a Multiparametric Assay

This work aims to evaluate the cytocompatibility of injectable and moldable restorative biomaterials based on granules of dense or porous biphasic calcium phosphates (BCPs) with human primary mesenchymal cells, in order to validate them as tools for stem cell-induced bone regeneration. Porous hydroxyapatite (HA) and HA/beta-tricalcium phosphate (beta-TCP) (60: 40) granules were obtained by the addition of wax spheres and pressing at 20 MPa, while dense materials were compacted by pressing at 100 MPa, followed by thermal treatment (1100 degrees C), grinding, and sieving. Extracts were prepared by 24-h incubation of granules on culture media, with subsequent exposition of human primary mesenchymal cells. Three different cell viability parameters were evaluated on the same samples. Scanning electron microscopy analysis of the granules revealed distinct dense and porous surfaces. After cell exposition to extracts, no significant differences on mitochondrial activity (2,3-bis(2-methoxy-4-nitro-5-sulfophenly)-5-[(phenylamino) carbonyl]-2H-tetrazolium hydroxide) or cell density (Crystal Violet Dye Elution) were observed among groups. However, Neutral Red assay revealed that dense materials extracts induced lower levels of total viable cells to porous HA/beta-TCP (P < 0.01). Calcium ion content was also significantly lower on the extracts of dense samples. Porogenic treatments on BCP composites do not affect cytocompatibility, as measured by three different parameters, indicating that these ceramics are well suited for further studies on future bioengineering applications.

Biocompatibility of New Calcium Aluminate Cement (Endo Binder)

Introduction: The purpose of this study was to evaluate the biocompatibility of calcium aluminate cement (EndoBinder) in subcutaneous tissue of rats. Methods: Fifteen rats, weighing 300 g, were separated into 3 groups (n = 5) in accordance with the time of death (7, 21, 42 days). Two incisions were made in the dorsal subcutaneous tissue of each rat in which were implanted 2 polyethylene tubes filled with the test materials, Endo Binder (EB) and Grey MTA (GMTA). The external tube walls were considered the negative control group (CG). After 7, 21, and 42 days, animals were killed, obtaining 5 samples per group, at each time interval of analysis. Results: From the morphologic and morphometric analyses by using a score of (0-3) (50, 100, and 400x), results showed absence of inflammatory reaction (0) for EB after 42 days. However, for GMTA, a slight inflammatory reaction (1) was observed after 42 days, which means the persistence of a chronic inflammatory process. When compared with CG, tissue reaction ranging from discrete (1-7 days) to absent (0-42 days) was observed. Conclusions: EndoBinder presented satisfactory tissue reaction; it was biocompatible when tested in subcutaneous tissue of rats. (J Endod 2012;38:367-371)