A new calcium silicate-based material (Biodentine) for filling radicular perforation in an endodontic-periodontal lesion: a case report

This case report presents an apical radicular perforation management using new calcium silicate-based cement (Biodentine) in a combined endodontic-periodontal lesion. The presence of apical radicular perforation may interfere in the endodontic treatment prognosis. Radicular perforation filling with bioactive cement through endodontic surgery is a possible treatment. This study presents an apical radicular perforation with periodontal involvement, due to alveolar bone loss on the buccal radicular surface from an incorrect intracanal preparation for the fiber post placing. The chosen alternative was a periapical surgery, the perforation was filled with a silicate and calcium chloride bioactive cement (Biodentine; Septodont, Saint-Maur-des-Fosses Cedex, France), and the radicular surface was etched with citric acid, because the access from root canal was impossible. The follow-up was for 8 months, through clinical and radiographic analysis. At the end of the follow-up, radiographic analyses showed the bone healing, and no clinical changes in periodontal probing depth, gingival recession, and the height of the interproximal mesial and distal papillae were observed. The root perforation treatment has a difficult management, especially when the dental root has a simultaneous periodontal commitment. The Biodentine proves to be a promising material for use in these situations.

Capacidade de termoplastificação da guta-percha com diferentes conicidades

jObjective: The objective of this study was to evaluate the thermoplasticity of the gutta-percha cones used for root canal obturation: Dentsply convencional (Dentsply Ind. e Com., Petrópolis, RJ, Brazil), Dentsply 0.04, (Dentsply Ind. e Com., Petrópolis, RJ, Brazil), Antaeos 0.04 (VDW GmbH, Munich, Germany), ProTaper (Dentsply Ind. e Com., Petrópolis, RJ, Brazil) and Alfa 0.06 (VDW GmbH, Munich, Germany). Material and method: Specimens of each material (n = 10) were prepared after heating. After 24 hours were again heated to 70 °C and placed between two glass plates and subjected to a compression of 5 kg for 2 minutes. The scanned image of the groups before and after the compression was analyzed with the software Image Tool (UTHSCSA Image Tool for Windows version 3.0, San Antonio, TX, USA). The flow capacity of the different materials was determined by the difference between the initial and final area of each specimen. The results were submitted to ANOVA and Tukey test with significance level of 5%. Result: Among the material evaluated, the gutta-percha cones Alpha 0.06 and ProTaper presented more thermoplasticity than other groups (p < 0.05). The Dentsply gutta-percha presented thermoplasticity intermediate. The groups Dentsply 0.04 and 0.04 showed lower thermoplasticity after heating (p > 0.05). Conclusion: The gutta-percha present different property of thermoplasticity, which is important to selection of thermoplastic obturation techniques.

Cirugía endodóntica con obturación simultánea del conducto radicular: caso atípico

The apical surgery with simultaneous root filling consists in the elimination of the local etiologic factors concomitant with the shaping and obturation of the root canal system. This technique is indicated when there is no possibility of obturating the root canal by conventional methods. Some adverse factors may difficult the clinical procedures, such as the radiographic interpretation. Periapical radiographs must not be used as the main diagnostic resource due to their inherent disadvantages, such as distortion and superimposition with other anatomical structures. The aim of this clinical case report is to show the limitations of radiographic examination in an apical surgery in which a root perforation was not visible in the radiographic image, as well as the gutta-percha was not related to its real clinical location.

Chemical characterization and bioactivity of epoxy resin and Portland cement-based sealers with niobium and zirconium oxide radiopacifiers

The purpose of this study was to characterize and to evaluate the bioactivity potential of experimental root canal sealers (ES) based on Portland cement, epoxy resin with nano- and micro-particles of niobium or zirconium oxide used as radiopacifiers in comparison to AH Plus and MTA Fillapex. Methods Specimens of the sealers (10 mm in diameter × 1 mm thick) were prepared and the radiopacity was evaluated according to ISO 6876 (2012) specifications. Characterization of the sealers was performed under the scanning electron microscope (SEM) immediately after setting and after immersion for 28 days in Hank's balanced salt solution (HBSS). In addition X-ray energy dispersive spectroscopy (EDS), X-ray diffraction (XRD) and Fourier transform infrared (FT-IR) spectroscopy were also performed. The pH and calcium ion release were measured after 1, 7, 14, 21 and 28 days after completion of seating using a digital pH meter and an atomic absorption spectrophotometer, respectively. Results The experimental sealers exhibited an average radiopacity of 2.5 mm thickness of aluminum, which was similar to MTA Fillapex (P > 0.05) and inferior to AH Plus (P < 0.05). AH Plus did not show bioactivity. Although the experimental sealers did not exhibit the formation of hydration product, they encouraged the deposition of crystalline spherical structures of calcium deficient phosphate. The highest pH and calcium release values were observed with the experimental sealers (P < 0.01). ES-Nb-micro was the only sealer to present hexagonal shaped crystal deposition. Significance Novel root canal sealers based on a mixture of Portland cement, epoxy resin and radiopacifier exhibited a degree of bioactivity although no evidence of cement hydration was demonstrated on material characterization. The radiopacifier particle size had limited effect on the sealer microstructure and chemical properties.

Push-out bond strength of calcium hydroxide and mineral trioxide aggregate based sealers

The adhesiveness of six root canal sealers: Acroseal, Endo CPM, Epiphany, White MTA, Sealapex and Sealer 26 to dentin, was evaluated in a push-out test design. Methods: Twenty eight roots of freshly extracted teeth were gauged with a size 5 Largo drill. With a cutting machine slices of 2 mm were prepared, rinsed with 5.25% NaOCl and a final rinse with 17% EDTA, dried and filled with one of the sealers. After setting their bond strength was measured in a mechanical testing machine. The data were statistically analyzed by using a One Way ANOVA and post hoc Tukey test. Results: The mean and standard deviation from values of bond strength was: Sealapex 2.2±0.4; Endo CPM 3.8±1.3; White MTA 6.0±1.4; Epiphany 10.9±2.6; Sealer 26 12.3±2.3; and Acroseal 12.2±1.4. Acroseal, Sealer 26 and Epiphany presented a significantly (P<0.01) greater bond strength compared with the other sealers. Also White MTA showed higher adhesiveness compared with Endo CPM and Sealapex (P<0.01). Conclusion: The bond strength between endodontic sealers and root dentin was maximal when Acroseal, Sealer 26 and Epiphany were used; Sealapex e Endo CPM, in turn, presented the lowest bond strength mean values.

Filling of simulated lateral canals with gutta-percha or thermoplastic polymer by warm vertical compaction

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Fracture resistance of simulated immature teeth after different intra-radicular treatments

The aim of this study was to evaluate the fracture resistance of simulated immature teeth after different intra-radicular treatments. Crowns and roots of bovine incisors were cut transversally and removed to simulate immature teeth. Root canal preparation and flaring were performed using a bur in crown-apex and apex-crown direction. The samples were distributed into 5 groups (n=10): Positive control (PoC) - no root canal flaring or filling; Negative control (NeC) - teeth were sectioned and their root canals were flared; Direct anatomical glass fiber post (RaP) - #2 Reforpost main glass fiber post relined with composite resin; Double tapered conical glass fiber posts (ExP) - #3 Exacto glass fiber post; and #2 Reforpost main glass fiber + Reforpin accessory glass fiber posts (RrP). In RaP, ExP and RrP, 4.0-mm apical plugs were done with MTA Angelus. The specimens were embedded in polystyrene resin inside cylinders and the periodontal ligament was simulated with a polyether-based impression material. The specimens were submitted to compressive fracture strength test (0.5 mm/min at 135° relative to the long axis of the tooth) in a servo-hydraulic mechanical testing machine MTS 810. Data were subjected to one-way ANOVA and Dunnett's C or Tukey's tests (α=0.05). The control groups (PoC and NeC) showed lower fracture strength than the experimental groups. NeC presented the lowest resistance and ExP presented the highest resistance among the experimental groups. The flaring procedures produced a detrimental effect on the fracture resistance of the bovine teeth. Glass fiber intra-radicular posts increased significantly the fracture resistance of simulated immature teeth.

Estudo da diversidade microbiana e níveis de endotoxinas em lesões endo-periodontais

Pós-graduação em Odontologia Restauradora - ICT

Citocompatibilidade, propriedades antibiofilme e físicas e cimentos endodônticos associados à amoxilina

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Effects of Ciprofloxacin-containing Scaffolds on Enterococcus faecalis Biofilms

Introduction: Antibiotic-containing polymer-based nanofibers (hereafter referred to as scaffolds) have demonstrated great potential for their use in regenerative endodontics from both an antimicrobial and cytocompatibility perspective. This study sought to evaluate in vitro the effects of ciprofloxacin (CIP)-containing polymer scaffolds against Enterococcus faecalis biofilms. Methods: Human mandibular incisors were longitudinally sectioned to prepare radicular dentin specimens. Sterile dentin specimens were distributed in 24-well plates and inoculated with E. faecalisfor biofilm formation. Infected dentin specimens were exposed to 3 groups of scaffolds, namely polydioxanone (PDS) (control), PDS + 5 wt% CIP, and PDS + 25 wt% CIP for 2 days. Colony-forming units (CFU/mL) (n = 10) and scanning electron microscopy (SEM) (n -= 2) were performed to quantitatively and qualitatively assess the antimicrobial effectiveness, respectively. Results: PDS scaffold containing CIP at 25 wt% showed maximum bacteria elimination with no microbial growth, differing statistically (P < .05) from the control (PDS) and from PDS scaffold containing CIP at 5 wt%. Statistical differences (P < .05) were also seen for the CFU/mL data between pure PDS (5.92-6.02 log CFU/mL) and the PDS scaffold containing CIP at 5 wt% (5.39 5.87 log CFU/mL). SEM images revealed a greater concentration of bacteria on the middle third of the dentin specimen. after 5 days of biofilm formation. On scaffold exposures, SEM images showed similar results when compared with the CFU/mL data. Dentin specimens exposed to PDS + 25 wt% CIP scaffolds displayed a practically bacteria-free surface. Conclusions: On the basis of the data presented, newly developed antibiotic-containing electrospun scaffolds hold promise as an intracanal medicament to eliminate biofilm/infection before regenerative procedures.

Microbiological Profile Resistant to Different Intracanal Medications in Primary Endodontic Infections

Introduction: This clinical study aimed to determine the microbiological profile resistant to different intracanal medications in primary endodontic infections by using both microbiological culture and the checkerboard DNA-DNA hybridization technique. Methods: Twenty primarily infected root canals were selected and then instrumented before being randomly divided into 2 groups according to the intracanal medications: calcium hydroxide (Ca[OH](2)) or Ca(OH)(2) + chlorhexidine (CHX). Samples were collected before and after root canal procedures, which consisted in submitting them to microbiological culture and processing them for checkerboard DNA-DNA hybridization. Results: No differences were found between the Ca(OH)(2) (99.98%) and Ca(OH)(2) + CHX groups (99.76%) regarding the median percentage values for the reduction of cultivable bacteria. The most frequently detected species were Capnocytophaga ochracea (70%) and Fusobacterium nucleatum ssp. vincentii (70%) in the initial samples. After instrumentation, the most frequently detected species were E. faecium (60%). After root canal treatments using either Ca(OH)(2) or Ca(OH)(2) + CHX as intracanal medications, the most frequently detected species were E nucleatum ssp. vincentii (90%) and Enterococcus faecium (40%), respectively. Both treatments significantly decreased the number of bacterial species compared with the initial sample. However, this reduction was significantly greater in the Ca(OH)(2) + CHX group (P < .05). This difference was also observed when evaluating the total bacterial load (P < .05). Conclusions: The use of Ca(OH)(2) associated with CHX as an intracanal medication showed better results by acting on gram-positive and gram-negative microorganisms although such an action to eradicate enterococci should also be sought.

Clinical Influence of Different Intracanal Medications on Th1-type and Th2-type Cytokine Responses in Apical Periodontitis

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Cleaning capacity promoted by motor-driven or manual instrumentation using ProTaper Universal system: Histological analysis

The aim of this study was to assess the cleaning capacity of the Protaper system using motor-driven or manual instrumentation. Materials and Methods: Ten mandibular molars were randomly separated into 2 groups (n = 5) according to the type of instrumentation performed, as follows: Group 1 - instrumentation with rotary nickel-titanium (Ni-Ti) files using ProTaper Universal System (Dentsply/Maillefer); and, Group 2 - instrumentation with Ni-Ti hand files using ProTaper Universal (Dentsply-Maillefer). Afterwards, the teeth were sectioned transversely and submitted to histotechnical processing to obtain histological sections for microscopic evaluation. The images were analyzed by the Corel Photo-Paint X5 program (Corel Corporation) using an integration grid superimposed on the image. Results: Statistical analysis (U-Mann-Whitney - P < 0.05) demonstrated that G1 presented higher cleaning capacity when compared to G2. Conclusions: The rotary technique presented better cleaning results in the apical third of the root canal system when compared to the manual technique.

Efeito dos lasers de Nd:YAG e de Er:YAG na adaptação das obturações de canais radiculares: análise do selamento marginal apical

Pós-graduação em Odontologia Restauradora - ICT