Signaling Pathways Activation by Primary Endodontic Infectious Contents and Production of Inflammatory Mediators

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

Non-destructive thermal wave method applied to study thermal properties of fast setting time endodontic cement

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

A new surgical technique to treat corneal perforations using amniotic membrane and surgical adhesive

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

Changes in heart period during endodontic treatment

Background: Tooh extraction was demonstrated to increase sympathetic modulation of the heart, however, it is not understood the effects of endodontic treatment on cardiac autonomic regulation. We evaluated heart rate variability (HRV) during endodontic treatment. Method: 50 male and female patients aged between 18 and 40 years old and diagnosed with irreversible pulpitis or pulp necrosis of the lower molars with indication of gender endodontic treatment were analyzed. HRV was analyzed in the time (SDNN, RMSSD, pNN50) and frequency (LF, HF and LF/HF ratio) domains recorded in the first session of root canal treatment. The indices were analyzed in the following periods: T1) ten minutes before the endodontic treatment, T2) ten minutes after the administration of anesthesia before endodontic treatment, T3) during the entire period of endodontic treatment and T4) thirty minutes after the end of the endodontic treatment. Results: The SDNN, RMSSD and pNN50 indices increased at T2 compared to T1, the pNN50 and RMSSD indices increased at T3 and T4 compared to T2. The LF in normalized units increased at T4 compared to T2 and in absolute units it was increased at T4 compared to T1. The HF in normalized units was reduced at T4 compared to T2 and in absolute units was reduced at T1, T3 and T4 compared to T2. The LF/HF ratio was higher at T4 compared to T2. Conclusion: The global modulation of heart increases after local anesthesia and vagal tone reduce during surgery procedures and after the surgical procedures.

Clinical investigation of bacterial species and endotoxin in endodontic infection and evaluation of root canal content activity against macrophages by cytokine production

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

18-Year Follow-up of Dens Invaginatus: Retrograde Endodontic Treatment

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

Tooth Discoloration Induced by Endodontic Phenothiazine Dyes in Photodynamic Therapy

Objective: This study sought to assess if discoloration of tooth structures occurs after photodynamic therapy (PDT) and to determine the efficacy of a protocol to remove the photosensitizers. Background data: PDT has been used in root canal treatment to enhance cleaning and disinfection of the root canal system. PDT uses a low power laser in association with a dye as a photosensitizer. Photosensitizers can induce staining of the dental structures, resulting in an unaesthetic appearance. Methods: Forty teeth were randomly divided into four groups according to the photosensitizer used and pre-irradiation time: 0.01% methylene blue for 5 min (MB5); 0.01% methylene blue for 10 min (MB 10); 0.01% toluidine blue for 5 min (TB5); and 0.01% toluidine blue for 10 min (TB 10). Specimens were irradiated with a 660 nm diode laser with a 300 mu m diameter optical fiber, at 40 mW power setting for 3 min. Immediately after, the photosensitizers were removed with Endo-PTC cream +2.5% sodium hypochlorite (NaOCl). The shade was measured by a Vita Easyshade spectrophotometer based on the CIELAB color system (L*a*b* values) at three different experimental times: before PDT (T0), immediately after PDT (T1), and after removal of the photosensitizer (T2). Results: The results showed a decrease in the averages of the L*a*b* coordinate values after PDT (T1) in all the groups, when compared with the number at T0, with a significant statistical difference in group MB10. After photosensitizer removal (T2), all the values of the coordinates increased with significant statistical differences (p < 0.05) between T1 and T2 in L* and a*. Conclusions: It can be concluded that both methylene blue and toluidine blue dyes cause tooth discoloration, and that Endo-PTC cream associated with 2.5% NaOCl effectively remove these dyes, regardless of the pre-irradiation time used for PDT.

Two-and tridimensional analysis of periapical repair after endodontic surgery

Objective The aim of this study was to evaluate repair after endodontic surgery using two- and tridimensional imaging methods. Materials and methods Periapical radiographs and cone beam computed tomography (CBCT) were performed before the surgeries and after 48 h (baseline), 4 months, and 8 months. The area (square millimeters) of periapical lesions in CBCT and in radiographs was compared regarding the percentage of repair. In the CBCT, multiple areas were converted to volume. Repeated-measures analyses and paired t tests (α=0.05) were used to compare the methods. Correlation coefficients were calculated between the periods of evaluation within the CBCT volumetric analysis. Bland-Altman plots were used to compare the methods, based on the 95 % limits of agreement for the difference of the means. Results Baseline showed a larger lesion volume (192.54 mm3 ) than 4-month (79.79 mm3 ) and 8-month (47.51 mm3 ) periods. No differences were found in the percentage of repair in the first 4 months and after 8 months. The volumetric analysis showed a higher percentage of repair when the first and last 4 months were compared. No differences were found in the percentage of repair by area in the CBCTs. Repair of 73 % was obtained after 8 months. Similar results were observed by the Bland-Altman agreement analyses. Conclusions The percentage of repair varied after 8 months, when lower values were obtained by volumetric evaluation. Clinical relevance Considering the outcome at follow-up periods over 4 months, tridimensional evaluation by CBCT is more capable of determining the absence of periapical bone repair than conventional two-dimensional radiographs. Therefore, the use of CBCT would be suggested only for more complex cases with slower evolution of repair or for the association of factors that make prognosis difficult after surgery.

Ethanol is inefficient to remove endodontic sealer residues of dentinal surface

Endodontic sealer residues on dentinal surface have negative effects on adhesion of adhesives system and/or can cause discoloration of the dental crown. Objective: To evaluate the efficacy of 95% ethanol in removal of residues of epoxy-based (AH Plus), methacrylate-based (Epiphany SE) or calcium-based (Sealapex) sealers on dentinal surface. Material and methods: Thirty-two bovine incisor dental crown fragments (0.5 mm x 0.5 mm) were treated with 17% EDTA and 2.5% NaOCl. The specimens were divided into three experimental groups (n = 10): G1 (AH Plus), G2 (Epiphany SE) and G3 (Sealapex). In each group was applied a coating of one endodontic sealer type and were left undisturbed for 5 minutes. After this period, the specimens were cleaned with 95% ethanol. The control group was composed by two specimens that did not receive any sealer or cleaning treatment. The sealer residues persistence after cleaning with 95% ethanol was evaluated by scanning electron microscopy (x500) and a score system was applied. Data obtained were analyzed by Kruskal-Wallis and Dunn tests (α = 5%). Results: Moderate amount of endodontic sealer residues were observed in all groups, regardless of the endodontic sealer compositions. G1, G2 and G3 presented similar amount of sealer residues on dentinal surface after cleaning with 95% ethanol (p > 0.05). Conclusion: 95% ethanol was inefficiency to remove completely AH Plus, Epiphany SE and Sealapex residues of sealer-contaminated dentin.

Ethanol is inneficient to remove endodontic sealer residues of dentinal surface

Introduction: Endodontic sealer residues on dentinal surface have negative effects on adhesion of adhesives system and/or can cause discoloration of the dental crown. Objective: To evaluate the efficacy of 95% ethanol in removal of residues of epoxy-based (AH Plus), methacrylate-based (Epiphany SE) or calcium-based (Sealapex) sealers on dentinal surface. Material and methods: Thirty-two bovine incisor dental crown fragments (0.5 mm x 0.5 mm) were treated with 17% EDTA and 2.5% NaOCl. The specimens were divided into three experimental groups (n = 10): G1 (AH Plus), G2 (Epiphany SE) and G3 (Sealapex). In each group was applied a coating of one endodontic sealer type and were left undisturbed for 5 minutes. After this period, the specimens were cleaned with 95% ethanol. The control group was composed by two specimens that did not receive any sealer or cleaning treatment. The sealer residues persistence after cleaning with 95% ethanol was evaluated by scanning electron microscopy (x500) and a score system was applied. Data obtained were analyzed by Kruskal-Wallis and Dunn tests (α = 5%). Results: Moderate amount of endodontic sealer residues were observed in all groups, regardless of the endodontic sealer compositions. G1, G2 and G3 presented similar amount of sealer residues on dentinal surface after cleaning with 95% ethanol (p > 0.05). Conclusion: 95% ethanol was inefficiency to remove completely AH Plus, Epiphany SE and Sealapex residues of sealercontaminated dentin.

A method for retrieving endodontic or atypical non-endodontic separated instruments from the root canal: a report of two cases

Aim: This clinical report presents a new method for retrieving separated instruments from the root canal with minimally invasive procedures. Background: The presence of separated instrument in root canal may interfere in the endodontic treatment prognosis. There are several recommended methods to retrieve separated instruments, but some are difficult in clinically practice. Case report: This study describes two cases of separated instrument removal from the root canal using a stainless-steel prepared needle associated with a K-file. Case 1 presented a fractured gutta-percha condenser within the mandibular second premolar, it was separated during incorrect intracanal medication calcium hydroxide placement. Case 2 had a fractured sewing needle within the upper central incisor that the patient used to remove food debris from the root canal. After cervical preparation, the fractured instruments were fitted inside a prepared needle and then an endodontic instrument (#25 K-file) was adapted with clockwise turning motion between the needle inner wall and the fragment. Conclusion: The endodontic or atypical nonendodontic separated instrument may be easily pull on of the root canal using a single and low cost device. Clinical significance: The methods for retrieving separated instruments from root canal are difficult and destructive procedures. The present case describes a simple method to solve this problem.

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.

Radiopacity and flow of different endodontic sealers

The present study evaluated the radiopacity and flow of different endodontic sealers: AH Plus, Endo CPM, MTA Fillapex, Sealapex, Epiphany, and Epiphany SE. For the radiopacity test, six specimens measuring 10mm in diameter and 1mm in thickness were fabricated from each material. They were radiographed on an occlusal film alongside an aluminum step wedge. Radiographs were digitized to determine the radiopacity equivalence in millimeters of aluminum. To evaluate the flow, a 120 g load was placed on top of a glass slab containing 0.05 } 0.005ml of sealer. The diameters of each material were measured (mm) with a caliper and samples were photographed. Digitized images were analyzed using the UTHSCSA Image Tool for Windows software, to determine the sealer area (mm2). Data were submitted to ANOVA and Tukey's test at 5% significance. AH Plus and Epiphany SE presented the greatest radiopacity (12.5 mm Al and 12.0 mm Al, respectively) (p>0.05), followed by Epiphany (9.6 mm Al) and Fillapex (8.9 mm Al). Endo CPM (5.46 mm Al) and Sealapex (5.51 mm Al) presented lower radiopacity. MTA Fillapex presented significantly higher values of flow than other sealers (33.11 mm and 844.9 mm2). AH Plus, Epiphany, and Epiphany SE had similar values. Endo CPM (21.05 mm and 342.8 mm2) and Sealapex (19.98 mm and 352.5 mm2) presented the lowest flow values (p>0.05). All sealers presented radiopacity and flow values according to ISO and ANSI/ADA recommendations.