In vivo evaluation of tissue response to new endodontic sealers

Introduction: The sealers can be in direct contact with the periapical tissues. Thus, these materials must have appropriate physical and biological properties, providing conditions for repair to occur. Objective: The aim of this study was to evaluate the response of rat subcutaneous tissue to endodontics sealers. Material and methods: Three materials comprised the groups: group I – Zinc Oxide, Eugenol and Iodoform paste, group II – Portland cement with propylene glycol, and group III – MTA Fillapex® (Angelus). These materials were placed in polyethylene tubes and implanted into dorsal connective tissue of Wistar rats for seven and 15 days. The specimens were stained with hematoxylin and eosin and evaluated regarding to inflammatory reaction parameters through a light microscope. The data were compared using Kruskal-Wallis test with significance level of 5%. The intensity of inflammatory response against the sealers was analyzed by two blinded and previously calibrated observers for all experimental periods. Results: The histological evaluation showed that all the materials caused a moderated inflammatory reaction at seven days which decreased with time. A greater inflammatory reaction was observed at seven days in group I. The other specimens had significantly less inflammatory cells when compared to this group. Tubes with MTA Fillapex® presented some giant cells, macrophages and lymphocytes after seven days. At 15 days, the presence of fibroblasts and collagen fibers was observed indicating normal tissue healing. The group II showed similar results to those observed in MTA Fillapex® already at seven days. At 15 days the inflammatory reaction presented was almost absent at the tissue, with many collagen fibers indicating normal tissue healing. Statistical analysis showed a significant statistical difference amongst the group I (seven days) and II (15 days) (p < 0.05). In the other groups no (Continue)

In vivo evaluation of tissue response to new endodontic sealers

Introduction: The sealers can be in direct contact with the periapical tissues. Thus, these materials must have appropriate physical and biological properties, providing conditions for repair to occur. Objective: The aim of this study was to evaluate the response of rat subcutaneous tissue to endodontics sealers. Material and methods: Three materials comprised the groups: group I – Zinc Oxide, Eugenol and Iodoform paste, group II – Portland cement with propylene glycol, and group III – MTA Fillapex® (Angelus). These materials were placed in polyethylene tubes and implanted into dorsal connective tissue of Wistar rats for seven and 15 days. The specimens were stained with hematoxylin and eosin and evaluated regarding to inflammatory reaction parameters through a light microscope. The data were compared using Kruskal-Wallis test with significance level of 5%. The intensity of inflammatory response against the sealers was analyzed by two blinded and previously calibrated observers for all experimental periods. Results: The histological evaluation showed that all the materials caused a moderated inflammatory reaction at seven days which decreased with time. A greater inflammatory reaction was observed at seven days in group I. The other specimens had significantly less inflammatory cells when compared to this group. Tubes with MTA Fillapex® presented some giant cells, macrophages and lymphocytes after seven days. At 15 days, the presence of fibroblasts and collagen fibers was observed indicating normal tissue healing. The group II showed similar results to those observed in MTA Fillapex® already at seven days. At 15 days the inflammatory reaction presented was almost absent at the tissue, with many collagen fibers indicating normal tissue healing. Statistical analysis showed a significant statistical difference amongst the group I (seven days) and II (15 days) (p < 0.05). In the other groups no significant statistical differences were observed. Conclusion: MTA Fillapex® and Portland cement with propylene glycol were more biocompatible than the other tested cements.

Preliminary study of the inflammatory response to subcutaneous implantation of three root canal sealers

P>Aim To evaluate the kinetics of the inflammatory tissue response to three root canal sealers using a physicochemical method for quantification of the enhanced vascular permeability and histopathological analysis. Methodology Twenty-eight male Wistar rats randomly assigned to four groups according to the evaluation periods (1, 3, 7 and 14 days) were used to assess the vascular permeability and histopathological reaction to RoekoSeal, AH Plus and Sealapex (new formulation) sealers, using saline and Chloropercha as negative and positive controls, respectively. Seven rats were sacrificed per period. The biocompatibility of the sealers was evaluated spectrophotometrically and histopathologically. Results At day 14, Sealapex produced significantly more inflammatory exudate than AH Plus and RoekoSeal (P < 0.05); however, there was no significant difference between AH Plus and RoekoSeal (P > 0.05). Sealapex (new formulation) was the most irritating sealer, producing severe inflammation with the presence of multinucleated giant cells. RoekoSeal was the most biocompatible sealer, producing the least amount of inflammatory exudate. Conclusions RoekoSeal root canal sealer was biocompatible when implanted in connective tissue.

Bacterial leakage in root canals filled with conventional and MTA-based sealers

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

Secretion of tumor necrosis factor-alpha by mouse peritoneal macrophages in the presence of dental sealers, sealapex and endomethasone

After filling root canals, the healing process depends on the chemical composition or physical-chemical properties of the material used, among other factors. All root canal sealers, whether solid or plastic, are foreign matter for the body if they remain in permanent contact with apical and periapical tissues. As a result, the first organic reaction that occurs is an attempt to phagocytize the material. During phagocytosis, macrophages release a large number of cell mediators into the area, among which are cytokines that are essential in intercellular communication and in many physiological and pathophysiological processes. One of these cytokines is tumor necrosis factor-alfa (TNF-α), which acts through links to specific receptors on the cell membrane initiating a cascade of events leading to induction, activation, or inhibition of numerous cytokine-regulated genes in the cell nucleus. The release of TNF-α in a cell culture of mouse peritoneal macrophages incubated with three concentrations (25, 50, and 100 mg/ml) of two endodontic sealers was measured. The solutions containing the calcium hydroxide-based root canal sealer (Sealapex) released fewer units of TNF-α than solutions containing the zinc oxide and eugenol-based sealer (Endomethasone).

Periapical repair after root canal filling with different root canal sealers

The aim of this study was to evaluate periapical repair after root canal filling with different endodontic sealers. Sixty four root canals from dog ́s teeth were filled, divided into 4 groups (n=16). Root canals were instrumented with K-type files and irrigated with 1% sodium hypochlorite solution. Root canals were filled in the same session by active lateral condensation of the cones and sealers: Intrafill, AH Plus, Roeko Seal and Resilon/Epiphany System. After 90 days, the animals were euthanized and the tissues to be evaluated were processed and stained with hematoxylin and eosin. For histopathological analysis, the following parameters were evaluated: inflammatory process, mineralized tissue resorption, and apical mineralized tissue deposition. Histopathological analysis demonstrated that Intrafill had less favorable results in terms of apical and periapical repair, compared to the other sealers (p<0.05). AH Plus, Roeko Seal, and Epiphany sealers had similar and satisfactory results (p>0.05). In conclusion, AH Plus and the materials Roeko Seal and Epiphany are good options for clinical use in Endodontics.

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.

Adesão dos cimentos Epiphany SE e iRoot SP: Resistência à tração e mapeamento dentinário por microscopia digital

O objetivo deste estudo foi avaliar o efeito da microestrutura dentinária na adesão de cimentos endodônticos modernos através: do desenvolvimento de uma metodologia para caracterizar microestruturalmente a dentina; da avaliação da resistência de união (através de ensaios de tração) dos cimentos endodônticos Epiphany SE, iRoot SP e AH Plus; da correlação dos dados obtidos da caracterização da microestrutura dentinária e dos ensaios de tração. Trinta terceiros molares inclusos, recém extraídos, foram embutidos em resina epóxi e seccionados 0,5mm abaixo da junção esmalte-dentina. Doze amostras foram eliminadas durante à preparação metalográfica devido à exposição da câmara pulpar. De cada dente, uma área de análise (AA) com 3,25 mm de diâmetro foi mapeada utilizando técnicas de microscopia ótica digital para: captura de ~400 imagens formando um mosaico; análise digital de imagens, obtendo os resultados de quantidade de túbulos (QT) e de fração de área de túbulos (FAT) do mosaico; conversão da imagem do mosaico em um mapa colorido em que as cores estão diretamente relacionadas à densidade de área tubular. As dezoito amostras restantes foram divididas em 3 grupos (N=6), de acordo com o cimento utilizado, para confecção dos corpos de prova para os ensaios de tração. Os valores de da resistência de união (RU) obtidos foram analisados estatisticamente com teste não-pareado t com correção de Welch e pelo teste F para comparar variâncias Os dados de FAT e de QT foram submetidos ao teste de D'Agostino & Pearson revelando-se não normais (P>0,05), o que indica grande variabilidade da amostragem. O cimento Epiphany SE apresentou uma resistência de união significativamente menor que o cimento AH Plus (P <0,05). Os corpos de prova do iRoot SP falharam prematuramente e não foram analisados. A aplicação do teste r de Spearman não demonstrou correlação significativa entre FAT e RU (P>0,05). O MEV de pressão variável foi utilizado para avaliar qualitativamente a superfície de fratura após os ensaios de tração. A análise revelou um padrão de fratura mista para o AH Plus e o Epiphany SE, além de diferenças no tamanho e na forma das partículas desses cimentos, o que pode influenciar no comportamento mecânico. Dentro da amostragem realizada, não se encontrou correlação significativa entre microestrutura dentinária e a resistência de união.

Capacidade de selamento de três materiais retrobturadores frente à infiltração microbiana por Enterococcus faecalis

O objetivo deste estudo foi comparar a capacidade de selamento apical de três materiais retrobturadores em dentes submetidos à infiltração microbiana por Enterococcus faecalis. Além de analisar a ocorrência da infiltração microbiana em relação à variável tempo. Para tal, foram utilizados 80 caninos superiores permanentes humanos extraídos, instrumentados com o sistema rotatório ProTaper Universal (MAILLEFER) e obturados pela técnica de compactação lateral, com dois tipos de cimento endodôntico: Endofill (DENTSPLY) e AH Plus (DENTSPLY). A apicetomia foi realizada com a remoção de 3mm do terço apical e o retropreparo confeccionado com pontas ultrasônicas. As amostras foram subdivididas, aleatoriamente, em 6 grupos com 10 dentes cada, e 2 grupos controles. Os materiais utilizados para a retrobturação foram MTA branco (ANGELUS), IBC BioAggregate (INNOVATIVE BIOCERAMIX INC.) e Acroseal (SEPTODONT). Foram confeccionados dispositivos para fixação dos dentes aos tubos Eppendorfs. As amostras foram inoculadas com cepas de E. faecalis e incubadas a 37C, por um período de 90 dias, para análise da presença de turvação do meio Enterococcosel. Para a realização da análise estatística foram utilizados os seguintes testes: Qui-quadrado com Prova Exata de Fisher e Kruskal-Wallis. Os resultados mostraram que todos os grupos nos quais foi realizada a obturação e a posterior retrobturação apresentaram infiltração. Comparando todos os grupos, não houve diferença significativa entre os materiais testados. Em relação apenas aos materiais retrobturadores, o Acroseal obteve a menor infiltração, seguido do MTA branco e do IBC BioAggregate. As amostras obturadas com o cimento Endofill não apresentaram diferença estatística em relação à variável tempo. Porém, nas amostras obturadas com o cimento AH Plus, houve maior ocorrência de infiltração nas amostras retrobturadas com o IBC BioAggregate e menor infiltração nas amostras retrobturadas com Acroseal, com diferença estatisticamente significante ao nível de 10%.

Avaliação do grau de porosidade de três cimentos endodônticos: estudo realizado com microtomogafia computadorizada e análise digital de imagens

O presente trabalho teve como objetivo avaliar volumetricamente a presença de poros em três cimentos obturadores. Para a análise de porosidade, quatro cilindros de cada cimento foram preparados e escaneados usando um microtomógrafo de alta resolução (Skyscam 1174, Kontich, Bélgica). O cálculo da porosidade foi realizado por meio de análise de imagens digitalizadas dos blocos de cimentos. Os quais foram microtomografados para criação de modelos tridimensionais. A presença de poros e vacúolos foi então avaliada por inferência do software CT analiser. Os resultados mostraram que o i-Root SP teve o menor índice de porosidade (0,07%), enquanto o AH plus e o MTA Fillapex não apresentaram diferenças estatisticamente significativas entre si (p≥0,05). Apesar dos resultados para o índice de porosidade total do MTA Fillapex e do AH plus não terem diferenças significativas(p>0,05), os achados do presente trabalho mostraram que o MTA fillapex obteve resultados significativamente maiores nos volumes médios individuais dos poros internos que o Ah plus e o i-Root SP. Os resultados foram tabulados e analisados estatisticamete através do teste Anova ao nível de significância de 5%.

Produção de IL-1β, IL-6 e IL-8 por fibroblastos estimulados por cimentos endodônticos e submetidos à terapia laser de baixa potência

O sucesso do tratamento endodôntico depende da cuidadosa realização de todas as suas fases, terminando com uma obturação tridimensional que alcance todo o sistema de canais radiculares. Desta forma, os materiais obturadores, ou as substâncias liberadas, entrarão em contato com os tecidos perirradiculares, o que poderá influenciar a resposta inflamatória e o processo de reparo. A terapia laser de baixa potência (TLBP) tem sido estudada quanto à sua ação anti-inflamatória, favorecendo o reparo. O objetivo deste estudo foi investigar a produção das citocinas IL-1β, IL-6 e IL-8 por fibroblastos de gengiva humana (linhagem FMM1) como resposta à presença dos extratos dos cimentos endodônticos AH Plus, MTA Fillapex e EndoSequence BC Sealer, bem como a eficácia da TLBP, neste modelo. Para isto, extratos destes cimentos, recém-manipulados e após 24 h do endurecimento, foram preparados em meio de cultura DMEM fresco, conforme as normas ISO 10993-12. Inicialmente, a citotoxicidade dos cimentos foi avaliada, após a interação das células com a diluição seriada destes extratos (1:1 a 1:16), por meio do ensaio MTT. Para a análise da produção de citocinas, 106 células por poço foram cultivadas em placas de cultura de 24 poços, para a interação com os extratos dos cimentos, na diluição 1:4. Estabeleceram-se os grupos não irradiado e irradiado. No grupo irradiado, as culturas celulares receberam duas irradiações do laser InGaAlP (660 nm, 30 mW, 5 J/cm2 e área do feixe de 0,028 cm2), com intervalo de 12 h. O grupo não irradiado foi submetido às mesmas condições ambientais que o irradiado. Os sobrenadantes das culturas foram coletados, centrifugados, aliquotados e armazenados congelados, para a posterior análise pelo ensaio de ELISA. Todos os dados obtidos (médias erro padrão) foram tratados estatisticamente por ANOVA one-way, complementado pelo teste de Tuckey e ANOVA two-way, com correção de Bonferroni (p< 0,05). A citotoxicidade dos cimentos AH Plus e EndoSequence BC Sealer revelou-se tempo/concentração-dependente, enquanto a do MTA Fillapex mostrou-se concentração-dependente. Os cimentos endodônticos induziram a produção das citocinas IL-1β, IL-6 e IL-8 pelos fibroblastos, sem diferença significativa com os controles (p> 0,05). Somente o LPS de E. coli induziu a secreção de IL-8, com diferença estatística (p< 0,05). A TLBP não foi capaz de modular a produção das citocinas em questão, significativamente.

Assessment of antimicrobial effect of Biosilicate (R) against anaerobic, microaerophilic and facultative anaerobic microorganisms

This study assessed the antimicrobial activity of a new bioactive glass-ceramic (Biosilicate (R)) against anaerobic, microaerophilic, and facultative anaerobic microorganisms. Evaluation of the antimicrobial activity was carried out by three methods, namely agar diffusion, direct contact, and minimal inhibitory concentration (MIC). For the agar diffusion technique, bio glass-ceramic activity was observed against various microorganisms, with inhibition haloes ranging from 9.0 +/- 1.0 to 22.3 +/- 2.1 mm. For the direct contact technique, Biosilicate (R) displayed activity against all the microorganisms, except for S. aureus. In the first 10 min of contact between the microorganisms and Biosilicate (R), there was a drastic reduction in the number of viable cells. Confirming the latter results, MIC showed that the Biosilicate (R) inhibited the growth of microorganisms, with variations between <= 2.5 and 20 mg/ml. The lowest MIC values (7.5 to <= 2.5 mg/ml) were obtained for oral microorganisms. In conclusion, Biosilicate (R) exhibits a wide spectrum of antimicrobial properties, including anaerobic bacteria.

Clinical comparison between the bleaching efficacy of 37% peroxide carbamide gel mixed with sodium perborate with established intracoronal bleaching agent

Objective. The aim was to evaluate the bleaching efficacy of sodium perborate/37% carbamide peroxide paste and traditional sodium perborate/distilled water for intracoronal bleaching. Study design. Thirty patients with dark anterior teeth were divided into 2 groups (n = 15): group A: sodium perborate/ distilled water; and group B: sodium perborate/37% carbamide peroxide paste. The bleaching treatment limited each patient to the maximum of 4 changes of the bleaching agent. Initial and final color shades were measured using the Vita Lumin shade guide. Results. Data was analyzed with Wilcoxon test for initial and final comparison according to the bleaching agent, demonstrating efficacy of the bleaching treatment with both agents. Mann-Whitney test was used for comparison of the efficacy of the bleaching agents, showing that there was no significant difference between them. Conclusion. The sodium perborate/37% carbamide peroxide association for intracoronal bleaching has proven to be as effective as sodium perborate/distilled water. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 107: e43-e47)

Influence of prior 810-nm-diode intracanal laser irradiation on hydrophilic resin-based sealer obturation

Dentin wall structural changes caused by 810-nm-diode laser irradiation can influence the sealing ability of endodontic sealers. The objective of this study was to evaluate the apical leakage of AH Plus and RealSeal resin-based sealers with and without prior diode laser irradiation. Fifty-two single-rooted mandibular premolars were prepared and divided into 4 groups, according to the endodontic sealer used and the use or non-use of laser irradiation. The protocol for laser irradiation was 2.5W, continuous wave in scanning mode, with 4 exposures per tooth. After sample preparation, apical leakage of 50% ammoniacal silver nitrate impregnation was analyzed. When the teeth were not exposed to irradiation, the Real Seal sealer achieved the highest scores, showing the least leakage, with significant differences at the 5% level (Kruskal-Wallis test, p = 0.0004), compared with AH Plus. When the teeth were exposed to the 810-nm-diode laser irradiation, the sealing ability of AH Plus sealer was improved (p = 0282). In the Real Seal groups, the intracanal laser irradiation did not interfere with the leakage index, showing similar results in the GRS and GRSd groups (p = 0.1009).

In vitro antimicrobial activity of acroseal, polifl and epiphany against Enterococcus faecalis

Using the agar diffusion method, this study evaluated the in vitro antimicrobial activity of the commercial endodontic sealers Acroseal and Epiphany, a castor-oil based experimental sealer, Polifl, and a primer agent (Epiphany self-etching primer), against Enterococcus faecalis. Zinc oxide and eugenol cement (ZOE) served as control. Five wells per dish were made at equidistant points and immediately flled with the test and control materials. After incubation of the dishes at 37°C for 24 h and 48 h, the diameter of the zones of microbial growth inhibition produced around the wells was measured (in mm) with a millimeter rule. After 48 h, the diameters of the zones of microbial growth inhibition were the same as those observed at 24 h, only the substances continued to diffuse. Epiphany and Polifl did not show antibacterial activity (no formation of zones of microbial growth inhibition). The primer produced the largest zones of inhibition (17.62 mm) followed by Acroseal (7.25 mm) and ZOE (7.12 mm). E. faecalis was resistant to Epiphany and Polifl, while the primer and Acroseal sealer were effective against this microorganism under the tested conditions.