Evaluation of the Interaction Between Sodium Hypochlorite and Several Formulations Containing Chlorhexidine and its Effect on the Radicular Dentin-SEM and Push-Out Bond Strength Analysis

The aim of the current study was to evaluate the presence of debris and smear layer after endodontic irrigation with different formulations of 2% chlorhexidine gluconate (CHX) and its effects on the push-out bond strength of an epoxy-based sealer on the radicular dentin. One hundred extracted human canines were prepared to F5 instrument and irrigated with 2.5% sodium hypochlorite and 17% ethylenediaminetetraacetic acid. Fifty teeth were divided into five groups (n=10), according to the final irrigation protocol with different 2% CHX formulations: G1 (control, no final rinse irrigation), G2 (CHX solution), G3 (CHX gel), G4 (Concepsis), and G5 (CHX Plus). In sequence, the specimens were submitted to scanning electron microscopy (SEM) analysis, in the cervical-medium and medium-apical segments, to evaluate the presence of debris and smear layer. The other 50 teeth were treated equally to a SEM study, but with the root canals filled with an epoxy-based endodontic sealer and submitted to a push-out bond strength test, in the cervical, middle, and apical thirds. G2, G3, G4, and G5 provided higher precipitation of the debris and smear layer than G1 (P<0.05), but these groups were similar to each other (P>0.05), in both segments. The values obtained in the push out test did not differ between groups, independent of the radicular third (P>0.05). The CHXs formulations caused precipitation of the debris and smear layer on the radicular dentin, but these residues did not interfere in the push-out bond strength of the epoxy-based sealer. Microsc. Res. Tech. 77:17-22, 2014. (c) 2013 Wiley Periodicals, Inc.

SEM Evaluation of the Interface Between Filling and Root- End Filling Materials

The aim of this ex vivo study was to evaluate, by scanning electron microscopy (SEM), the presence of gaps at the interface between filling material and three root-end filling materials. Thirty human upper molars disto-buccal roots were instrumented and filled with gutta-percha and eugenol-based sealer. The apicoectomy was performed 2mm from the apex and retrograde cavities were prepared with ultrasonic points (3mm in deep). The samples were divided into three experimental groups (n=10): Group Iwhite mineral trioxide aggregate (MTA); Group IISuper EBA; and Group IIIPortland cement. The root-end filling materials were inserted into the retocavities using a MTA carrier. After 48h, the roots were transversally sectioned in order to obtain the apical 5mm. Next, each specimen was prepared longitudinally with crescent granulation of abrasives water-wet sandpapers in order to expose the filling and root-end filling materials. Then, the specimens were subjected to slow dehydration with silica gel, mounted onto specific stubs and coated with paladium coverage for SEM analysis of the interface between filling and root-end filling materials. The percentage of gaps at the interfacial area was calculated by using Image Tool 3.0 software. Super EBA presented the higher percentage of gaps (1.5 +/- 0.67%), whereas MTA presented the lowest values (0.33 +/- 0.20%; p=0.0004). Despite the statistical differences observed between Super EBA and MTA, all the root-end filling materials presented great adaptation to the filling material, presenting small amount of gaps. SCANNING 36:252-257, 2014. (c) 2013 Wiley Periodicals, Inc.

MTA e hidróxido de cálcio como materiais obturadores de canal radicular em reimplante tardio de dente de macaco

O tratamento endodôntico é uma etapa importante do protocolo de atendimento do reimplante dentário e tem uma relação direta com o aparecimento das reabsorções radiculares, maior causa de perda dos dentes reimplantados. O objetivo do trabalho foi analisar o processo de reparo no reimplante tardio de dente de macaco, utilizando o hidróxido de cálcio (Ca(OH)2) e o MTA como materiais obturadores de canal. Cinco macacos Cebus apella adultos tiveram seus incisivos laterais superiores e inferiores, direito e esquerdo, extraídos e deixados em meio ambiente por 60 minutos. Decorrido esse período, foi realizado o preparo biomecânico dos canais e os dentes foram divididos em dois grupos experimentais: grupo I - canal preenchido com pasta de Ca(OH)2 e grupo II - canal preenchido com MTA (Angelus®). Após o selamento da abertura coronária com ionômero de vidro, o ligamento periodontal foi removido e os dentes imersos em solução de fluoreto de sódio 2%, pH 5,5, por 10 minutos. Em seguida, os alvéolos foram irrigados com soro fisiológico e os dentes reimplantados e contidos por 30 dias com fio de aço e resina composta. A eutanásia dos animais foi realizada 60 dias após o reimplante. Os espécimes de ambos os grupos apresentaram reabsorção por substituição e pontos de anquilose ao longo dos três terços radiculares e ausência de reabsorção inflamatória. Não houve diferença significante entre os dois grupos com relação à reabsorção por substituição, porém a quantidade de anquilose foi significativamente maior no grupo do Ca(OH)2. Baseado nesses resultados conclui-se que o MTA pode ser uma opção clínica viável para a obturação de dentes tardiamente reimplantados que necessitam de um longo período de curativo com hidróxido de cálcio.

Infiltração coronária microbiana em canais radiculares obturados pela técnica do cone único com diferentes cimentos endodônticos

With the emergence of new filling materials with different properties and behaviors, the approach of endodontic treatment must be readjusted so that the appropriate result can be achieved. New endodontic sealers include methacrylate resin-based, plant resin-based and the evolution of epoxy-based sealers. This study verified the behavior of new materials that presents controversial results in the literature, about coronal bacterial leakage. That for, 56 single-rooted human teeth were prepared in the direction crown-apex and filled with gutta-percha points with taper of 4% using the single cone technique. Roots were divided randomly into 4 groups according to the sealer (Apexit Plus, AH Plus, EndoREZ and Polifil). After filling, the roots were incorporated in a leakage model, which upper chamber contained a suspension of Streptococcus mutans, and lower chamber a broth, leaving 3 mm of root apical portion immersed. Leakage was assessed for turbidity in lower chamber every day for 60 days. Survival analysis was performed using the nonparametric Kaplan- Meier method (p<0,05). All experimental groups presented leakage during the study’s period, however the maximum time achieve was 22 days. The medium time of leakage was: Apexit Plus 6,3 days, AH Plus 6,3 days and Polifil 5,1 days, but in EndoREZ all specimens infiltrated in the first day, presenting shorter capacity of impermeabilization compared to the other groups. Concluding that none of the sealers tested was able to prevent coronal bacterial leakage

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.

Influence of Insertion Techniques for Resin Cement and Mechanical Cycling on the Bond Strength Between Fiber Posts and Root Dentin

Purpose: To evaluate the effect of the insertion technique for resin cement and mechanical cycling on the bond strength between fiber posts and root dentin.Materials and Methods: Sixty-four single-rooted bovine teeth were endodontically prepared to receive glass-fiber posts. The insertion of cement into the root canal was performed using one of the following techniques: POS, insertion with the post; LEN, the use of a lentulo-type drill; EXP, insertion with a straight-tip explorer; or CEN, the use of a Centrix syringe. Half of the specimens were mechanically cycled. All specimens were sectioned into slices of 1.8 mm for the push-out test and 0.5 mm for analysis of the cement layer quality.Results: The insertion technique affected the interaction between factors (bond strength and mechanical cycling; p < 0.0001). Insertion of the Centrix syringe after mechanical cycling showed the highest bond values (13.6 +/- 3.2 MPa). Group-to-group comparisons for baseline and cycled conditions indicated that mechanical cycling significantly influenced the bond strength (p < 0.0001) of the POS and CEN groups. The quality of the cement layer did not differ between the techniques when evaluated in the middle (p = 0.0612) and cervical (p = 0.1119) regions, but did differ in the apical region (p = 0.0097), where the CEN group had better layer quality for the two conditions tested (baseline and cycled).Conclusion: The use of the Centrix syringe improved the homogeneity of the cement layer, reducing the defects in the layer and increasing adhesive strength values to dentin, even after mechanical cycling.

Clinical results with two different methods of root-end preparation and filling in apical surgery: mineral trioxide aggregate and adhesive resin composite

INTRODUCTION: The aim of apical surgery is to hermetically seal the root canal system after root-end resection, thereby enabling periradicular healing. The objective of this nonrandomized prospective clinical study was to report results of 2 different root-end preparation and filling methods, ie, mineral trioxide aggregate (MTA) and an adhesive resin composite (Retroplast). METHODS: The study included 353 consecutive cases with endodontic lesions limited to the periapical area. Root-end cavities were prepared with sonic microtips and filled with MTA (n = 178), or alternatively, a shallow concavity was prepared in the cut root face, with subsequent placement of an adhesive resin composite (Retroplast) (n = 175). Patients were recalled after 1 year. Cases were defined as healed when no clinical signs or symptoms were present and radiographs demonstrated complete or incomplete (scar tissue) healing of previous radiolucencies. RESULTS: The overall rate of healed cases was 85.5%. MTA-treated teeth demonstrated a significantly (P = .003) higher rate of healed cases (91.3%) compared with Retroplast-treated teeth (79.5%). Within the MTA group, 89.5%-100% of cases were classified as healed, depending on the type of treated tooth. In contrast, more variable rates ranging from 66.7%-100% were found in the Retroplast group. In particular, mandibular premolars and molars demonstrated considerably lower rates of healed cases when treated with Retroplast. CONCLUSIONS: MTA can be recommended for root-end filling in apical surgery, irrespective of the type of treated tooth. Retroplast should be used with caution for root-end sealing in apical surgery of mandibular premolars and molars.

Layered silicate nanocomposites based on various high-functionality epoxy resins. Part II: The influence of an organoclay on the rheological behavior of epoxy prepolymers

The effect of an organically surface modified layered silicate on the viscosity of various epoxy resins of different structures and different functionalities was investigated. Steady and dynamic shear viscosities of the epoxy resins containing 0-10 wt% of the organoclay were determined using parallel plate rheology. Viscosity results were compared with those achieved through addition of a commonly used micron-sized CaCO3 filler. It was found that changes in viscosities due to the different fillers were of the same order, since the layered silicate was only dispersed on a micron-sized scale in the monomer (prior to reaction), as indicated by X-ray diffraction measurements. Flow activation energies at a low frequency were determined and did not show any significant changes due to the addition of organoclay or CaCO3. Comparison between dynamic and steady shear experiments showed good agreement for low layered silicate concentrations below 7.5 wt%, i.e. the Cox-Merz rule can be applied. Deviations from the Cox-Merz rule appeared at and above 10 wt%, although such deviations were only slightly above experimental error. Most resin organoclay blends were well predicted by the Power Law model, only concentrations of 10 wt% and above requiring the Herschel-Buckley (yield stress) model to achieve better fits. Wide-angle X-ray measurements have shown that the epoxy resin swells the layered silicate with an increase in the interlayer distance of approximately 15 Angstrom, and that the rheology behavior is due to the lateral, micron-size of these swollen tactoids.

Method for determination of root curvature radius using cone-beam computed tomography images

This article describes and discusses a method to determine root curvature radius by using cone-beam computed tomography (CBCT). The severity of root canal curvature is essential to select instrument and instrumentation technique. The diagnosis and planning of root canal treatment have traditionally been made based on periapical radiography. However, the higher accuracy of CBCT images to identify anatomic and pathologic alterations compared to panoramic and periapical radiographs has been shown to reduce the incidence of false-negative results. In high-resolution images, the measurement of root curvature radius can be obtained by circumcenter. Based on 3 mathematical points determined with the working tools of Planimp® software, it is possible to calculate root curvature radius in both apical and coronal directions. The CBCT-aided method for determination of root curvature radius presented in this article is easy to perform, reproducible and allows a more reliable and predictable endodontic planning, which reflects directly on a more efficacious preparation of curved root canals.

In vitro analysis of thermocompaction time and gutta-percha type on quality of main canal and lateral canals filling

The aim of this study was to evaluate the quality of filling in main and lateral root canals performed with the McSpadden technique, regarding the time spent on the procedure and the type of gutta-percha employed. Fifty simulated root canals, made with six lateral canals placed two apiece in the cervical, middle and apical thirds of the root, were divided into 5 groups. Group A: McSpadden technique with conventional gutta-percha, performed with sufficient time for canal filling; Group B: McSpadden technique with conventional gutta-percha, performed in twice the mean time used in Group A; Group C: McSpadden technique with TP gutta-percha, performed with sufficient time for canal filling; Group D: McSpadden technique with TP gutta-percha, performed in twice the mean time used in Group C; Group E: lateral condensation technique. Images of the filled root canals were taken using a stereomicroscope and analyzed using the Leica QWIN Pro software for filling material flow, gutta-percha filling extension and sealer flow. Data were analyzed by analysis of variance (ANOVA) and Tukey test (p < 0.05). The best values of penetration in lateral canals in the middle third occurred in the groups where TP gutta-percha was used. However, in the apical third, group B showed the best values. Although a longer time of compactor use allows greater penetration of the filling material into the lateral canals, the presence of voids resulted in bad quality radiographic images, suggesting porosity. The best quality of filling material was observed in Group A (McSpadden technique with conventional Gutta-Percha, performed with sufficient time for root canal filling).

Heat Release, Time Required, and Cleaning Ability of Mtwo R and ProTaper Universal Retreatment Systems in the Removal of Filling Material

Introduction: This ex vivo study evaluated the heat release, time required, and cleaning efficacy of MTwo (VDW, Munich, Germany) and ProTaper Universal Retreatment systems (Dentsply/Maillefer, Ballaigues, Switzerland) and hand instrumentation in the removal of filling material. Methods: Sixty single-rooted human teeth with a single straight canal were obturated with gutta-percha and zinc oxide and eugenol-based cement and randomly allocated to 3 groups (n = 20). After 30-day storage at 37 degrees C and 100% humidity, the root fillings were removed using ProTaper UR, MTwo R, or hand files. Heat release, time required, and cleaning efficacy data were analyzed statistically (analysis of variance and the Tukey test, alpha = 0.05). Results: None of the techniques removed the root fillings completely. Filling material removal with ProTaper UR was faster but caused more heat release. Mtwo R produced less heat release than the other techniques but was the least efficient in removing gutta-percha/sealer. Conclusions: ProTaper UR and MTwo R caused the greatest and lowest temperature increase on root surface, respectively; regardless of the type of instrument, more heat was released in the cervical third. Pro Taper UR needed less time to remove fillings than MTwo R. All techniques left filling debris in the root canals. (I Endod 2010;36:1870-1873)

Compromised Bond Strength after Root Dentin Deproteinization Reversed with Ascorbic Acid

Introduction: The present study evaluated the effect of a reducing agent on the bond strength of deproteinized root canal dentin surfaces when using a self-adhesive versus dual-cured cement. Regional differences were also evaluated. Methods: A total of 45 bovine incisor roots were divided into 3 groups: irrigation with physiologic solution (control), 10-minute deproteinization with 5% NaOCl, and 10-minute deproteinization with 5% NaOCl followed by 10 minutes of 10% ascorbic acid. Fiber posts were cemented with either RelyX 0100 or RelyX ARC (with SingleBond 2 or Clearfil SE Bond). The push-out bond strength was evaluated after 24 hours of storage. Data were submitted to three-way analyses of variance and Dunnett 13 tests (alpha = 0.05). Results: No differences between cements were observed within the testing conditions, regardless of the adhesive (P < .05). Deproteinization reduced bond strengths. Subsequent treatment with ascorbic acid was capable of reversing bond strength value changes to levels similar to those of controls. Regional radicular differences were also found, where coronal > middle > apical. Conclusions: The reducing agent was capable. of reversing the effect of dentin deproteinization, and RelyX U100 behaved similarly to RelyX ARC. (J Endod 2010;36:130-134)

Evaluation of the flow rate of 3 endodontic sealers: Sealer 26, AH Plus, and MTA Obtura

Objective. The aim of this study was to evaluate the flow rate of 3 endodontic sealers: Sealer 26, AH Plus, and MTA Obtura. Study design. According to the method proposed by the American Dental Association (ADA specification no. 57), the sealers were placed between 2 glass slabs under a weight of 120 g. The diameters of the formed discs were measured with a digital paquimeter. The test was repeated 5 times for each sealer. Results. The results were expressed as arithmetic means, and the statistical analysis was performed through Tukey test. AH Plus showed significantly superior flow rate compared with Sealer 26 and MTA Obtura. There was no statistically significant difference between flow rates presented by Sealer 26 and MTA Obtura. Conclusion. Within the limitations of this in vitro study, it was concluded that all of the the endodontic sealers tested presented greater flow than the minimum recommended in the ADA 57 specification. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:e47-e49)

Evaluation of pH and Calcium Ion Release of Root-end Filling Materials Containing Calcium Hydroxide or Mineral Trioxide Aggregate

Introduction: To evaluate calcium ion release and pH of Sealer 26 (S26) (Dentsply, Rio de Janeiro, RJ, Brazil), white mineral trioxide aggregate (MTA), Endo CPM Sealer (CPM1) (EGEO SRL Bajo licencia MTM Argentina SA, Buenos Aires, Argentina), Endo CPM Sealer in a thicker consistency (CPM 2), and zinc oxide and eugenol cement (ZOE). Methods: Material samples (n = 10) were placed in polyethylene tubes and immersed in 10 mL of distilled water. After 3, 6,12,24, and 48 hours and 7,14, and 28 days, the water pH was determined with a pH meter, and calcium release was assessed by atomic absorption spectrophotometry. An empty tube was used as the control group. Results: The control group presented a pH value of 6.9 at all studied periods and did not show the presence of calcium ion. S26 presented greater hydroxyl ion release up to 12 hours (p < 0.05). From 24 hours until 28 days, S26, MTA, CPM1, and CPM2 had similar results. in ail periods, ZOE presented the lowest hydroxyl ion release. CPM1, followed by CPM2, released the most calcium ions until 24 hours (p < 0.05). Between 48 hours and 7 days, CPM1 and CPM2 had the highest release. A greater calcium ion release was observed for CPM2, followed by CPM1 at 14 days and for S26, CPM1, and CPM2 at 28 days. ZOE released the least calcium ions in all periods. Conclusion: Sealer 26, MTA, and Endo CPM sealer at normal or thicker consistency release hydroxyl and calcium ions. Endo CPM sealer may be an alternative as root-end filling material. (J Endod 2009;35:1418-1421)

Microhardness of resin cements in the intraradicular environment: Effects of water storage and softening treament

Objectives. To analyze the microhardness of four dual-cure resin cements used for cementing fiber-reinforced posts under the following conditions: after 7 days of storage in water, after additional 24 h of immersion in 75% ethanol, and after 3 months of storage in water. Hardness measurements were taken at the cervical, middle and apical thirds along the cement line. Methods. Root canals of 40 bovine incisors were prepared for post space. Fibrekor (R) glass fiber-reinforced posts (Jeneric/Pentron) of 1 mm in diameter were cemented using Panavia F 2.0 (Kuraray), Variolink (Ivoclar-Vivadent), Rely X Unicem (3M ESPE) or Duolink (Bisco) (N = 10). After 7 days of water storage at 37 degrees C, half the sample (N = 5) was longitudinally sectioned and the initial microhardness measured along the cement line from cervical to apex. These same samples were further immersed in 75% ethanol for 24 h and reassessed. The remaining half (N = 5) was kept unsectioned in deionized water at 37 degrees C for 3 months, followed by sectioning and measuring. Data were analyzed by a series of two-way ANOVA and Tukey tests at alpha = 5%. Results. Statistically significant differences were identified among the cements, thirds and conditions. Significant interactions were also observed between cements and thirds and between cements and conditions. Panavia F exhibited significantly higher initial microhardness than the other three cements, which showed no statistical difference among themselves. Variolink and Duolink showed significantly higher microhardness values in the cervical third, without significant difference among the thirds for the other cements. Immersion in ethanol significantly reduced the hardness values for all cements, regardless of the thirds. Storage in water for 3 months had no influence on the hardness of most of the cements, with the exception of Unicem that showed a significant increase in the hardness values after this period. Results showed heterogeneity in the microhardness of the cements inside the canal. All cements presented some degree of softening after ethanol treatment, which suggests instability of the polymer. The quality of curing of resin cements in the root canal environment seems unpredictable and highly material dependent. (C) 2009 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.