Root canal treatment of three-rooted maxillary second premolars: Report of four cases

The aim of this report is to contribute to a better understanding of the radiographic, clinical and anatomic findings in maxillary second premolars. This paper reports the endodontic treatment of two cases of three-rooted three-canal maxillary second premolars in different patients, and two sound maxillary second premolars also with three canals and three independent roots in a sibling of one of the patients. Although the presence of maxillary second premolars with one or two canals and one root is much more common, other anatomic conditions can be found. A correct clinical and radiographic diagnosis based on knowledge of root canal anatomy and critical interpretation of radiographs is necessary for a safer and successful endodontic treatment of these teeth.

Effects of chlorhexidine and sodium hypochlorite on the microhardness of root canal dentin

Objective. The purpose of this study was to evaluate the effects of endodontic irrigants on the microhardness of root canal dentin.Study design. Thirty extracted single-rooted human teeth were used. The crowns were sectioned at the cementoenamel junction. Each root was transversely sectioned into cervical, middle, and apical segments, resulting in 90 specimens. The 3 sections of each root were separately mounted in an individual silicon device with acrylic resin. The specimens were randomly divided into the following 3 groups (n = 30), according to the irrigant solution used: (1) group 1, control (saline solution); (2) group 2, 2% chlorhexidine gluconate solution; and (3) group 3, 1% sodium hypochlorite (NaOCl). After 15 minutes of irrigation, dentin microhardness was measured on each section at 500 mu m and 1000 mu m from the pulp-dentin interface with a Vickers diamond microhardness tester in Vickers hardness number (VHN).Results. Data obtained were analyzed using analysis of variance and the Tukey test (5%). Specimens irrigated with 2% chlorhexidine (group 2) or 1% NaOCl (group 3) presented lower values of dentin microhardness, with significant difference in relation to the control group (P < .05).Conclusion. It could be concluded that chlorhexidine and NaOCl solutions significantly reduced the microhardness of root canal dentin at 500 mu m and 1000 mu m from the pulp-dentin interface.

In vitro effects of calcium hydroxide and polymyxin B on endotoxins in root canals

Objectives. To evaluate the effects of intracanal medicaments on endotoxins in root canals.Methods. Seventy-five freshly extracted maxillary incisors were used in this study. The crowns of teeth were sectioned near the CEJ in order to standardize the root length to 14 mm. The root canals were instrumented to an apical size #50 file and irrigated with 1% sodium hypochlorite solution and sterilized with 60 Co gamma irradiation. Standardized suspension containing Escherichia coli endotoxin was inoculated into the 60 root canals. The specimens were randomly assigned to 5 groups (n=15), according to the intracanal medicament used: (G1) calcium hydroxide; (G2) polymyxin B; (0) combination neomycin-potymyxin B-hydrocortisone; (G4) positive control (no intracanal medicament); (G5) negative control (no endotoxin and no intracanal medicament). After 7 days, the detoxification of endotoxin was evaluated by Limulus lysate assay and antibody production in B-tymphocytes culture.Results. Groups 1, 2 and 5 presented the best results by Limulus lysate and were significantly different to groups 3 and 4 (p<0.05). Stimulation of antibodies production in cell culture by groups 1 and 6 was smaller and statistically different than groups 2, 3, 4 and 5 (p<0.05). Groups 2 and 5 induced a small increase in the antibodies production in relation to the groups 1 and 6. Groups 3 and 4 induced a significant increase of antibodies production (p<0.05).Conclusions. The calcium hydroxide and polymyxin B intracanal medicaments detoxified endotoxin in root canals and altered the properties of LPS to stimulate the antibody production by B-Lymphocytes. The combination neomycin-polymyxin B-hydrocortisone did not detoxified endotoxin. (C) 2004 Elsevier Ltd. All rights reserved.

Evaluation of simulated external root resorptions with digital radiography and digital subtraction radiography

Introduction: Root resorption can cause damage in orthodontic patients. Digital subtraction radiography (DSR) is a useful resource for the detection of mineral losses. The purpose of this study was to compare the efficacy of digital radiography (DR) and DSR in detecting simulated external root resorption. Examiner agreement between the 2 techniques was also evaluated. Methods: Root resorptions of various sizes were simulated on the apical and lingual aspects of 49 teeth from 9 dry human mandibles. The teeth were radiographed in standardized conditions. The radiographs were registered with Regeemy Image Registration and Mosaicking (version 0.2.43-RCB, DPI-INPE, Sao Jose dos Campos, São Paulo, Brazil) and subtracted with Image Tool (University of Texas Health Science Center at San Antonio). The subtracted images and the digital radiographs were evaluated by 3 oral radiologists. Results: No statistically significant differences were found for the methods in the detection of apical root resorptions, independently from lesion size, and of lingual resorptions of 1.2 mm or greater. DSR was significantly better than DR for detection of lingual resorptions up to 1 mm. Resorptions less than 0.5 mm were not precisely detected by either method. DSR provided better intraexaminer and interexaminer agreement than did DR. Conclusions: Both methods are precise for detection of apical root resorptions as small as 0.5 mm and lingual resorptions of 1 mm or more. However, DSR frequently performed better than did DR. (Am J Orthod Dentofacial Orthop 2011;139:324-33)

SEALING ABILITY of CASTOR OIL POLYMER AS A ROOT-END FILLING MATERIAL

Objective: The purpose of this study was to evaluate the sealing ability of castor oil polymer (COP), mineral trioxide aggregate (MTA) and glass ionomer cement (GIC) as root-end filling materials. Forty-five single-rooted human teeth were cleaned and prepared using a step-back technique. The apical third of each root was resected perpendicularly to the long axis direction. All teeth were obturated with gutta-percha and an endodontic sealer. After, a root-end cavity with 1.25-mm depth was prepared using a diamond bur. The specimens were randomly divided into three experimental groups (n = 15), according to the root-end filling material used: G1) COP; G2) MTA; G3) GIC. The external surfaces of the specimens were covered with epoxy adhesive, except the root-end filling. The teeth were immersed in rhodamine B dye for 24 hours. Then, the roots were sectioned longitudinally and the linear dye penetration at the dentin/material interface was determined using a stereomicroscope. ANOVA and Tukey's tests were used to compare the three groups. The G1 group (COP) presented smaller dye penetration, statistically different than the G2 (MTA) and G3 (GIC) groups (p < 0.05). No statistically significant difference in microleakage was observed between G2 and G3 groups (p > 0.05). The results of this study indicate that the COP presented efficient sealing ability when used as a root-end filling material showing results significantly better than MTA and GIC.

Effectiveness of ozonated water on Candida albicans, Enterococcus faecalis, and endotoxins in root canals

The aim of this study was to evaluate the effectiveness of ozonated water in the elimination of Candida albicans, Enterococcus faecalis, and endotoxins from root canals. Twenty-four single-rooted human teeth were inoculated with C. albicans and E. faecalis, and 24 specimens were inoculated with Escherichia coli endotoxin. Ozonated water (experimental group) or physiologic solution (control group) was used as irrigant agent. Antimicrobial effectiveness was evaluated by the reduction of microbial counts. Lipopolissacharide complex presence was assessed by limulus amebocyte lysate test and B-lymphocyte stimulation. Data were analyzed by Wilcoxon and Mann-Whitney tests (5%). Ozonated water significantly reduced the number of C. albicans and E. faecalis at the immediate sampling, but increased values were detected after 7 days. Ozonated water did not neutralize endotoxin. It could be concluded that ozonated water was effective against C. albicans and E. faecalis but showed no residual effect. No activity on endotoxin was observed.

In vitro evaluation of the action of irrigating solutions associated with intracanal medications on Escherichia coli and its endotoxin in root canals

Objective: The purpose of this study was to evaluate the efficacy of auxiliary chemical substances and intracanal medications on Escherichia coli and its endotoxin in root canals. Material and Methods: Teeth were contaminated with a suspension of E. coli for 14 days and divided into 3 groups according to the auxiliary chemical substance used: G1) 2.5% sodium hypochlorite (NaOCl); G2) 2% chlorhexidine gel (CLX); G3) pyrogen-free solution. After, these groups were subdivided according to the intracanal medication (ICM): A) Calcium hydroxide paste (Calen (R)), B) polymyxin B, and C) Calcium hydroxide paste+2% CLX gel. For the control group (G4), pyrogen-free saline solution was used without application of intracanal medication. Samples of the root canal content were collected immediately after biomechanical preparation (BMP), at 7 days after BMP, after 14 days of intracanal medication activity, and 7 days after removal of intracanal medication. The following aspects were evaluated for all collections: a) antimicrobial activity; b) quantification of endotoxin by the limulus Amebocyte lysate test (LAL). Results were analyzed by the kruskal-wallis and Dunn's tests at 5% significance level. Results: The 2.5% NaOCl and CLX were able to eliminate E. coli from root canal lumen and reduced the amount of endotoxin compared to saline. Conclusions: It was concluded that 2.5% NaOCl and CLX were effective in eliminating E. coli. Only the studied intracanal medications were to reduce the amount of endotoxin present in the root canals, regardless of the irrigant used.

IN VITRO INCIDENCE of ROOT CANAL BIFURCATION IN MANDIBULAR INCISORS BY RADIOVISIOGRAPHY

Objective: The aim of this study was to verify, in vivo and in vitro, the prevalence of root canal bifurcation in mandibular incisors by digital radiography. Material and Methods: Four hundred teeth were analyzed for the in vivo study. Digital radiographs were taken in an orthoradial direction from the mandibular incisor and canine regions. The digital radiographs of the canine region allowed visualizing the incisors in a distoradial direction using 20 degrees deviation. All individuals agreed to participate by signing an informed consent form. The in vitro study was conducted on 200 mandibular incisors positioned on a model, simulating the mandibular dental arch. Digital radiographs were taken from the mandibular incisors in both buccolingual and mesiodistal directions. Results: The digital radiography showed presence of bifurcation in 20% of teeth evaluated in vitro in the mesiodistal direction. In the buccolingual direction, 17.5% of teeth evaluated in vivo and 15% evaluated in vitro presented bifurcation or characteristics indicating bifurcation. Conclusions: Digital radiography associated with X-ray beam distally allowed detection of a larger number of cases of bifurcated root canals or characteristics of bifurcation.

Peroxide penetration from the pulp chamber to the external root surface after internal bleaching

Purpose: To quantify the amount of peroxide penetration from the pulp chamber to the external surface of teeth during the walking bleaching technique. Methods: Seventy-two bovine lateral incisors were randomly divided over five experimental groups and one control (n = 12 per group): (1) 35% hydrogen peroxide (HP); (2) 35% carbamide peroxide (CP); (3) sodium perborate (SP); (4) (HP+SP); (5) (CP+SP) and (6) Control (CG), deionized water. All groups were treated according to the walking bleach technique. After 7 days at 37 degrees C in an acetate buffer solution, 100 mu l violet leukocrystal coloring and 50 mu l peroxidase was added, producing a blue stain that could be measured in a spectrophotometer and then converted into peroxide mu g/ml. Results: G5 exhibited the greatest penetration, while G2 and G3 produced the lowest values. All bleaching agents penetrated from the pulp chamber to the external root surface. There was a direct correlation between the presence of oxidative agents and penetration potential. Sodium perborate in distilled water was less oxidative and appeared to be the least aggressive bleaching agent. (Am J Dent 2010;23:171-174).

Effects of mechanical cycling on the bonding of zirconia and fiber posts to human root dentin

Purpose: To evaluate the effect of cyclical mechanical loading on the bond strength of a fiber and a zirconia post bonded to root dentin.Materials and Methods: Forty single-rooted human teeth (maxillary incisors and canines) were sectioned, and the root canals were prepared at 12 mm. Twenty randomly seleced specimens received a quartz fiber post (FRC) (D.T. Light-Post) and 20 others received a zirconia post (ZR) (Cosmopost). The posts were resin luted (All Bond 2 + resin cement Duo-link) and each specimen was embedded in epoxy resin inside a PVC cylinder. Ten specimens with FRC post and 10 specimens with ZR post were submitted to fatigue testing (2,000,000 cycles; load: 50 N; angle of 45 degrees; frequency: 8 Hz), while the other 20 specimens were not fatigued. Thus, 4 groups were formed: G1: FRC+O cycles; G2: FRC+2,000,000 cycles; G3: ZR+O cycles; G4: ZR+2,000,000 cycles. Later, the specimens were cut perpendicular to their long axis to form 2-mm-thick disk-shaped samples (4 sections/specimen), which were submitted to the push-out test (1 mm/min). The mean bond strength values (MPa) were calculated for each tooth (n = 10) and data were submitted to statistical analysis (alpha = 0.05).Results: Two-way ANOVA revealed that the bond strength was significantly affected by mechanical cycling (p = 0.0014) and root post (p = 0.0325). The interaction was also statistically significant (p = 0.0010). Tukey's test showed that the mechanical cycling did not affect the bonding of FRC to root dentin, while fatigue impaired the bonding of zirconium to root dentin.Conclusion: (1) the bond strength of the FRC post to root dentin was not reduced after fatigue testing, whereas the bonding of the zirconia post was significantly affected by the fatigue. (2) Cyclical mechanical loading appears to damage the bond strength of the rigid post only.

Evaluation of light transmission through translucent and opaque posts

Objectives: The transmission of light through translucent posts was observed, and the microhardness of light-cured cement used to secure these posts was evaluated at different depths. Methods: Fifteen single-rooted standard bovine teeth, 16 mm in size, were used. The root canals were prepared using #3 drills Light-Post (five teeth) and Aestheti Post (five teeth) systems (BISCO), with a working-length of 12 mm. In five teeth, translucent posts were cemented (Light-Post #2), while another five teeth received opaque posts (Aestheti Post #2). The roots were painted with black nail varnish to prevent the passage of light through the lateral walls of the roots. The root canals of all the specimens were treated with the All-Bond 2 adhesive system (BISCO) and cemented with light-cured cement (Enforce, Dentsply). All the roots were transversally cut to obtain six specimens 1.5 mm thick. Every two sections corresponded to a specific region of the root (cervical, middle, apical), making it possible to observe the cement microhardness at different levels. The groups (n=10) were defined as: G1: translucent post (TP)/cervical region; G2: TP/middle region; G3: TP/apical region; G4: Opaque post (OP)/cervical region; G5: OP/middle region; G6: PO/apical region. Five root canals were only filled with cement for use as a control (G7). Then, Vickers microhardness analyses were performed. Results: In G3, G5 and G6, the cement was not sufficiently hard to allow for microhardness analysis. When submitted to the ANOVA test, G1 (35.07), G2 (24.28) and G4 (28.64) presented no statistical differences. When the previous groups were compared to G7 (51.00) using the Kruskal-Wallis test, a statistical difference was found. Conclusion: Translucent posts allow cement polymerization up to the middle portion of the root.

In vitro evaluation of the effectiveness of irrigants and intracanal medicaments on microorganisms within root canals

Aim To evaluate in vitro the effectiveness of sodium hypochlorite (NaOCl). chlorhexidine (CHX) and live intracanal medicaments on microorganisms within root canals.Methodology Ninety-six human single-rooted extracted teeth were used. After removing the crowns, canal preparation was completed and the external root Surfaces were coated with epoxy resin. Following sterilization. The teeth were contaminated with Candida albicans and enterococcus faecalis. and were incubated at 37 +/- 1 degreesC for 7 days. The teeth were divided according to the irrigant solution or intracanal medicament: group 1. sterile physiologic solution (SPS) and calcium hydroxide (Ca(OH)(2)) paste: group 2. SPS and camphorated paramonochlorophenol (CPMC): group 3.SPS and tricresol formalin: group 4, SPS and CaOH2 + CPMC paste: group 5, SPS and PMC furacin; group 6.2.5%, NaOCl without intracanal medication: group 7, 2.0% CHX without intracanal medication and group 8, SPS Without intracanal medication (control group). Microbiological samples were collected with sterile paper points, and bacterial growth was determined. The data were submitted to the analysis of variance (ANOVA. P = 0.05).Results For C. albicans, groups 3 and S were statistically less effective than groups 1, 2. 4 and 5 (Kruskal-Wallis (K-W) = 65.241; gl = 7; P = 0.001). For E. faecalis, groups 6 and 8 were statistically less effective than groups 1-4 and 7 (K-W = 61.048; gl = 7; P = 0.001).Conclusions Ca(OH)(2) + CPMC paste was the most effective intracanal medicament for the elimination of the two microorganisms; 2.0% CHX solution was more effective than 2.5% NaOCl against E. faecalis.

ANTIMICROBIAL ACTIVITY of SODIUM HYPOCHLORITE ASSOCIATED WITH INTRACANAL MEDICATION FOR Candida albicans and Enterococcus faecalis INOCULATED IN ROOT CANALS

Objective: The purpose of this study was to evaluate the action of sodium hypochlorite (NaOCl) associated with an intracanal medication against Candida albicans and Enterococcus faecalis inoculated in root canals. Material and Methods: Thirty-six human single-rooted teeth with single root canals were used. The canals were contaminated with C. albicans and E. faecalis for 21 days and were then instrumented with 1% NaOCl. The roots were divided into 3 groups (n=12) according to the intracanal medication applied: calcium hydroxide paste, 2% chlorhexidine (CHX) gel, and 2% CHX gel associated with calcium hydroxide. The following collections were made from the root canals: a) initial sample (IS): 21 days after contamination (control), b) S1: after instrumentation, c) S2: 14 days after intracanal medication placement; S3: 7 days after intracanal medication removal. The results were analyzed statistically by the Kruskal-Wallis test at 5% significance level. Results and Conclusions: Both 1% NaOCl irrigation and the intracanal medications were effective in eliminating E. faecalis and C. albicans inoculated in root canals.

Assessment of external root temperature during root canal irradiation by Nd:YAG and Er:YAG lasers

Different types of laser have been widely studied for applicability in the oral health area. In the endodontic area, investigations with some types of laser have been conducted to establish safe parameters for clinical application in root canals. However, it has not been duly explained whether the temperature increase caused by laser irradiation could cause alteration in the temperature on the external surface of the root and, consequently, alterations in the cells of the periodontal ligament, causing resorption and even loss of the dental element. The proposal in this paper was to gauge the external root temperature in the apical and cervical regions of the roots of human teeth during root canal irradiation with Nd:yttrium aluminum garnet (YAG) and Er:YAG lasers using different parameters. The novel approach of this paper is the use of the technique of laser applications along the total length of the root canal with series of repetitive irradiation, however, using time of 1 s of irradiation associated with 1 s off to avoid cumulative thermal effects. Experimental results confirm the accuracy of the parameters and exposure regimen obtained. All the parameters used in this paper are acceptable from a clinical as well as a biological point of view. (C) 2009 Laser Institute of America.

Resistance to compression of weakened roots subjected to different root reconstruction protocols

Objective: This study evaluated, in vitro, the fracture resistance of human non-vital teeth restored with different reconstruction protocols. Material and methods: Forty human anterior roots of similar shape and dimensions were assigned to four groups (n=10), according to the root reconstruction protocol: Group I (control): non-weakened roots with glass fiber post; Group II: roots with composite resin by incremental technique and glass fiber post; Group III: roots with accessory glass fiber posts and glass fiber post; and Group IV: roots with anatomic glass fiber post technique. Following post cementation and core reconstruction, the roots were embedded in chemically activated acrylic resin and submitted to fracture resistance testing, with a compressive load at an angle of 45 degrees in relation to the long axis of the root at a speed of 0.5 mm/min until fracture. All data were statistically analyzed with bilateral Dunnett's test (alpha=0.05). Results: Group I presented higher mean values of fracture resistance when compared with the three experimental groups, which, in turn, presented similar resistance to fracture among each other. None of the techniques of root reconstruction with intraradicular posts improved root strength, and the incremental technique was suggested as being the most recommendable, since the type of fracture that occurred allowed the remaining dental structure to be repaired. Conclusion: The results of this in vitro study suggest that the healthy remaining radicular dentin is more important to increase fracture resistance than the root reconstruction protocol.