Cytotoxic effects of white-MTA and MTA-Bio cements on odontoblast-like cells (MDPC-23)

This study evaluated the cytotoxic effects of 2 mineral trioxide aggregate (MTA) cements - White-MTA-Angelus and a new formulation, MTA-Bio - on odontoblast-like cell (MDPC-23) cultures. Twenty-four disc-shaped (2 mm diameter x 2 mm thick) specimens were fabricated from each material and immersed individually in wells containing 1 mL of DMEM culture medium for either 24 h or 7 days to obtain extracts, giving rise to 4 groups of 12 specimens each: G1 - White-MTA/24 h; G2 - White-MTA/7 days; G3 - MTA-Bio/24 h; and G4 - MTA-Bio/7 days. Plain culture medium (DMEM) was used as a negative control (G5). Cells at 30,000 cells/cm 2 concentration were seeded in the wells of 24-well plates and incubated in a humidified incubator with 5% CO 2 and 95% air at 37°C for 72 h. After this period, the culture medium of each well was replaced by 1 mL of extract (or plain DMEM in the control group) and the cells were incubated for additional 2 h. Cell metabolism was evaluated by the MTT assay and the data were analyzed statistically by ANOVA and Tukey's test (α=0.05). Cell morphology and the surface of representative MTA specimens of each group were examined by scanning electron microscopy. There was no statistically significant difference (p>0.05) between G1 and G2 or between G3 and G4. No significant difference (p>0.05) was found between the experimental and control groups either. Similar cell organization and morphology were observed in all groups, regardless of the storage periods. However, the number of cells observed in the experimental groups decreased compared to the control group. MTA-Bio presented irregular surface with more porosities than White-MTA. In conclusion, White-MTA and MTA-Bio presented low cytotoxic effects on odontoblast-like cell (MDPC-23) cultures.

Scanning electron microscopy analysis of RinsEndo system and conventional irrigation for debris removal

A new device for irrigation, which presents hydrodynamic activation based on the pressure-suction technology, has recently been introduced to the market: the Rinsendo system. This study compared the efficacy of the Rinsendo system and conventional (manualdynamic) irrigation in the removal of debris from the root canal walls, using scanning electron microscopy (SEM). Twenty mandibular premolars with completely formed roots were selected and randomly divided into group 1 (irrigation with the Rinsendo system) and group 2 (conventional irrigation). The canals were irrigated with 1 ml of saline at each change of instrument. instrumentation started with a #15 K file and continued up to a #40 K file, which was standardized as the working length instrument. Then, the teeth were sectioned in buccolingual direction and the halves were sputter-coated with gold and examined by SEM. The apical, middle and cervical root canal thirds were evaluated, and the results were analyzed statistically by the Mann-Whitney test for comparison between methods, Kruskal-Wallis test for comparison among thirds, and Miller test for individual comparisons. A significance level of 5% was set for all analyses. The results did not show significant differences (p>0.05) between methods at each third and among thirds for each technique analyzed individually. in conclusion, there was no difference in the cleaning ability of the Rinsendo system and conventional irrigation.

Calcium hydroxide intracanal dressing removal with different rotary instruments and irrigating solutions: A scanning electron microscopy study

This study evaluated the efficacy of 2 types of rotary instruments employed in association with sodium hypochlorite (NaOCl) or EDTA in removing calcium hydroxide (CH) residues from root canals dentin walls. Forty-two mandibular human incisors were instrumented with the ProTaper System up to F2 instrument, irrigated with 2.5% NaOCl followed by 17% EDTA and filled with a CH intracanal dressing. After 7 days, the CH dressing was removed using 4 techniques: NiTi rotary instrument size 25, 0.06 taper (K3 Endo) and irrigation with 17% EDTA (Group 1), NiTi rotary F1 instrument (ProTaper) and irrigation with 17% EDTA (Group 2), NiTi rotary instrument size 25, 0.06 taper and irrigation with 2.5% NaOCl (Group 3) and NiTi rotary F1 instrument and irrigation with 2.5% NaOCl (Group 4). Two roots without intracanal dressing were used as negative controls. Teeth were evaluated by scanning electron microscopy, in the cervical and apical canal thirds. None of the techniques removed the CH dressing completely. In the apical and cervical thirds, F1 instrument was better than instrument size 25, 0.06 taper in removing CH residues (p<0.05), regardless of the final irrigating solution. No difference was found between the irrigating solutions in the groups of F1 instrument and of instrument size 25, 0.06 taper (p>0.05). The negative controls had no CH residues on the dentin walls. In conclusion, the ProTaper F1 instrument was better than K3 Endo instrument size 25, 0.06 taper in the removal of CH intracanal medication, regardless of irrigating solution used.

Functional and esthetic rehabilitation with In-Ceram alumina and zirconia system: A multidisciplinary approach

The development of all-ceramic systems following metalceramics restorations allowed simulation of natural dentition due to favorable esthetics and resistance. In-Ceram is an alternative when esthetics is primordial as well as resistance required in rehabilitation. However, an ideal smile is associated to not only shape, color, texture and translucency but also harmony with gingival tissue. So, the aim of this study is to report a clinical case based on periodontal and fixed partial dentures principles to perform periodontal plastic surgery followed by esthetic rehabilitation. A female patient, 40-year-old, presented complaint about dental esthetics. After clinical and radiographic exams, metal-ceramics crowns (teeth 11, 12, 13, 21, 22 and 23) were considered unsatisfactory due to marginal leakage, color change in gingival tissue associated to metallic margin, and gummy smile. So, a crown lengthening surgery of anterior teeth was performed followed by rehabilitation of superior teeth with In-Ceram single crowns. Clinical significance: The interaction between periodontics and fixed prosthodontic area is the key of an adequated treatment planning which involves gingival smile to provide function and an esthetic condition in association with an esthetic, resistant and predictable material.

Three-year follow up of customized glass fiber esthetic posts

Customized glass fiber posts that is well adjusted into the root canal and have mechanical properties similar to those of dentin may be a suitable treatment for severely compromised endodontically treated teeth. This article reports a 3-year follow up of severely damaged endodontically treated teeth restored with unidirectional fiber glass customized post and core system instead of a conventional fiber post. The fabrication of this glass fiber customized post is a simple technique, providing an increased volume of fibers into the root canal, and an adequate polymerization of the post-core system. Over a three-year period, the treatments demonstrated good clinical and radiographic characteristics, with no fracture or loss of the post and/or crown. This technique can be considered effective, less invasive, and suitable for restore endodontically treated teeth.

Ozonized Oils: A qualitative and quantitative analysis

Most of the problems of endodontic origin have a bacterial etiological agent. Thus, there is a continued interest in seeking more effective chemical substances that can replace the camphorated paramonochiorophenol or antibiotics as intracanal medicaments. Among the possible substances, ozone has some interesting biological characteristics: bactericidal action, debriding effect, angiogenesis stimulation capacity and high oxidizing power. The purpose of this study was to chemically evaluate the presence of ozone in sunflower, castor, olive and almond oil, as well as in propylene glycol and byproducts of ozonation, such as formaldehyde. These compounds were ozonized, inserted into empty and sterile vials, and analyzed by testing the reaction between ozone and indigo, for determining the presence of ozone, and subjected to the chromotropic acid test for determining the presence of formaldehyde. It was observed complete absence of ozone in all samples tested and presence of formaldehyde. The bactericidal and healing action of ozonized oils could be attributed to products formed by the ozonation of mineral oils, such as formaldehyde, not to the ozone itself.

Influence of apical enlargement in cleaning and extrusion in canals with mild and moderate curvatures

Optical microscopy and morphometric analysis were used in this study to evaluate, in vitro, the cleaning of the apical region in root canals with mild or moderate curvatures subjected to biomechanical preparation with a rotary system, as well as to assess the amount of extruded material to the periapical area. Lateral incisors (n = 32), 16 with curvature angles smaller or equal to 10° (GI) and 16 between 11° and 25° angles (GII) were submitted to Hero 642 rotary instrumentation with different surgical diameters: (A) 30.02 and (B) 45.02. Irrigation was performed at each change of instrument with 5 mL of ultrapure Milli-Q water and the extruded material through the apical foramen was collected. Root cross-sections were subjected to histological analysis by optical microscopy (×40) and the images were evaluated morphometrically using the Image Tool software. Quantification of the extruded material was performed by weighing after liquid evaporation. ANOVA showed no statistically significant differences (p>0.05) among the groups with respect to the procedures used to clean the apical region. Considering the amount of extruded material, the Tukey's HSD showed that canals with mild curvature prepared with the 45.02 surgical diameter showed significantly higher values (p<0.05) that those of the other groups, which were similar between themselves (p>0.05). In conclusion, the effect of cleaning the apical region did not differ in the groups, considering root curvature and the surgical diameter of instruments used for apical preparation. The amount of extruded material was greater in canals with mild curvature that were prepared with the 45.02 surgical instrument diameter.

Flexibility and torsional resistance of three nickel-titanium retreatment instrument systems

Aim To assess the dimensional characteristics, flexibility and torsional behaviour of nickel-titanium retreatment instruments. Methodology Using image analysis software and high-resolution digital images, the instrument length, tip angle, diameter at 3mm from the tip and the distance between the blades (pitch length) of the following eight instruments were measured (n=12 for each measurement parameter): the ProTaper Universal retreatment (PTU-R) D1, D2 and D3 instruments; the R-Endo R1, R2 and R3 retreatment instruments; and the Mtwo retreatment (Mtwo-R) sizes 25 and 15 retreatment instruments. Maximum torque and the angular deflection at fracture as well as the bending moment at 45° were measured (n=12) according to the International Standards Organisation (ISO) specification number 3630-1. Data were analysed using the analysis of variance (α=0.05). Results The length of the active part of the instruments was found to vary according to the depth of the canal into which they were designed to reach. The pitch length also increased along the active length. The PTU-R D1 and the Mtwo-R instruments had active tips. Measurements of the bending moment at 45° revealed that the Mtwo-R 15 instrument was the most flexible, whereas the PTU-R D1 was the least flexible. The maximum torque tended to increase as the instrument diameter at 3mm from the tip increased, whereas the angular deflection at fracture varied in the opposite direction. Conclusions The geometrical characteristics of the retreatment instruments and their flexibility and torsion behaviour were consistent with their intended clinical application. © 2011 International Endodontic Journal.

Evaluation of tissue reaction, cell viability and cytokine production induced by Sealapex Plus

The aim of this study was to investigate the effects of mineral trioxide aggregate (MTA), Sealapex, and a combination of Sealapex and MTA (Sealapex Plus) on the reaction of subcutaneous connective tissue of rats, and on cell viability and cytokine production in mouse fibroblasts. The tissue reaction was carried out with dentin tubes containing the materials implanted in the dorsal connective tissue of rats. The histological analysis was performed after 7 and 30 days. Millipore culture plate inserts with polyethylene tubes filled with materials were placed into 24-well cell culture plates with mouse fibroblasts to evaluate the cell viability by MTT assay. ELISA assays were also performed after 24 h of exposure of the mouse fibroblasts to set material disks. Histopathologic examination showed Von Kossa-positive granules that were birefringent to polarized light for all the studied materials at the tube openings. No material inhibited the cell viability in the in vitro test. It was detected IL-6 production in all root-end filling materials. MTA and Sealapex Plus induced a slight raise of mean levels of IL-1β. The results suggest that Sealapex Plus is biocompatible and stimulates the mineralization of the tissue.

Nd:YAG Laser Irradiation effect on apical intracanal dentin-a microleakage and SEM evaluation

The purpose of this in vitro study was to evaluate the effect of neodymium:yttrium-aluminum-garnet (Nd:YAG) laser irradiation on intracanal dentin surface by SEM analysis and its interference in the apical seal of filled canals. After endodontic treatment procedures, 34 maxillary human incisors were randomly assigned to 2 groups. In the negative control group (n=17), no additional treatment was performed and teeth were filled with vertically condensed gutta-percha; in the laser-treated group (n=17), the root canals were irradiated with Nd:YAG laser (1.5 W, 100 mJ, 15 Hz) before filling as described for the control group. Two specimens of each group were prepared for SEM analysis to evaluate the presence and extent of morphological changes and removal of debris; the other specimens were immersed in 0.5% methylene blue dye (pH 7.2) for 24 h for evaluation of the linear dye leakage at the apical third. SEM analysis of the laser-treated group showed dentin fusion and resolidification without smear layer or debris. The Student's t-test showed that the laser-treated group had significantly less leakage in apical third than the control group. Within the limitations of this study, it may be concluded that the morphological changes on the apical intraradicular dentin surface caused by Nd:YAG laser resulted in less linear dye apical leakage.

In vitro susceptibility of oral Candida albicans strains to different pH levels and calcium hydroxide saturated aqueous solution

Candida albicans is present in the oral cavity and in the whole digestive tract of humans and other animals, being frequently related to endodontic treatment failure. The present study determined the incidence of C. albicans in the oral cavity and the susceptibility of isolates to different pH values and saturated calcium hydroxide aqueous solution at pH 12.5. Sixty-five patients attending the Endodontic Clinic at the Sagrado Coração University participated in the study. The collected samples were cultivated in selective media for C. albicans and the isolates were tested in terms of resistance to both alkaline pH and saturated aqueous solution of calcium hydroxide. In relation to time variables, yeast viability was assessed by the Sabouraud's agar culture and fluorescein diacetate and ethidium bromide fluorescent staining method. Results from the different pHs and experimental times, including those from different techniques measuring fungal viability, were compared using the chi-square and Fisher's exact tests (α=0.05). The yeasts became completely inviable after 48 h of contact with the calcium hydroxide solution. On the other hand, when exposed to the alkaline culture broth, the yeasts were found to be viable at pHs 9.5 and 10.5 for up to 7 days. In conclusion, C. albicans can only be completely inhibited by direct contact with saturated calcium hydroxide aqueous solution after 48 h of exposure.

Tooth embedding medium influences the accuracy of electronic apex locator

This study evaluated the influence of tooth embedding media on the accuracy ofan electronic apex locator. The root canal length of 20 human mandibular canines was measured by inserting a 15 K-file into the root canal up to the apical foramen. The distance was measured with a digital caliper. The embedding media evaluated were alginate, saline, floral foam or gauze soaked in saline. Electronic root canal length measurement was performed with Root ZX II. Data were analysed using ANOVA for repeated measurements and Tukey test, at a significance level of 5%. There was no difference between the actual root canal length measurement and the electronic reading recorded with alginate medium. The readings obtained with the other media differed from the actual root canal length measurements. Alginate provided greater accuracy in electronic root canal length determination by Root ZX II than saline, floral foam and gauze.

Apexification with white MTA in an immature permanent tooth with dens invaginatus

Dens invaginatus, also known as dens in dente, is a developmental dental anomaly resulting in an invagination of the enamel organ into the dental papilla. These cases present technical difficulties to the root canal treatment. Apexification using an apical plug of mineral trioxide aggregate (MTA) has been indicated as an alternative to long-term intracanal use of calcium hydroxide in immature permanent teeth. It is considered as a simple and rapid technique. This paper reports a case of Oehlers' Type 1 dens invaginatus in an immature permanent maxillary right lateral incisor, which presented pulp necrosis secondary to dental trauma and was treated by apexification with white MTA apical plugging followed by conventional root canal therapy. The operative procedures are described and the technique is discussed. The physical and biological properties of MTA, associated with appropriate instrumentation and obturation techniques, make this material an excellent option in the endodontic therapy of immature permanent teeth with dens invaginatus.

Micro-CT assessment of two different endodontic preparation systems

The aim of this study was to compare two endodontic preparation systems using micro-CT analysis. Twenty-four one-rooted mandibular premolars were selected and randomly assigned to two groups. The samples (n = 12) of Group 1 were prepared using the ProTaper Universal rotary system, while Group 2 (n = 12) was prepared using the EndoEZE AET system complemented by manual apical preparation with K-type hand files up to #30. A 2.5% sodium hypochlorite solution was used in both groups for irrigating. Both groups were scanned by highresolution microcomputed tomography before and after preparation (SkyScan 1172, SkyScan, Kontich, Belgium). The root canal volume and surface area was measured before and after preparation, and the differences were calculated and analyzed for statistically significant differences using ANOVA complemented by the Tukey test (p < 0.05). The results showed no statistically significant differences between the mean volumes of dentin removal by the two systems. However, the EndoEZE AET system presented a significantly greater mean surface area compared to the ProTaper system (p < 0.05). The EndoEZE AET system enabled preparation of a greater root canal surface area when compared to the ProTaper Universal system. There seemed to be no difference in dentin volume loss between the two systems used.

Histological and immunohistochemical analyses of the chronology of healing process after immediate tooth replantation in incisor rat teeth

Dental tissues have special characteristics, and its regenerative capacity is noteworthy. However, understanding the circumstances that lead to regeneration is challenging. In this study, the chronology of the healing process after immediate replantation of rat incisor teeth was examined by histological and immunohistochemical analyses within a 60-day period. Thirty-six male Wistar rats had their maxillary right incisors extracted and replanted after 15min in saline storage. The rats were sacrificed immediately 3, 7, 15, 28, and 60days after replantation. The histological analysis showed rupture of the periodontal ligament and formation of a blood clot, which started being replaced by a connective tissue after 3days. At 7days, the gingival mucosa epithelium was reinserted and areas of root resorption could be seen. At 15days, the periodontal ligament was repaired. At 3days, the pulp presented an absence of the odontoblast layer, which started being replaced by a connective tissue. This tissue suffered gradual calcification, filling the root canal at 28 and 60days. The root ends were closed. The immunohistochemical analysis revealed greater expression of OP, OPG, and RANK proteins in the initial periods (0 and 3days), while TRAP expression predominated at 28 and 60days (P<0.05). In conclusion, in delayed tooth replantation, there is great new bone formation activity in the earlier periods of the repair process, while a predominance of bone resorption and remodeling is observed in the more advanced periods. © 2012 John Wiley & Sons A/S.