Efficacy of Endodontic Treatment for Endotoxin Reduction in Primarily Infected Root Canals and Evaluation of Cytotoxic Effects

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

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.

Root surface treatment using diode laser in delayed tooth replantation: radiographic and histomorphometric analyses in rats

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

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.

Action of propolis and medications against Escherichia coli and endotoxin in root canals

This study evaluated the action of propolis and intracanal medications against Escherichia coli and endotoxin. Forty-eight dental roots were contaminated with E. coli. The root canals were instrumented with propolis and divided into groups according to the type of intracanal medication: Ca(OH)(2), polymyxin B, or Ca(OH)(2) + 2% chlorhexidine gel. In the control group, saline solution was used without application of intracanal medication. Counts of colony-forming units were carried out and the endotoxin was quantified by the chromogenic Limulus amobocyte lysate assay. The results were evaluated by analysis of variance and the Dunn test (5%). Root canal irrigation with propolis was effective to completely eliminate E. coli and reduce the amount of endotoxins. All intracanal medications contributed to the significant decrease in endotoxins. Only intracanal medications may reduce the amount of endotoxins in the root canals. The greatest efficacy was observed for medications containing Ca(OH)(2). (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;110:e70-e74)

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.

The Disk-Specimen Thickness Does Not Influence the Push-Out Bond Strength Results Between Fiber Post and Root Dentin

This study evaluated the effect of different thickness of disk-shaped specimens on the push-out bond strength test. Eighteen lower bovine teeth were sectioned (20mm) and prepared (15mm) with the same post system drill (Light Post (R) #1, Schaumburg, IL, Bisco, USA). The apical third of each specimen was embedded in a plastic matrix filled with an acrylic resin (Dencrilay (TM), Dencril, São Paulo, Brazil). The posts were cleaned with alcohol, silanated (ProSil (R), FGM, Joenville, SC, Brazil) and cemented with the RelyX (TM) U100 (3M ESPE, St. Paul, MN, USA). Each specimen was sectioned into three pieces of differing thicknesses (1, 2, and 4 mm). These disk-samples were allocated into 3 groups (n=18) and subjected to push-out testing. One-way ANOVA showed no influence of the specimen thickness on the results (p=0.842). No correlation was observed between thickness and push-out bond strength (Pearson Correlation, r(2)=0.0688; P=0.6209). The push-out bond strength test was not affected by the thickness of the disk-specimens.

The adhesive system and root canal region do not influence the degree of conversion of dual resin cement

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

Effects of Nd : YAG and Er : YAG lasers on the sealing of root canal fillings

Objective: the ability of the laser irradiation to promote the cleaning and disinfection of the radicular canal system has become this type of treatment in a viable and real alternative in endodontics. The purpose of this study was to evaluate the apical marginal sealing of root canal fillings after the irradiation with the laser of Nd:YAG or of Er:YAG. Materials and Methods: Forty-two human, extracted single-rooted teeth had their crowns sectioned and the root canals prepared with a no. 70 K-file. Then, they were dried and divided into three groups according to canal wall treatment: group 1: the canals were filled with EDTA for 3 min, followed by irrigation with 1% sodium hypochlorite solution; group 2: the canal walls were irradiated with Nd:YAG laser; and group 3: the canal walls were irradiated with Er:YAG laser. Afterwards, the root canals were obturated by the lateral condensation technique. The roots were externally waterproof, except in the apical foramen and immerged in 2% methylene blue aqueous solution during 48 hours. Results: the results showed that the largest infiltrations happened in the group 3-Er:YAG (7.3 mm), proceeded by the group 1-EDTA (1.6 mm) and by the group 2-Nd:YAG (0.6 mm). The group Er:YAG differed statistically of the others (p < 0.05). Conclusion: It was concluded that the Er:YAG laser intracanal irradiation previously to the root canal filling must be used with caution until future research is define the best parameters for it's use.

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.