Investigation of chemical changes in sealers during application of the warm vertical compaction technique

Aim To assess (i) heat generated by pluggers during warm vertical compaction of gutta-percha and investigation of temperature changes on the external root surface during canal filling, and (ii) the chemical changes of root canal sealers induced by heat.Methodology Four sealers, namely AH Plus, MTA Plus and two other experimental sealers based on tricalcium silicate, were characterised. External temperatures generated on the root surface during warm vertical compaction of gutta-percha with different sealers inside the root canal were monitored using an infrared thermography camera. Chemical changes induced by heating the sealers were assessed by Fourier transform infrared (FT-IR) spectroscopy.Results MTA Plus and the experimental sealers were composed of a cement and radiopacifier, with epoxy resin or a water-soluble polymer as dispersant, whilst AH Plus was epoxy resin-based. The heat generated at the tips of the continuous wave pluggers was found to be lower than the temperature set and indicated on the device LCD display. The sealers reduced the heat generated on the external root surfaces during the heating phase. AH Plus sustained changes to its chemical structure after exposure to heat, whilst the other sealers were unaffected.Conclusions The temperatures recorded at the tips of continuous wave pluggers varied with their taper and were lower than the temperature set on the System B LCD display. Root canal sealers reduced the dissipation of heat generated during warm vertical compaction, with the temperature at the external root surface maintained at 37-41 degrees C, a temperature below that is necessary to cause irreversible damage to bone and periodontium. The use of AH Plus sealer during warm vertical compaction techniques results in chemical changes in the sealer. The effect on sealer properties needs to be further investigated.

Tissue-engineering-based Strategies for Regenerative Endodontics

Stemming from in vitro and in vivo pre-clinical and human models, tissue-engineering-based strategies continue to demonstrate great potential for the regeneration of the pulp-dentin complex, particularly in necrotic, immature permanent teeth. Nanofibrous scaffolds, which closely resemble the native extracellular matrix, have been successfully synthesized by various techniques, including but not limited to electrospinning. A common goal in scaffold synthesis has been the notion of promoting cell guidance through the careful design and use of a collection of biochemical and physical cues capable of governing and stimulating specific events at the cellular and tissue levels. The latest advances in processing technologies allow for the fabrication of scaffolds where selected bioactive molecules can be delivered locally, thus increasing the possibilities for clinical success. Though electrospun scaffolds have not yet been tested in vivo in either human or animal pulpless models in immature permanent teeth, recent studies have highlighted their regenerative potential both from an in vitro and in vivo (i.e., subcutaneous model) standpoint. Possible applications for these bioactive scaffolds continue to evolve, with significant prospects related to the regeneration of both dentin and pulp tissue and, more recently, to root canal disinfection. Nonetheless, no single implantable scaffold can consistently guide the coordinated growth and development of the multiple tissue types involved in the functional regeneration of the pulp-dentin complex. The purpose of this review is to provide a comprehensive perspective on the latest discoveries related to the use of scaffolds and/or stem cells in regenerative endodontics. The authors focused this review on bioactive nanofibrous scaffolds, injectable scaffolds and stem cells, and pre-clinical findings using stem-cell-based strategies. These topics are discussed in detail in an attempt to provide future direction and to shed light on their potential translation to clinical settings.

Ação antimicrobiana da clorexidina gel e líquida e do hipoclorito de sódio

The purpose of this study was to evaluate in vitro antimicrobial activity of chlorhexidine gel and liquid 2%, and 2% sodium hypochlorite on Candida albicans, Enterococcus faecalis, Escherichia coli in root canals. For this, we used 40 human single-rooted teeth were divided into 4 groups (n = 10) according to assist the chemical used: 1) 2% chlorhexidine liquid, 2) 2% chlorhexidine gel, 3) sodium hypochlorite 2%, and 4) physiological saline (control). Content were collected immediately after root canal instrumentation and after 7 days of biomechanical. For the samples was conducted to evaluate the antimicrobial activity and the results were subjected to statistical analysis of Kruskal-Wallis and Dunn's test with a significance of 5%. It was found that chlorhexidine gel and liquid as well as sodium hypochlorite were effective against the microorganisms tested

Avaliação in vitro da ação de substâncias químicas auxiliares, clorexidina e medicações intracanais sobre C. albicans, E. faecalis, E. coli e sua endotoxina em canais radiculares: [recurso eletrônico]

The purpose of this study was to evaluate the antimicrobial activity of chlorhexidine gel 2% as auxiliary chemical substance on the biomechanical preparation (BMP) and medication intracanal (ICM) on C. albicans, E. faecalis, E. coli and their endotoxin in root canals. We used 48 single-rooted human teeth divided into four groups according to dressing ICM: 1) Ca(OH)2 + pyrogen-free saline solution; 2) 2% chlorhexidine gel (CLX); 3) Ca(OH)2 + CLX, and; 4) pyrogen-free saline solution (control group). Were collected the contents of root canals to confirm the presence of microorganisms (confirmation), immediately after instrumentation (1st collection), after 7 days of the BMP (2nd collection), after 14 days of the action of ICM (3rd Collection) and 7 days after removal of the ICM (4 th collection). Were performed: the evaluation of antimicrobial activity and the content analysis of endotoxins for all sampling tests. The results were statistically analyzed using Kruskall-Wallis and Dunn tests with a significance of 5%. It was found that the CLX as auxiliary chemical substance has significantly reduced microorganisms confirmation collection when compared. In relation to the neutralization of endotoxin, it was found that the 1st and 2nd collections presented a decrease of 92.03% and 98.10% in mean percentage respectively, when compared to the confirmation collection. In the 3rd and 4th samplings, the Ca (OH)2 + CLX group showed the best results. It was concluded that the BMP and the ICM were able to eliminate the tested microrganisms, however, they were not able to completely eliminate endotoxins root canal

Propriedades físico-químicas e mecânicas, potencial bioativo e caracterização da interface dentina-cimento de cimentos endodônticos experimentais à base de cimento Portland associados à radiopacificadores micro e nanoparticulados

Pós-graduação em Odontologia - FOAR

Digital radiography for determination of primary tooth length: in vivo and ex vivo studies

Background. Methods for determining the root canal length of the primary tooth should yield accurate and reproducible results. In vitro studies show some limitations, which do not allow their findings to be directly transferred to a clinical situation. Aim. To compare the accuracy of radiographic tooth length obtained from in vivo digital radiograph with that obtained from ex vivo digital radiograph. Method. Direct digital radiographs of 20 upper primary incisors were performed in teeth (2/3 radicular resorption) that were radiographed by an intraoral sensor, according to the long-cone technique. Teeth were extracted, measured, and mounted in a resin block, and then radiographic template was used to standardise the sensor-target distance (30 cm). The apparent tooth length (APTL) was obtained from the computer screen by means of an electronic ruler accompanying the digital radiography software (CDR 2.0), whereas the actual tooth length (ACTL) was obtained by means of a digital calliper following extraction. Data were compared to the ACTL by variance analysis and Pearson’s correlation test. Results. The values for APTL obtained from in vivo radiography were slightly underestimated, whereas those values obtained from ex vivo were slightly overestimated. No significance was observed between APTL and ACTL. Conclusion. The length of primary teeth estimated by in vivo and ex vivo comparisons using digital radiography was found to be similar to the actual tooth length.

Acurácia das medidas de limas endodônticas em radiografias digital e convencional: estudo in vitro em dentes decíduos

The objective of this study is to evaluate the measurement accuracy of endodontic files obtained by digital and conventional radiographies in primary teeth. Kerr and Hedströen files (# 20), with the reference as the apparent length of tooth, were inserted in the root canal of 18 extracted primary teeth, which were x-rayed by digital and conventional techniques. Measurements from a reference point to the apical end were carried out by an experienced operator twice in a week. An electronic ruler was used for the digital method and a caliper was used for the conventional method. The data were subjected to Pearson correlation test and Student´s t test (p = 0.05). The correlation between the first and the second measurements was r = 0.99, regardless the type of file and method. Comparing the measurements within the methods, the agreement was r = 0.96 for Kerr and r = 0.95 for Hedströen files. The values of length files in the digital radiographies were statistically lower than that obtained in the conventional radiographies (p = 0.02). However, the values obtained by the two methods were statistically similar to real length of teeth for Kerr files (p = 0.29) and for Hedströen files (p = 0.18). The digital radiography was a more trustful method to obtain the lengths of endodontic files.

Cutting Ability of Nickel-titanium rotary systems protaper, mtwo and k3

Nickel-titanium rotatory systems should remove dentin during the root canal preparation to promote the enlargement and tapered shape with continuously narrowing towards the apex. Objective: The aim of this study was to analyze the cutting ability of three NiTi rotatory systems (n = 12): ProTaper (group 1), Mtwo (group 2), and K3 (group 3). Material and methods: Thirty six maxillary molar teeth were weighted on an analytical balance before and after the rotatory preparation of the mesio-buccal root canal. Data was statistically analyzed by ANOVA and Tukey s test with a significance level of 5%. Results: The results revealed the following mass differences (g) before and after the root canal preparation: ProTaper (group 1 – 0.0159 ± 0.004), Mtwo (group 2 – 0.0125 ± 0.002), and K3 (group 3 – 0.007 ± 0.003). Conclusion: ProTaper showed the highest cutting ability among the three tested nickel-titanium rotatory systems followed by Mtwo and K3.

Lack of bone healing: an unusual complication following surgically assisted rapid palatal expansion

Bone defects at interdental osteotomy sites are as a complication of surgi-cally assisted rapid palatal expansion (SARPE). The replacement of osseoustissue by fibrous connective tissue impairs the spontaneous closure of adiastema between central incisors, and orthodontic tooth movementthrough the defect area may lead to root resorption. Treatment of such asituation requires an orthodontic-surgical approach. In this report, wedescribe the lack of bone healing at the midline osteotomy site after SARPE,which was treated by autogenous bone grafting as assessed by cone beamcomputed tomography. In addition, we discuss factors related to the aetiol-ogy and treatment of a bone defect after SARPE.

Effects of coronal leakage on concentration of hydrogen ions and calcium hydroxide release of several calcium hydroxide pastes over different periods of time

Purpose: To evaluate the effects of coronal leakage on concentration of hydrogen ions (pH) and calcium release of several calcium hydroxide pastes, over different periods of time. Material and Methods: Fifty extracted human mandibular central incisors (n=10) were instrumented up to the F2 instrument and assigned to the following intracanal dressing: G1- Calen, G2- Calen with 0.4% chlorhexidine (CHX), G3- Calcium hydroxide with camphorated paramonochlorophenol (CPMC) and glycerin, G4- Calen, but temporary filling material maintained during all test (positive control) and G5- Root canal without intracanal dressing (negative control). All groups were immersed in distilled water for 7 days. In sequence, the temporary filling materials were removed, except in controls groups. All specimens were individually mounted on a specific device and only its root again immersed in distilled water. Concentration of hydrogen ions and calcium release by calcium hydroxide pastes in distilled water were evaluated in 24h, 7, 14 and 28 days. The results were submitted to ANOVA test (p = 0.05). After 28 days, root canals from experimental groups were examined in SEM. Results: G1, G2, G3 and G4 presented similar pH values and calcium release and did not differ from each other (p>0.05), up to 7 days. After this time G1, G2 and G3 presented values lower values than G4 (p<0.05). In SEM analysis, calcium hydroxide residues were observed in all experimental groups. Conclusions: After 7 days, coronal leakage decreased the concentration of hydrogen ions and calcium ion release provided by all calcium hydroxide pastes.

CLSM assessment of tubule penetration and bacterial leakage evaluation of two resin-based sealer

Aim: The aims of this study were to assess the penetration of two endodontic sealers (salicylate and epoxy resin-based sealers) into dentinal tubules using CLSM; and to evaluate the bacterial leakage of roots filled with the same sealers associated with gutta-percha. Material and Methods: For sealer penetrability assessment, thirty bovine roots were instrumented and divided into three groups: AHP: EDTA + filling with AH Plus and gutta-percha (n=10), MTAF: EDTA + filling with MTA Fillapex and gutta-percha (n=10), control group: canals were not irrigated with EDTA and were filled with gutta-percha and AH Plus (n=5) or MTA Fillapex (n=5). Rhodamine B was added to the sealers in order to provide adequate fluorescence. The roots were transversely sectioned 3mm from the apex to enable CLSM analysis. Leakage was evaluated for turbidity of the broth in a split chamber model system for 30 days, using Enterococcus faecalis as a microbial marker. Thirty roots were instrumented and divided in four grupos: AHP: filling with AH Plus and gutta-percha (n=10); MTAF: filling with MTA Fillapex and gutta-percha (n=10); positive control: filling with gutta-percha without sealer (n = 5); negative control: sealing with cyanoacrylate to test the seal of the system (n = 5). Results: The medians for dentinal tubule penetration were 6.8% (AHP) and 6.6% (MTAF) (P = 0.82). The average time for bacterial leakage was 8 days in both experimental groups (P = 0.79). Conclusion: MTA Fillapex and AH Plus presented similar behavior regarding dentinal tubule penetration and bacterial leakage.

Evaluación del comportamiento biológico de tres cementos obturadores endodónticos en tejido subcutáneo de ratones

The aim of this study was to evaluate the biological behavior of the root canal filling sealers: Endofill, Endomethasone and Sealer 26 when in contact with the subcutaneous connective tissue of rat. For the study one control and three experimental groups were used. A total of 15 animals were divided into 5 for each period: 7, 21, and 60 days. The obtained histological sections were processed and stained using the hematoxiline & eosine technique. The histological sections were subjective and comparatively analyzed using optic microscopy. The intensity of the inflammatory reaction and the level of fibrosis of the tissue were registered. The results were registered in scores and statistical analysis by KRUSKAL-WALLIS p<0,05 and MILLER methods. The statistical analysis revealed that in the period of 60 days, there was statistical significance to group II (Endofill) between group (control) and III (Endomethasone) with mononuclear cells into connective tissue. All materials promoted inflammatory reaction more intense at 7 and 21 days with the Endomethasone showing the best results.

Influência da reinstrumentação do degrau apical radicular após o posicionamento primário do cone principal de guta-percha noselamento apical

The aim of this study was to evaluate in vitro the apical leakage after the apical re-preparation and replacement of the principal gutta-percha point plus endodontic sealer (Sealer 26TM). Sixty extracted human canines were prepared by using a step back technique up to size 50 K type file apically. At each change of instrument the canals were irrigated with distilled water. After that step, the external surface roots were coated and subdivided into six groups with ten roots each: I – single gutta percha point technique; II – lateral condensation and III – hybrid technique. The IV, V and VI groups were similar to others groups but after to place the principal gutta percha point, it was removed, re-prepared up to size 60K file and in sequence replaced the principal gutta percha point and the root canal filling finished. The specimens were immersed in 2% Rhodamine BTM for 7 days at 37 oC. The apical leakage was measured by Image ToolsTM program. With Kruskal Wallis test statistical analysis showed that there was no significant difference between the techniques (p > 0.05).

Influência do cimento obturador e agente de irrigação final na infiltração marginal em situações de sobreobturações endodônticas

Objective: The objective of this paper was to verify if the final irrigation at 17% EDTA, separately or followed by chlorhexidine digluconate at 2% interferes on the apical marginal leakage in root canal overfilling, due to the use of two root canal filling materials (Sealer 26TM or SealapexTM). Methods: Forty lower incisors extracted, with a single root canal, were biomechanically prepared, at 2.0mm beyond the radicular apex, with ProTaper SystemTM, finishing it with the F3 instrument. Irrigation was accomplished with 1.0 mL NaOCl at 2.5% at each change of equipment caliper and, in the end, with 5.0 mL normal saline solution. After achieving this procedure, the foraminal channels was standardized with a file K 25 until its DO appears in the foraminal opening. From this moment, the teeth were subdivided into two groups of 20 specimens each, because of the final irrigation method used: I – irrigation with EDTA at 17% for 3min and II – identical protocol, thus, after EDTA aspiration at17%, it was again irrigated with chlorhexidine digluconate at 2%, also kept intra-canal for 3min. Each group was again sub-divided into two sub-groups (ten teeth each), according to the cement used (Sealer 26TM or SealapexTM), and filled by using a single gutta-percha F1 (ProTaperTM, Universal Filling), in such a manner that it goes 2.0 mm beyond the radicular apex. Soon after that, the teeth were immersed in Rhodamine BTM for 72h, vacuum and after the roots have been bucolingually grooved, the leakages marked were measured with program Image ToolTM. Results and Conclusions: The leakage magnitude was similar among themselves (p > 0.05), except for group Sealapex®, thus the final use with chlorhexidine reduced apical leakage (p < 0.05).

Avaliação do pH, da solubilidade e da infiltração marginal em retrobturações com o Sealer 26 puro ou acrescido de iodofórmio

Sealer 26® cement contains bisphenol epoxy resin associated with calcium hydroxide, presenting smaller radiopacity than other endodontic cements. Aiming to improve this property, iodoform has been added in its composition. However, this addition's possible changes in physical and chemical properties still need to be studied. OBJECTIVE: To evaluate the apical sealing ability, solubility, and pH of Sealer 26® alone or with iodoform, at several proportions. MATERIAL AND METHODS: Three experimental mixtures of Sealer 26®, alone or with iodoform, were prepared and subjected to solubility test. Additionally, these combinations were inserted into polyethylene tubes and immersed in distilled water, and, their pH was evaluated after 24-h and 7-day periods. Subsequently, forty roots of extracted lower incisors subdivided into four groups of 10 specimens each, were retrograde filled with one of the previously described mixtures and gutta-percha points. The roots were immersed in Rhodamine B, under vacuum, for 72 hours. After this period, the specimens were longitudinally sectioned, root fragments photographed, these images scanned, and apical infiltration measured by Image tool software. The obtained data were subjected to statistical analysis, at a significance level of 5%. RESULTS: Marginal leakage and solubility tests did not show any difference among the experimental groups (p > 0.05). pH analysis was only statistically different at 24-h period and between Sealer 26® alone and 1.1g iodoform group (p < 0.05). CONCLUSION: The presence of iodoform in Sealer 26®, at the used proportions, did not alter the solubility, apical marginal leakage and pH properties of the original cement.