Topography of four different endodontic rotary systems, before and after being used for the 12th time

Root canal preparation may damage NiTi instruments resulting in wear and deformation. The aim of this study was to make a comparative evaluation of the surface topography of the cervical third of four different rotary systems, before and after being used twelve times, in 1.440 resin blocks with simulated root canals with standardized 45 degrees curvatures, and analyzed by atomic force microscopy AFM. The blocks were divided into four groups and prepared according to the manufacturers recommendations: Group 1 - K3 (R); Group 2 - Protaper Universal (R); Group 3 - Twisted Files (R) and Group 4 - Biorace (R). After each preparation, the instruments were washed and autoclaved. A total of 240 instruments were selected, being 30 new instruments and 30 after having been used for the 12th time, from each group. These instruments were analyzed by AFM and for quantitative evaluation, the mean RMS (Root mean square) values of the cervical third of the specimens from the four groups were used. The result showed that all the rotary files used for the 12th time suffered wear with change in the topography of the cervical region of the active portion of the file (ANOVA p < 0.01). Classifying the specimens in increasing order, from the least to the greatest wear suffered, Group 3 (2.8993 nm) presented the least wear, followed by Group 4 (12.2520 nm), Group 1 (36.0043 nm) and lastly, Group 2 (59.8750 nm) with the largest amount of cervical surface wear. Microsc. Res. Tech. 75:97-102, 2012. (c) 2011 Wiley Periodicals, Inc.

Antimicrobial effect of endodontic solutions used as final irrigants on a dentine biofilm model

Aim To evaluate the residual biovolume of live bacterial cells, the mean biofilm thickness and the substratum coverage found in mixed biofilms treated with different endodontic irrigant solutions. Methodology Twenty-five bovine dentine specimens were infected intraorally using a removable orthodontic device. Five samples were used for each irrigant solution: 2% chlorhexidine, 1% sodium hypochlorite (NaOCl), 10% citric acid, 17% EDTA and distilled water. The solutions were used for 5 min. The samples were stained using the Live/Dead technique and evaluated using a confocal microscope. Differences in the amount of total biovolume (mu m3), number of surviving cells (mu m3), mean biofilm thickness (mu m) and substratum coverage (%) of the treated biofilms were determined using nonparametric statistical tests (P < 0.05). Results Similar values of biovolume total, biovolume of live subpopulations and substratum coverage were found in 2% chlorhexidine, 10% citric acid, 17% EDTA and distilled water-treated biofilms (P > 0.05). The lower values of the studied parameters were found in 1% NaOCl-treated dentine (P < 0.05) with the exception of the mean biofilm height criteria that did not reveal significant differences amongst the irrigant solutions (P > 0.05). Conclusions One per cent sodium hypochlorite was the only irrigant that had a significant effect on biofilm viability and architecture.

In Vitro Macroscopic and Endoscopic Analysis of Three-Rooted Maxillary Premolars and Two-Rooted Mandibular Premolars in the Same Individual: a Case Report

The recent addition of endoscopy in dental practice has enabled clinicians to have an excellent view of the operative field, yielding highly successful visualization of anatomical structures that are difficult to access, both in oral surgery and endodontics. The purpose of this report is to provide an in vitro macroscopic, radiographic, and endoscopic description of the anatomic variation of the roots of maxillary and mandibular first premolars in the same patient. A 22-year-old patient was referred by an orthodontist for the extraction of all the first premolars. Once extracted, the premolars were examined macroscopically and then analyzed radiographically after trepanation and filled root canal systems. Subsequently, a diaphanization process was carried out and the samples were sectioned at the middle and apical third for observation by endoscope. It was found that both the maxillary first premolars had three roots, and mandibular first premolars had two roots, all with complete root formation. Apical deltas or accessory canals were not identified in the radiographic images; however, through endoscope at the middle third, it was possible to observe an accessory canal to the first maxillary and mandibular right premolars. Thus, it can be concluded that the view through the endoscope allows better identification of accessory canals than X-rays.

Changes in the surface of four calcium silicate-containing endodontic materials and an epoxy resin-based sealer after a solubility test

Aim To compare the changes in the surface structure and elemental distribution, as well as the percentage of ion release, of four calcium silicate-containing endodontic materials with a well-established epoxy resin-based sealer, submitted to a solubility test. Methodology Solubility of AH Plus, iRoot SP, MTA Fillapex, Sealapex and MTA-Angelus (MTA-A) was tested according to ANSI/ADA Specification 57. The deionized water used in the solubility test was submitted to atomic absorption spectrophotometry to determine and quantify Ca2+, Na+, K+, Zn2+, Ni2+ and Pb2+ ions release. In addition, the outer and inner surfaces of nonsubmitted and submitted samples of each material to the solubility test were analysed by means of scanning electron microscopy and energy-dispersive spectroscopy (SEM/EDX). Statistical analysis was performed by using one-way anova and Tukeys post hoc tests (a = 0.05). Results Solubility results, in percentage, sorted in an increasing order were -1.24 +/- 0.19 (MTA-A), 0.28 +/- 0.08 (AH Plus), 5.65 +/- 0.80 (Sealapex), 14.89 +/- 0.73 (MTA Fillapex) and 20.64 +/- 1.42 (iRoot SP). AH Plus and MTA-A were statistically similar (P > 0.05), but different from the other materials (P < 0.05). High levels of Ca2+ ion release were observed in all groups except AH Plus sealer. MTA-A also had the highest release of Na2+ and K+ ions. Zn+2 ion release was observed only with AH Plus and Sealapex sealers. After the solubility test, all surfaces had morphological changes. The loss of matrix was evident and the filler particles were more distinguishable. EDX analysis displayed high levels of calcium and carbon at the surface of Sealapex, MTA Fillapex and iRoot SP. Conclusions AH Plus and MTA-A were in accordance with ANSI/ADAs requirements regarding solubility whilst iRoot SP, MTA Fillapex and Sealapex did not fulfil ANSI/ADAs protocols. High levels of Ca2+ ion release were observed in all materials except AH Plus. SEM/EDX analysis revealed that all samples had morphological changes in both outer and inner surfaces after the solubility test. High levels of calcium and carbon were also observed at the surface of all materials except AH Plus and MTA-A.

Influence of prior 810-nm-diode intracanal laser irradiation on hydrophilic resin-based sealer obturation

Dentin wall structural changes caused by 810-nm-diode laser irradiation can influence the sealing ability of endodontic sealers. The objective of this study was to evaluate the apical leakage of AH Plus and RealSeal resin-based sealers with and without prior diode laser irradiation. Fifty-two single-rooted mandibular premolars were prepared and divided into 4 groups, according to the endodontic sealer used and the use or non-use of laser irradiation. The protocol for laser irradiation was 2.5W, continuous wave in scanning mode, with 4 exposures per tooth. After sample preparation, apical leakage of 50% ammoniacal silver nitrate impregnation was analyzed. When the teeth were not exposed to irradiation, the Real Seal sealer achieved the highest scores, showing the least leakage, with significant differences at the 5% level (Kruskal-Wallis test, p = 0.0004), compared with AH Plus. When the teeth were exposed to the 810-nm-diode laser irradiation, the sealing ability of AH Plus sealer was improved (p = 0282). In the Real Seal groups, the intracanal laser irradiation did not interfere with the leakage index, showing similar results in the GRS and GRSd groups (p = 0.1009).

Influence of pulp condition on the accuracy of an electronic foramen locator in posterior teeth: an in vivo study

The aim of this study was to assess, in vivo, the accuracy of the NovApex (R) electronic foramen locator in determining working length (WL) in vital and necrotic posterior teeth. The NovApex (R) was used in 144 canals: 35 teeth with vital pulps (68 canals) and 42 teeth with necrotic pulps (76 canals). WL was measured with the NovApex (R) locator and confirmed using the radiographic method. Differences between electronic and radiographic measurements ranging between 0.0 and 0.4 millimeters were classified as acceptable; differences equal to or greater than 0.5 millimeter were considered unacceptable. Pearson's chi-square test was used to assess the influence of pulp condition on the accuracy of NovApex (R) (alpha = 0.05). Regardless of pulp condition, differences between electronic and radiographic WL measurements were acceptable in 73.61% of the canals. No statistically significant differences in accuracy were observed when comparing vital and necrotic canals (p > 0.05). There were 38 unacceptable measurements. In none of these cases was the file tip located beyond the radiographic apex; in 32, it was located short of the NovApex (R) measurement. Pulp condition had no significant effect on the accuracy of NovApex (R).

Variability of physicochemical properties of an epoxy resin sealer taken from different parts of the same tube

Baldi JV, Bernardes RA, Duarte MAH, Ordinola-Zapata R, Cavenago BC, Moraes JCS, de Moraes IG. Variability of physicochemical properties of an epoxy resin sealer taken from different parts of the same tube. International Endodontic Journal,similar to 45, 915920, 2012. Abstract Aim To analyse several physicochemical properties of AH Plus (Dentsply DeTrey, Konstanz, Germany), including setting time, flow, radiopacity and the degree of conversion (DC); and to correlate the results with the source of the material: from the beginning, middle or end of the tubes in which they were supplied. Methodology Three experimental groups were established for each property investigated. Group 1 corresponded to material taken from the beginning of tubes A and B; Group 2 corresponded to material taken from the middle of each tube; and group 3 corresponded to that from the end of each tube. The setting time, flow and radiopacity were studied according to American National Standards Institute/American Dental Association (ANSI/ADA) Specification 57. DC was determined from infrared spectra, which were recorded at 1-h intervals for the first 6 h; then, at 2-h intervals for the next 14 h; then, at 24 and 30 h. Data were analysed statistically by analysis of variance (anova), TukeyKramer, KruskalWallis and Dunn tests, with a significance level of 5%. Results Group 1 had a significantly longer setting time (2303 +/- 1058 min) (P < 0.05). Group 3 had the lowest flowability (30.0 +/- 0.7 mm) and the highest radiopacity (14.85 +/- 1.8 mm Al) (P < 0.05). No differences were found for the DC test (P > 0.05). Conclusion The results suggest that segregation occurs between the organic and inorganic components of AH Plus sealer, thereby changing the setting time, flow and radiopacity.

Fracture susceptibility of endodontically treated teeth

Aim: To assess the influence of cervical preparation on fracture susceptibility of roots. Material and methods: During root canal instrumentation, the cervical portions were prepared with different taper instruments: I: no cervical preparation; II: #30/.08; III: #30/.10; IV: #70/.12. The specimens were sealed with the following filling materials (n = 8), A: unfilled; B: Endofill/gutta-percha; C: AH Plus/gutta-percha; D: Epiphany SE/Resilon. For the fracture resistance test, a universal testing machine was used at 1 mm per minute. Results: anova demonstrated difference (P < 0.05) between taper instruments with a higher value for group I (205.3 +/- 77.5 N) followed by II (185.2 +/- 70.8 N), III (164.8 +/- 48.9 N), and IV (156.7 +/- 41.4 N). There was no difference (P > 0.05) between filling materials A (189.1 +/- 66.3 N), B (186.3 +/- 61.0 N), C (159.7 +/- 69.9 N), and D (176.9 +/- 55.2 N). Conclusions: Greater cervical wear using a #70/.12 file increased the root fracture susceptibility, and the tested filling materials were not able to restore resistance.

Microhardness of Radicular Dentin Treated with 980-nm Diode Laser and Different Irrigant Solutions

Objective: The aim of this study was to evaluate the microhardness of radicular dentin after treatment with 980-nm diode laser and different irrigant solutions. Background data: There are few reports of the consequences of diode laser irradiation emitted at 980 nm on the mechanical properties of dentin. Methods: Seventy-two single canal, human canines with complete root formation were randomly distributed among three groups (n = 24), according to the irrigant solution used in the biomechanical preparation: distilled water; 1% NaOCl; and, 1% NaOCl + 17% EDTA. These groups subsequently were divided into three subgroups (n = 8), according to the diode laser parameter: no irradiation (control); 1.5W/100 Hz; and 3.0 W/100 Hz. Laser was applied with helicoidal movements for 20 sec. Roots were sectioned in slices and the fragment corresponding to the middle third was submitted to the microhardness test (KHN) at depths of 30, 90, 150, and 300 mu m. Results: ANOVA and Tukey tests showed that the microhardness of the groups irradiated with 1.5 W/100 Hz (49.7 +/- 11.2) and 3.0W/100 Hz (50.6 +/- 11.9) were statistically similar to each other (p > 0.05) and different (p < 0.05) from the non-irradiated group (45.0 +/- 9.7). Higher microhardness values were obtained at 150 mu m (49.2 +/- 11.0) and 300 mu m (52.3 +/- 11.3) which were similar among themselves and different (p < 0.05) only at the depth of 30 mu m (44.4 +/- 10.5). No differences were found among the irrigant solutions (p > 0.05). Conclusions: The microhardness of the radicular dentin increased after irradiation with 980-nm diode laser.

Assessing apical transportation in curved canals: comparison between cross-sections and micro-computed tomography

The aim of this study was to compare two methods of assessing apical transportation in curved canals after rotary instrumentation, namely, cross-sections and micro-computed tomography (mu CT). Thirty mandibular molars were divided into two groups and prepared according to the requirements of each method. In G1 (cross-sections), teeth were embedded in resin blocks and sectioned at 2.0, 3.5, and 5.0 mm from the anatomic apex. Pre- and postoperative sections were photographed and analyzed. In G2 (mu CT), teeth were embedded in a rubber-base impression material and scanned before and after instrumentation. Mesiobuccal canals were instrumented with the Twisted File (TF) system (SybronEndo, Orange, USA), and mesiolingual canals, with the Endo Sequence (ES) system (Brasseler, Savannah, USA). Images were reconstructed, and sections corresponding to distances 2.0, 3.5, and 5.0 mm from the anatomic apex were selected for comparison. Data were analyzed using Mann-Whitney's test at a 5% significance level. The TF and ES instruments produced little deviation from the root canal center, with no statistical difference between them (P > 0.05). The canal transportation results were significantly lower (0.056 mm) in G2 than in G1 (0.089 mm) (p = 0.0012). The mu CT method was superior to the cross-section method, especially in view of its ability to preserve specimens and provide results that are more closely related to clinical situations.

Bactericidal effects of two parameters of Er:YAG laser intracanal irradiation: ex-vivo study

The success of endodontic treatment depends on the complete elimination of microorganisms from the root canal system, thus the search for new procedures to eliminate them is justified. The aim of this study was to assess bacterial reduction after intracanal irradiation with the Er:YAG laser. The canals of 70 extracted human maxillary canines were prepared up to file #40 using 1% NaOCl, irrigated with 17% EDTA, and then washed with physiological solution activated by ultrasound. The roots were sterilized by autoclaving, inoculated with 10 mu l of a suspension containing 1.5 x 10(8) CFU/ml of Enterococcus faecalis ATCC 29212 and incubated at 37A degrees C for 72 h. The canals were irradiated with the Er:YAG laser using two energy settings: 60 mJ and 15 Hz, and 100 mJ and 10 Hz. The remaining bacteria were counted immediately and 48 h after laser irradiation. The results showed a high bacterial reduction at both time points. With 60 mJ and 15 Hz there was an immediate reduction of 99.73% and the reduction was 77.02% after 48 h, and with 100 mJ and 10 Hz there was an immediate reduction of 99.95% and the reduction was 84.52% after 48 h. Although the best results were observed with 100 mJ of energy, the difference between the two settings was not statistically significant. The count performed 48 h after irradiation showed that E. faecalis were able to survive, and can grow even from small numbers.

Resistance to Flexural Fatigue of Reciproc R25 Files under Continuous Rotation and Reciprocating Movement

Introduction: The aim of the present work was to evaluate the resistance to flexural fatigue of Reciproc R25 nickel-titanium files, 25 mm, used in continuous rotation motion or reciprocation motion, in dynamic assays device. Methods: Thirty-six Reciproc R25 files were divided into 2 groups (n = 18) according to kinematics applied, continuous rotary (group CR) and reciprocation motion (group RM). The files were submitted to dynamic assays device moved by an electric engine with 300 rpm of speed that permitted the reproduction of pecking motion. The files run on a ring's groove of temperate steel, simulating instrumentation of a curved root canal with 400 and 5 mm of curvature radius. The fracture of file was detected by sensor of device, and the time was marked. The data were analyzed statistically by Student's t test, with level of significance of 95%. Results: The instruments moved by reciprocating movement reached significantly higher numbers of cycles before fracture (mean, 1787.78 cycles) when compared with instruments moved by continuous rotary (mean, 816.39 cycles). Conclusions: The results showed that the reciprocation motion improves flexural fatigue resistance in nickel-titanium instrument Reciproc R25 when compared with continuous rotation movement. (J Endod 2012;38:684-687)

Antimicrobial Photodynamic Therapy for the Treatment of Teeth with Apical Periodontitis: A Histopathological Evaluation

Introduction: This study evaluated the in vivo response of apical and periapical tissues of dogs' teeth with apical periodontitis after one-session endodontic treatment with and without antimicrobial photodynamic therapy (aPDT). Methods: Sixty root canals with experimentally induced apical periodontitis were instrumented and assigned to 4 groups receiving aPDT and root canal filling (RCF) or not: group aPDT+/RCF- (n = 20): aPDT (photosensitizer phenothiazine chloride at 10 mg/mL for 3 minutes and diode laser [2 = 660 nm, 60 mW/cm(2)] for 1 minute) and RCF in the same session; group aPDT+/RCF (n = 10); group aPDT /RCF+ (n = 20), and group aPDT /RCF (n = 10). Teeth were restored, and the animals were killed after 90 days. Sections from the maxillas and mandibles were stained with hematoxylin-eosin and Mallory trichrome and examined under light microscopy. Descriptive (ie, newly formed apical mineralized tissue, periapical inflammatory infiltrate, apical periodontal ligament thickness, and mineralized tissue resorption) and quantitative (ie, periapical lesion size and number of inflammatory cells) microscopic analysis was performed. Quantitative data were analyzed by the Kruskal-Wallis and Dunn tests (alpha =.05). Results: In the aPDT-treated groups, the periapical region was moderately/severely enlarged with no inflammatory cells, moderate neoangiogenesis and fibrogenesis, and the smallest periapical lesions. Conclusions: Although apical closure by mineralized tissue deposition was not achieved, the absence of inflammatory cells, moderate neoangiogenesis, and fibrogenesis in the periapical region in the groups treated with aPDT indicate that this can be a promising adjunct therapy to cleaning and shaping procedures in teeth with apical periodontitis undergoing one-session endodontic treatment. (J Endod 2012;38:360-366)

Toll-like Receptor 2 Knockout Mice Showed Increased Periapical Lesion Size and Osteoclast Number

Introduction: The aim of this study was to characterize the formation and progression of experimentally induced periapical lesions in TLR2 knockout (TLR2 KO) mice. Methods: Periapical lesions were induced in molars of 28 wild type (WT) and 27 TLR2 KO mice. After 7, 21, and 42 days, the animals were euthanized, and the mandibles were subjected to histotechnical processing. Hematoxylin-eosin-stained sections were examined under conventional light microscopy for the description of pulpal, apical, and periapical features and under fluorescence microscopy for the determination of the periapical lesion size. The subsequent sections were evaluated by tartrate resistant acid phosphatase histoenzymology (osteoclasts), Brown and Brenn staining (bacteria), and immunohistochemistry (RANK, RANKL, and OPG). Data were analyzed by the Mann-Whitney U and Kruskal-Wallis tests (alpha = 0.05), Results: The WT group showed significant differences (P < .05) in the periapical lesion size and the osteoclast number between 7 and 42 days and between 21 and 42 days. In the TLR2 KO group, significant differences (P < .05) in the periapical lesion size and the osteoclast number were found between 7 days and the other periods. There was a significant difference (P < .05) between the 2 types of animal regarding the periapical lesion size, which was larger in the TLR2 KO animals. No significant differences (P > .05) were found between WT and TLR2 KO mice related to the pulpal, apical, and periapical features; bacteria localization; and immunohistochemical results (except for RANK expression). Conclusions: TLR2 KO animals developed larger periapical lesions with a greater number of osteoclasts, indicating the important role of this receptor in the host's immune and inflammatory response to root canal and periradicular infection. (J Endod 2012;38:803-813)

Biocompatibility of New Calcium Aluminate Cement (Endo Binder)

Introduction: The purpose of this study was to evaluate the biocompatibility of calcium aluminate cement (EndoBinder) in subcutaneous tissue of rats. Methods: Fifteen rats, weighing 300 g, were separated into 3 groups (n = 5) in accordance with the time of death (7, 21, 42 days). Two incisions were made in the dorsal subcutaneous tissue of each rat in which were implanted 2 polyethylene tubes filled with the test materials, Endo Binder (EB) and Grey MTA (GMTA). The external tube walls were considered the negative control group (CG). After 7, 21, and 42 days, animals were killed, obtaining 5 samples per group, at each time interval of analysis. Results: From the morphologic and morphometric analyses by using a score of (0-3) (50, 100, and 400x), results showed absence of inflammatory reaction (0) for EB after 42 days. However, for GMTA, a slight inflammatory reaction (1) was observed after 42 days, which means the persistence of a chronic inflammatory process. When compared with CG, tissue reaction ranging from discrete (1-7 days) to absent (0-42 days) was observed. Conclusions: EndoBinder presented satisfactory tissue reaction; it was biocompatible when tested in subcutaneous tissue of rats. (J Endod 2012;38:367-371)