Análise do tempo de ação de medicações intracanais sobre candida albicans, enterococcus faecalis, escherichia cole em canais radiculares

The purpose of this study was to evaluate in vitro the antimicrobial activity of intracanal medications against Candida albicans, Enterococcus faecalis, Escherichia coli present in root canals. It was used 24 single root human teeths, contaminated for 28 days and prepared with physiological saline solution as irrigation solution. The teeth were divided into 2 groups according to the intracanal medication used: 1) 2% gel chlorhexidine, 2) sterile and pyrogen free physiological saline solution. Samples were taken of the root canals immediately after instrumentation, 7 days after intracanal medication and 7 days after removal of intracanal medication. For all samples the antimicrobial activity was performed by plating method. All results were submitted to Mann-Whitney and Dunn's test with significance of 5%. There was significant reduction of microorganisms after instrumentation and the intracanal medication of 2% gel chlorhexidine completely eliminated C. albicans and E. coli, and significantly reduced E. faecalis. It was concluded that 2% gel chlorhexidine as intracanal medication for 7 days was effective on microorganisms

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

Estudo morfométrico do canal do hipoglosso

The hypoglossal nerve (HN) is responsible for the intrinsic and extrinsic muscles of the tongue. Knowledge of this is extremely important because this nerve is responsible for tongue movement. HN paralysis can be associated to the disease itself in various zones in which the NH travels, mainly the hypoglossal canal (HC). Variations in shape of the hypoglossal canal have been pointed to as the cause of HN paralysis in several studies. Four hundred dried intact human skulls without sex or race identification, belonging to the Discipline of Anatomy of ICTSJC – UNESP were studied. Each canal was classified into types: type I (without division in the HC), type II (HC with low bone spike), type III (HC more than two projections bone), type IV (presence of complete bony bridge without dividing HC into two distinct canals) and type V (presence of bone bridge by dividing into two HC canals). HC was found in 100% of skulls studied in both side. Regarding types, we found 538 (67.25%) hypoglossal canal of type I (34%, right side and 33.25%, left side), 108 (13.5%) of type II (7.38%, right side, and 6.13%, left side), 60 (7.5%) hypoglossal canal of type III (3.5%, right side and 4.0%, left side) 84 (10.5%) of type IV (4.75%, right side and 5.75%, left side) and 5 (0.63%) of the type V (0.13%, right side and 0.5%, left side). We found 5 (0,63%) different HC and classified ourselves in type VI, VII and VIII. The average angle was 51,3º on right side and 50,25º on left side. Detailed knowledge of the anatomy of the CH supports professionals in interventions of bloody skull base and also in giving the correct diagnosis of the probable causes of paralysis of the hypoglossal nerve

Estudo da anatomia interna dos incisivos laterais superiores pelos métodos radiográficos digital e convencional

The maxillary lateral incisor has a very peculiar and internal morphology that can be influenced by the its external anatomy such as supernumerary roots and ruts deep root, which often hinders an effective endodontic treatment. Generally, this tooth have a single root with one root canal, but teeth with two to four channels can be found. The main canal can present ramifications such as accessory canals, laterals, collaterals, recorrents and apical deltas. All this factors interfere directally on endodonthics treatment. The objective of this work is a study of the internal anatomy of the maxillary lateral incisors by digital and conventional radiographics methods, comparing the results obteined by each method Six hundred upper lateral incisor were used in this study teeth of the collection of the Department of Anatomy ICT – UNESP. All the teeth were radiographed by vestibular face, using a digital radiographic unit(Dabi Atlante). After this step, all the teeth underwent by conventional radiographic technique(Kodak 2200) so that the results obtained were compared. To classify the channel system, it was adopted the classification of Pucci and Reig. All data obtained by digital technique were compared with those obtained in the conventional technique and were subjected to statistical analysis

Avaliação histológica de estratégias de engenharia tecidual para a terapia endodôntica

Pós-graduação em Ciência Odontólogica - FOA

Comparação entre soluções irrigadoras na endodontia: clorexidina x hipoclorito de sodio

The objective of this review was reporting an overview about the properties of two irrigating solutions, solution of sodium hypochlorite and chlorhexidine, used in the treatment of root canals. A solution must submit irrigating antimicrobial action, dissolve waste tissue, promote wetting to facilitate the instrumentation, and present biocompatibility with the adjacent tissues. The sodium hypochlorite used in different concentrations has been the solution of choice among professionals by presenting antimicrobial action and act as a solvent tissue. However, today, chlorhexidine has been widely used as an irrigating solution due to specific properties that enable its use, such as substantivity, antimicrobial effectiveness, and low toxicity. Thus the solution of chlorhexidine with different concentrations is presented as an alternative to irrigating solution for the treatment of root canals.

Incomplete vertical root fracture associated with lateral compaction technique: a microscopic analysis

Objective: This study evaluated the effects of root canal obturation employing lateral compaction technique and spreader load of 1.5 kg on the incidence of complete (CVRF) or incomplete vertical root fractures (IVRF). Material and Methods: Twenty-seven distal roots of extracted human mandibular molars were used. All root canals were prepared by biomechanical step-back technique and obturated by lateral compaction technique. The prepared roots were distributed into two groups: G1- experimental (n = 17) and G2- control (n = 10). During obturation, load of 1.5 kg was applied to a size # 30 finger spreader. Pre- and post-obturation images of the coronal portion of the roots were captured by inverted digital microscopy and analyzed by one trained examiner. Data were evaluated by Fisher’s test (p < 0.05) using GrapH Pad Prism 5.0. Results: No roots exhibited CVRF. All fractures observed before and after obturation were IVRF or “other defects”. In G2 (control group), there was no increase of IVRF number. Interestingly, G1 presented an increase in the IVRF number to 70.59% in the 12 teeth out of 17 teeth studied. The statistical analysis showed that the mean of IVRF increased significantly in G1 when compared to G2 (p < 0.05). Conclusion: The application of a 1.5 kg spreader load during lateral compaction technique does not produce complete vertical root fractures, but may produce incomplete fractures or “other defects”.

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.

Comparative analysis of three rotary instruments used for coronal pre-enlargement in radicular dentin thickness and root canal area of mandibular molars

Purpose: The purpose of this study was to evaluate the increase of the cervical area and dentin thickness in mesial and distal walls of the mesial canals from mandibular molars after the use of LA Axxess (LA), CP Drill (CP) and Gates-Glidden (GG) rotary instruments. Material and Methods: Sixty root canals from thirty mandibular first molar were sectioned 3 mm below the cement-enamel junction, divided in 3 groups (n = 20 root canals, each) according to rotary instrument used, and the cervical images were captured before and after pre-enlargement instrumentation. The increase of the instrumented cervical area (mm2) and the dentin removal thickness (mm), at mesial and distal walls were calculated using Image tools software, by comparison of images. Data were analyzed by ANOVA and Tukey tests (p=0.05). Results: All rotary instruments promoted thickness reduction in dentin walls. In mesial wall, all rotary instruments promoted similar thickness reduction of dentinal wall and did not differ from each other (p>0.05). In distal wall, LA Axxess instrument promoted higher dentin thickness reduction than other groups (p<0.05). The three rotary instruments promoted different increase at the instrumented cervical area (p<0.05), LA promoted the highest increase area and GG and CP presented similar results. Conclusion: LA 20/0.06 promoted the highest thickness reduction in distal wall and increase of cervical area of root canal. On the other hand, CP was the safest instrument, with lower dentin removal of distal wall and similar increased area to GG.

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.

Avaliação in vitro do pH do hidróxido de cálcio usado como medicação intracanal em associação com clorexidina e racealfatocoferol

Objective: The aim of this study was to evaluate the pH of calcium hydroxide (CalenTM) when associated or not with chlorhexidine 0.4%, and when associated with chlorhexidine with the addition of 20% or 10% of alphatocopherol (AchéTM), assessed in several periods of time. Methods: Fourty dentine tubes 20 mm, properly standardized, were made from bovine anterior teeth roots. Following, a perforation was achieved in the roots distal face at 7 mm from the cervical radicular line by using a #1/2 carbide bur. After complete root sealing is made, except in the perforation local, the radicular canals were filled with one of the following associations: Group I – Calen®; Group II – Calen™ with chlorehxidine at 0.4%; Group III – Calen™ with chlorhexidine at 0.4% with the addition of 20% (weight) of alhatocopherol compound and Group IV – Calen™ with chlorhexidine at 0.4% with the addition of 10% (weight) alphatocopherol. After cervical sealing is accomplished, the roots were immersed in water MiliQ and the pH, assessed in 24h, 7, 14, 21, 28 and 45 days. Results and Conclusion: In all periods tested, the pH of the calcium hydroxide (Calen™) was similar to the pH of the calcium hydroxide (Calen™) associated with chlorhexidine 0.4% and 10% alphatocopherol (p > 0.05). The association of 20% alphatocopherol obtained the pH lower than the association with 10% (p < 0.05). The pH of the association with chlorhexidine was similar to the pure calcium hydrocide (Calen™) after the 14th day (p > 0.05) only. Therefore, on the 45th day, this difference was significant again (p < 0.05).

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).

Avaliação da eficácia de limpeza de quatro agulhas irrigadoras endodônticas

The irrigation of root canals aims to their cleaning and disinfection, improving endodontic treatment success. OBJECTIVE: To investigate the influence of the diameter and type of irrigation needle and the root canal enlargement on the mechanical efficacy of endodontic irrigation. MATERIAL AND METHODS: Twelve human single-rooted mandibular incisors were used. During some instrumentation stages (enlargement by #20, #30, and #40 K file), root canals were filled with radiographic contrast solution mixed to propyleneglycol and zinc oxide. Needles with different diameters and designs were employed: G1 – 23G and lateral opening; G2 – 22G and apical opening; G3 – 30G and lateral opening; G4 – 30G and apical opening. The needles were inserted up to resistance, with 1 mm step-back to avoid root canal obliteration. The irrigation was performed with 2 mL of distilled water. Before and after irrigation/aspiration, teeth were radiographed at bucco-lingual and mesiodistal direction, using a digital radiographic system. Then, root canal areas, before (filled by contrast solution) and after irrigation (remnant of contrast solution), were submitted to image subtraction with Adobe Photoshop CS4 software. Subsequently, the areas were measured by Image Tool 3.0 software, allowing the obtaining of the cleaning percentage for each modality. Data were analysed by using Anova and Tukey's test. The level of significance was set at P < 0.05. RESULTS: For all root canal enlargements, 30G needles (G3 e G4) presented a better cleaning efficacy. In all groups, higher cleaning efficacy percentage was observed at #30 and #40 K file enlargement. CONCLUSION: Regardless their design, thinner needles were more effective; a better cleaning efficacy occurred in more enlarged root canals.

Influência da agulha irrigadora e da dilatação do canal radicular na eficácia da irrigação endodôntica

Introduction: The irrigation of root canals aims to their cleaning and disinfection, improving endodontic treatment success. Objective: To investigate the influence of the diameter and type of irrigation needle and the root canal enlargement on the mechanical efficacy of endodontic irrigation. Material and methods: Twelve human single-rooted mandibular incisors were used. During some instrumentation stages (enlargement by #20, #30, and #40 K file), root canals were filled with radiographic contrast solution mixed to propyleneglycol and zinc oxide. Needles with different diameters and designs were employed: G1 – 23G and lateral opening; G2 – 22G and apical opening; G3 – 30G and lateral opening; G4 – 30G and apical opening. The needles were inserted up to resistance, with 1 mm step-back to avoid root canal obliteration. The irrigation was performed with 2 mL of distilled water. Before and after irrigation/aspiration, teeth were radiographed at bucco-lingual and mesiodistal direction, using a digital radiographic system. Then, root canal areas, before (filled by contrast solution) and after irrigation (remnant of contrast solution), were submitted to image subtraction with Adobe Photoshop CS4 software. Subsequently, the areas were measured by Image Tool 3.0 software, allowing the obtaining of the cleaning percentage for each modality. Data were analysed by using Anova and Tukey’s test. The level of significance was set at P < 0.05. Results: For all root canal enlargements, 30G needles (G3 e G4) presented a better cleaning efficacy. In all groups, higher cleaning efficacy percentage was observed at #30 and #40 K file enlargement. Conclusion: Regardless their design, thinner needles were more effective; a better cleaning efficacy occurred in more enlarged root canals.

Effectiveness of ProTaper retreatment system associated with organic solvents in the removal of root canal filling material

Aim: To evaluate the effectiveness of ProTaper universal retreatment system in the removal of root canal filling material with thermomechanical compaction, in comparison to manualmechanical technique, associated with orange oil or eucalyptol. Materials and methods: Forty extracted lower incisors were filled with thermomechanical compaction technique. After 3 years, the root canal filling was removed by: G1 - manualmechanical technique with orange oil; G2 - manual-mechanical technique with eucalyptol; G3 - ProTaper universal retreatment system with orange oil and G4 - ProTaper universal retreatment system with eucalyptol. In sequence, all root canals were instrumented to F5 instrument. The teeth were longitudinally grooved, images of buccal half were obtained in stereomicroscope and covered area by root canal filling material was measured using image tool software, in cervical, middle and apical radicular thirds. The results were subjected ANOVA and Tukey test (p = 0.05). Results: In all thirds, the manual-mechanical technique showed lower presence of root canal filling material on root canal dentin in comparison to ProTaper retreatment universal system, regardless of organic solvent used (p < 0.05). There is no difference between organic solvents in removal root canal filling material (p > 0.05). Conclusion: The ProTaper universal retreatment system showed lower effectiveness in removal root canal filling material than manual-mechanical technique, regardless of organic solvents (orange oil or eucalyptol oil) used. Clinical significance: Recently rotary instruments have been proposed to removal of root canal filling material. However, there are no studies evaluating its effectiveness in removal root canal filling material in association with orange oil or eucalyptol oil.