Calcium hydroxide root canal sealers: Evaluation of pH, calcium ion concentration and conductivity

The calcium hydroxide ionization of four root canal sealers (Sealapex, CRCS, Sealer 26, and Apexit) was studied by measuring conductivity and pH and by conducting atomic absorption spectrophotometry. Samples 6 mm in diameter and 15 mm long were prepared from these sealers. After setting and 48 h storage in a desiccator, five samples of each material were placed in 50 mL distilled water and analysed after 0,1,2,4, 6 and 24 h and 5, 15 and 30 days. The results showed that Sealapex was the root canal sealer showing the highest pH, ionic calcium and total calcium values (P<0.05) throughout the experimental period, followed by CRCS, Apexit and Sealer 26.

Effect of different root canal sealers on periapical repair of teeth with chronic periradicular periodontitis

Teeth with induced chronic periradicular periodontitis in dogs were root canal treated. After the biomechanical preparation, using K files and 5.25% sodium hypochlorite as the irrigant solution, all root canals were dressed with an antibacterial dressing based on calcium hydroxide, which was left in place for 7 days. After this time, the root canals were obturated with lateral condensation of cold gutta-percha with either a calcium hydroxide root canal filling material (Sealapex) or a zinc oxide-eugenol sealer (Fill Canal). After 270 days, histopathological analysis showed better apical and periapical repair in the teeth obturated with Sealapex (P < 0.05).

Connective tissue responses to calcium hydroxide-based root canal medicaments

Aim: The objective of the present study was to evaluate the tissue inflammatory response induced by calcium hydroxide pastes, with or without paramonochlorophenol and camphor. Methodology: Isogenic BALB/c mice were inoculated into the subcutaneous tissue with either 0.1 mL of a suspension of Calen, Calen with camphorated paramonochlorophenol, Calen with paramonochlorophenol, Calasept paste or phosphate-buffered saline (control). After 6, 12 and 24 h and 2, 3, 5, 7 and 15 days, three animals in each group were sacrificed and the excised lesions processed for histopathological evaluation of the inflammatory response. Events monitored and graded included the assessment of vascular congestion, oedema, haemorrhage, inflammatory infiltrate, necrosis and tissue repair. Results: The pastes induced an inflammatory response at every observation period, although the intensity, duration and extension of inflammation varied. Calen paste always produced an initial short-term inflammatory response whilst the other pastes produced extended reactions. All pastes allowed repair to take place by the end of the experimental period, although the speed of this process varied between the materials. Calen presented the best biocompatibility; the phenolic compound caused greater tissue response, which was even more severe in the absence of camphor. Calasept paste was damaging and the repair process slower. Conclusions: All calcium hydroxide formulations caused an inflammatory response. The severity and longevity of the responses varied between pastes as a result of the various antiseptic agents. Although irritating, repair was apparent with all formulations.

Reaction of dogs' teeth to root canal filling with mineral trioxide aggregate or a glass ionomer sealer

This study was conducted to observe the reaction of apical tissues of dogs' teeth after root canal filling with gutta-percha and mineral trioxide aggregate (MTA) or a glass ionomer (Ketac-Endo) as a sealer. The root canals were instrumented and filled by the lateral condensation technique with the sealers studied. Animals were killed 6 months later, and the specimens were removed and prepared for histological analysis. Results showed no inflammatory reaction of apical tissue and total closure of the apical foramen of all the teeth sealed with MTA. The teeth sealed with Ketac-Endo showed two cases of partial closure and different degrees of chronic inflammatory reaction. In conclusion, MTA exhibited better biological properties than Ketac-Endo. Copyright © 1999 by The American Association of Endodontists.

A comparison of molar root canal preparation using stainless-steel and nickel-titanium instruments

Fifty-four extracted human mandibular molars were embedded and sectioned at two levels. The reassembled mesial root canals were prepared with stainless-steel hand K-files (Flexofiles) and either Nitiflex or Mity nickel-titanium hand K-files using a push-pull anticurvature filing technique. Each of the three experimental groups contained 36 mesial canals randomly distributed. Superimposed pre- and postinstrumentation cross-sectional root images were magnified using a stereomicroscope and transferred to a computer for measurement and statistical analysis. The direction and extent of canal center movement were evaluated. At the apical level, the groups produced no significant difference of direction of canal center movement. In cervical sections, all groups tended to move in a distolingual direction. The three groups, however, produced no significant difference in the cervical sections in the extent of canal center movement. In apical sections, Nitiflex produced the least canal center movement. Copyright © 1999 by The American Association of Endodontists.

Evaluation of cell culture cytotoxicity of five root canal sealers

The cytotoxicity of four calcium hydroxide-based root canal sealers (Sealapex, CRCS, Apexit, and Sealer 26) and one zinc oxide-eugenol-based sealer (Fill Canal) was evaluated microscopically for morphological changes in rat peritoneal macrophages. The least cytotoxic sealer was Fill Canal, followed in increasing order of cytotoxicity by CRCS, Sealer 26, Apexit, and Sealapex. Copyright © 2000 by The American Association of Endodontists.

Calcium hydroxide root canal dressing. Histopathological evaluation of periapical repair at different time periods.

The objective of this study was to evaluate periapical and apical repair using calcium hydroxide root canal dressings for different lengths of times in teeth with induced chronic periapical lesions. A total of 61 root canals of maxillary and mandibular premolars from 4 dogs were used. After mechanical preparation of the root canals using the crown-down technique, and 5.25% NaOCl as irrigating solution, the apical foramen was enlarged in all cases. A calcium hydroxide root canal dressing was applied. The control group did not receive a root canal dressing. The animals were killed at 7, 15 or 30 days. After histological preparation, serial sections were stained with hematoxylin-eosin and Mallory's trichrome. The best histopathological results occurred at 15 and 30 days, and the worst results occurred at 7 days and in the control group.

Effects of copper vapor laser radiation on the root canal wall of human teeth: A scanning electron microscope study

Objective: The aim of this study is to analyze the effects of copper vapor laser radiation on the radicular wall of human teeth. Materials and Methods: Immediately after the crowns of 10 human uniradicular teeth were cut along the cement-enamel junction, a chemical-surgical preparation of the radicular canals was completed. Then the roots were longitudinally sectioned to allow for irradiation of the surfaces of the dentin walls of the root canals. The hemi-roots were separated into two groups: one (control) with five hemi-roots that were not irradiated, and another (experimental) with 15 hemi-roots divided into three subgroups that were submitted to the following exposure times: 0.02,0.05, and 0.1 s. A copper vapor laser (510.6 nm) with a total average power of 6.5 W in green emission, frequency of 16.000 Hz, and pulse duration of 30 ns was used. Results: The results obtained by scanning electron microscope analysis showed the appearance of a cavity in the region of laser beam impact, with melting, recrystallization, and cracking on the edges of the dentin of the cavity due to heat diffusion. Conclusions: We determined that the copper vapor laser produces significant morphologic changes in the radicular wall of human teeth when using the parameters in this study. However, further research should be done to establish parameters that are compatible with dental structure in order to eliminate thermal damages. © Mary Ann Liebert, Inc.

Effect of rotary instrumentation and of the association of calcium hydroxide and chlorhexidine on the antisepsis of the root canal system in dogs

This study aimed at evaluating the antisepsis of the root canal system (RCS) and periapical region (PR) provided by rotary instrumentation associated with chlorhexidine + calcium hydroxide as intracanal medicament. Chronic periapical lesions were induced in 26 pre-molar roots in two dogs. After microbiological sampling, automatic instrumentation using the Profile system and irrigation with 5.25% sodium hypochlorite solution, with a final rinse of 14.3% EDTA followed by profuse irrigation with physiological saline were carried out in 18 root canals. After drying the canals, a paste based on calcium hydroxide associated with a 2% chlorhexidine digluconate solution was placed inside them. After 21 days, the medication was removed, leaving the root canals empty and coronally sealed. After 96 hours, a final microbiological sample was obtained, followed by histomicrobiological processing by the Brown & Brenn method. Eight untreated root canals represented the control group (C-G). Based on the Mann-Whitney test at a confidence level of 5% (p < 0.05), the procedures of antisepsis used offered significant efficacy (p < 0.05) resulting in 100.0% of the canals free of microorganisms. In the C-G, an elevated incidence of various microbial morphotypes was confirmed in all sites of the RCS, with the presence of microbial colonies in the periapical region. In contrast, the experimental group showed a similar pattern of infection in the RCS, although less intense and a reduced level of periapical infection (p < 0.05). It was concluded that adequate instrumentation followed by the application of calcium hydroxide + chlorhexidine offered significant elimination of microorganisms.

Delayed tooth replantation after root surface treatment with sodium hypochlorite and sodium fluoride: Histomorphometric analysis in rats

In cases of delayed tooth replantation, non-vital periodontal ligament remnants have been removed with sodium hypochlorite in an attempt to control root resorption. Nevertheless, reports of its irritating potential in contact with the alveolar connective tissue have been described. Therefore, this study evaluated the healing process on delayed replantation of rat teeth, after periodontal ligament removal by different treatment modalities. Twenty-four rats, assigned to 3 groups (n=8), had their upper right incisor extracted and left on the workbench for desiccation during 60 min. Afterwards, the teeth in group I were immersed in saline for 2 min. In group II, root surfaces were scrubbed with gauze soaked in saline for 2 min; and in group III, scrubbing was done with gauze soaked in 1% sodium hypochlorite solution. Thereafter, root surfaces were etched with 37% phosphoric acid and immersed in 2% acidulate-phosphate sodium fluoride solution, at pH 5.5. Root canals were filled with a calcium hydroxide-based paste and the teeth were replanted. The animals were sacrificed 60 days postoperatively and the pieces containing the replanted teeth were processed and paraffin- embedded. Semi-serial transversally sections were obtained from the middle third of the root and stained with hematoxylin and eosin for histomorphometric analysis. Data were analyzed statistically using Kruskal-Wallis and Dunn's tests. The results showed that root structure and cementum extension were more affected by resorption in group III (p<0.05). All groups were affected by root resorption but the treatment performed in group III was the least effective for its control. The treatment accomplished in groups I and II yielded similar results to each other.

Evaluation of the biocompatibility of root canal sealers using subcutaneous implants

The purpose of this study was to evaluate in vivo the biocompatibility of Endométhasone, Pulp Canal Sealer EWT and AHPlus root canal sealers after implantation in rat connective tissue. Twenty-four Wistar-Furth rats were used. Polyethylene tubes were filled with the sealers and implanted into specific dorsal subdermal tissue sites of the rats. Implants were removed after 3, 7 and 30 days, fixed and processed for glycol methacrylate-embedding technique to be examined microscopically. On the 3rd day, there was a mild inflammatory reaction to Pulp Canal Sealer EWT implants, but a severe response to the other sealers with presence of acute inflammatory cells. On the 7th day, tissue organization was more evident with attenuation of the inflammatory reaction, especially for the AH-Plus implants. On the 30th day, connective tissue with few inflammatory cells was observed in contact with all sealer implants. In this time interval, the tissue in contact with Pulp Canal Sealer EWT implants was more organized, while the tissue close to Endométhasone and AH-Plus implants showed a mild persistent inflammatory reaction and had similar results to each other. In conclusion, the sealers had a similar pattern of irritation, which was more severe in the beginning and milder with time, in such a way that all sealers showed a persistent mild reaction. Pulp Canal Sealer EWT yielded better tissue organization than Endométhasone and AH-Plus, which, in turn, showed similar results to each other.

Residual antibacterial activity of chlorhexidine digluconate and camphorated p-monochlorophenol in calcium hydroxide-based root canal dressings

The purpose of this study was to evaluate the residual antibacterial activity of several calcium hydroxide [Ca(OH) 2]-based pastes, placed in root canals of dogs' teeth with induced chronic periapical lesions. Root canals were instrumented with the ProFile rotary system and filled with 4 pastes: G1 (n=16): Ca(OH) 2 paste + anesthetic solution; G2 (n=20): Calen® paste + camphorated pmonochlorophenol (CMCP); G3 (n=18): Calen®; and G4 (n=18): Ca(OH) 2 paste + 2% chlorhexidine digluconate. After 21 days, the pastes were removed with size 60 K-files and placed on Petri plates with agar inoculated with Micrococcus luteus ATCC 9341. Pastes that were not placed into root canals served as control. After pre-diffusion, incubation and optimization, the inhibition zones of bacterial growth were measured and analyzed by Mann-Whitney U test at 5% significance level. All pastes showed residual antibacterial activity. The control samples had larger halos (p<0.05). The mean residual antibacterial activity halos in G1, G2, G3 and G4 were 7.6; 10.4; 17.7 and 21.4 mm, respectively. The zones of bacterial growth of G4 were significantly larger than those of G1 and G2 (p<0.05). In conclusion, regardless of the vehicle and antiseptic, all Ca(OH) 2-based pastes showed different degrees of measurable residual antibacterial activity. Furthermore, unlike CMCP, chlorhexidine increased significantly the antibacterial activity of Ca(OH) 2.

Periapical tissue healing after post space preparation with or without use of a protection plug and root canal exposure to the oral environment. Study in dogs

The purpose of this study was to evaluate the influence of coronal leakage on the healing of dogs' periapical tissues after root canal filling, post space preparation and protection or not with a temporary sealer plug. Forty root canals of dogs' teeth were instrumented and filled by the lateral condensation technique with gutta-percha points and Endomethasone or CRCS sealers. After post space preparation, the remaining filling material was protected or not with a plug of temporary Coltosol sealer and exposed to the oral environment for 90 days. Thereafter, the animals were sacrificed and the specimens were removed and prepared for histomorphological and histobacteriological analysis. The findings revealed 35% of microbial leakage in the groups without plugs and 15% of leakage in the groups with plugs. Statistical analysis showed that the use of a Coltosol plug improved significantly the histomorphological results regardless of the type of root canal sealer (p=0.05) and that CRCS and Endomethasone sealers showed similar results (p>0.05).

Resin bonding to root canal dentin: Effect of the application of an experimental hydrophobic resin coating after an all-in-one adhesive

Aim: Based on the hypothesis the application of a low-viscosity hydrophobic resin coating improves the bond of all-in-one adhesive, the purpose of the study was to evaluate the bond strength of four adhesive systems to bovine root dentin using the push-out test method. Methods and Materials: The root canals of 32 bovine roots (16 mm) were prepared to a length of 12 mm using a FRC Postec Plus preparation drill. The specimens were allocated into four groups according to the adhesive system used: (Group 1) All-in-one Xeno III; (Group 2) All-in-one Xeno III+ScotchBond Multi-Purpose Plus Adhesive; (Group 3) Simplified Etch & Rinse One Step Plus; and (Group 4) Multi-Bottle Etch & Rinse All-Bond 2. A fiber-reinforced composite retention post was reproduced using an additional silicon impression and fabricated with DuoLink resin cement. The root specimens were treated with the selected adhesive systems, and the resin posts were luted in the canals with DuoLink resin cement. Each root specimen was cross sectioned into four samples (±1.8 mm in thickness), and the post sections were pushed-out to determine the bond strength to dentin. Results: Group 2 (2.9±1.2) was statistically higher than Group 1 (1.1±0.5) and Group 3 (1.1±0.5). Groups 1 and 3 showed no statistically significant difference while Group 4 (2.0±0.7) presented similar values (p>0.05) to Groups 1, 2, and 3 [(one-way analysis of variance (ANOVA)] and Tukey test, α=0.05). Conclusion: The hypothesis was accepted since the application of the additional layer of a low-viscosity bonding resin improved the bond of the all-in-one adhesive. Further studies must be conducted to evaluate the long-term bond.

Root surface treatment with vitamin C in tooth replantation: microscopic study in rats

AIM: Late tooth replantation is a worthy procedure, especially in growing patients, being the best option for tooth avulsion. This study evaluated the effects of root surface treatment with 2% acidulated phosphate sodium fluoride and effervescent vitamin C (Redoxon) in late replantation. METHODS: Twenty rat teeth (Rattus norvegicus, albinus, Wistar) were extracted and left on a table for 6 h. Then, the dental papilla and enamel organ were sectioned and the pulp was removed through the apex. After removal of the periodontal ligament with a blade, the animals were divided into 2 groups: Group I teeth were immersed in 2% acidulated phosphate sodium fluoride solution for 10 min and obturated with Ca(OH)(2) paste. Group II teeth were immersed in effervescent vitamin C solution (Redoxon 2 g) for 10 min and obturated as for Group I. After these procedures, teeth were replanted and animals were killed after 60 days. RESULTS: The study revealed a larger amount of replacement resorption in Group I and larger amount of ankylosis in Group II, with statistically significant difference and absence of inflammatory resorption. CONCLUSION: The substances used for root surface treatment were unable to prevent replacement resorption and ankylosis, which are expected when the periodontal ligament has been lost.