Efficacy of disinfection procedures performed prior to regenerative endodontic therapy: An integrative review.

The aim of this integrative review was to identify whether the disinfection procedures performed prior to regenerative endodontic treatment were effective on biofilm removal from the root canals. The research was based on PubMed, Latin American and Caribbean Health Sciences Literature (Lilacs) and Scientific Electronic Library Online (SciELO) databases. Four articles were selected; one of the studies was in vivo and the others ex vivo. Different disinfection procedures were studied, characterised mainly by the use of intracanal medication, highlighting the double antibiotic paste, triple antibiotic paste and calcium hydroxide paste. Disinfection ability was evaluated against Enterococcus faecalis and multispecies biofilms by using the fluorescence technique and colony forming unit counting, for 7 to 21 days. Double antibiotic paste and triple antibiotic paste demonstrated excellent antibiofilm activity, unlike CH paste that showed limited disinfection, even when associated with different antimicrobial agents. Triple antibiotic paste was the most effective medication against biofilm.

Do alternative scaffolds used in regenerative endodontics promote better root development than that achieved with blood clots?

The aim of this integrative review was to identify whether alternative scaffolds used in regenerative endodontics contribute to better root development, in relation to the increase in root length and thickness of dentin walls, compared with blood clot (BC) scaffolds. The literature search was conducted in PubMed, SciELO and Lilacs databases, using descriptors related to the topic. After applying the eligibility criteria, 11 articles were selected and analyzed according to the proposed aim. Five clinical and six in vivo studies, conducted in animals, compared different types of alternative scaffolds with BCs, with emphasis on platelet-rich plasma (PRP) and platelet-rich fibrin (PRF). All scaffolds, alternative or BC, promoted an increase in root length and dentin wall thickness, with varying percentages of increase between studies. In general, there was a significant increase in root length and dentin thickness promoted by PRF and PRP scaffolds, compared with BC. It was concluded that the majority of the scaffolds tested contributed to the increase in root length and thickness of dentin walls, with emphasis on PRF and PRP.

Do alternative scaffolds used in regenerative endodontics promote better root development than that achieved with blood clots?

Abstract The aim of this integrative review was to identify whether alternative scaffolds used in regenerative endodontics contribute to better root development, in relation to the increase in root length and thickness of dentin walls, compared with blood clot (BC) scaffolds. The literature search was conducted in PubMed, SciELO and Lilacs databases, using descriptors related to the topic. After applying the eligibility criteria, 11 articles were selected and analyzed according to the proposed aim. Five clinical and six in vivo studies, conducted in animals, compared different types of alternative scaffolds with BCs, with emphasis on platelet-rich plasma (PRP) and platelet-rich fibrin (PRF). All scaffolds, alternative or BC, promoted an increase in root length and dentin wall thickness, with varying percentages of increase between studies. In general, there was a significant increase in root length and dentin thickness promoted by PRF and PRP scaffolds, compared with BC. It was concluded that the majority of the scaffolds tested contributed to the increase in root length and thickness of dentin walls, with emphasis on PRF and PRP.

Resumo O objetivo desta revisão integrativa foi identificar se os scaffolds alternativos utilizados em endodontia regenerativa contribuem para um melhor desenvolvimento radicular, em relação ao aumento do comprimento e espessura das paredes da dentina, em comparação com os scaffolds de coágulo sanguíneo (BC). A pesquisa bibliográfica foi realizada nas bases de dados PubMed, SciELO e Lilacs, utilizando descritores relacionados ao tema. Após a aplicação dos critérios de elegibilidade, 11 artigos foram selecionados e analisados de acordo com o objetivo proposto. Cinco estudos clínicos e seis in vivo, realizados em animais, compararam diferentes tipos de scaffolds alternativos com BCs, com ênfase no plasma rico em plaquetas (PRP) e fibrina rica em plaquetas (PRF). Todos os scaffolds, alternativos ou BC, promoveram um aumento no comprimento da raiz e na espessura da parede dentinária, com percentuais variáveis de aumento entre os estudos. Em geral, houve um aumento significativo do comprimento da raiz e da espessura da dentina promovido pelos scaffolds PRF e PRP, em comparação com a BC. Concluiu-se que a maioria dos scaffolds testados contribuiu para o aumento do comprimento das raízes e da espessura das paredes dentinárias, com ênfase em PRF e PRP.

EVALUATION OF ENDODONTIC FILES USED BY UNDERGRADUATED STUDENTS' CONTAMINATION, AFTER CLEANING AND STERILIZATION

Introduction: A thorough endodontic files decontamination protocol, prior to sterilization, is extremely important. Retentions existing in the files active part hinder asepsis, and inadequate cleaning interferes with the sterilization process. Thus, the aim of this study was to evaluate the endodontic files contamination used by undergraduate students from the University Southern Santa Catarina (Unisul), after cleaning and sterilization process. Materials and Methods: Dentistry undergraduate students from the 6th to the 10th period at Unisul, Pedra Branca unit, participated in the research. Endodontic files, caliber # 40, # 45 or # 50, were collected from the sterile metal box and then incubated in a broth culture medium, at 37ºC, in aerobiosis. After 48 hours, the culture medium was evaluated for turbidity, which would indicate the instrument contamination. The total number of contaminated samples for each period was computed and the data statistically analyzed by the chi-square test (α = 5%). Results: A total of 98.46% of the files were sterile. Only 1 file, from a 10th period student, showed contamination. There was no association between the contamination presence and course period (P > 0.05). Conclusion: The endodontic files cleaning and sterilization process is being carried out effectively by dentistry undergraduate students from the 6th to the 10th period at Unisul, Pedra

Effectiveness of different anesthetic methods for mandibular posterior teeth with symptomatic irreversible pulpitis: a systematic review and meta-analysis.

OBJECTIVE: This systematic review aimed to assess the effectiveness of anesthetic methods for mandibular posterior teeth with symptomatic irreversible pulpitis, comparing to the inferior alveolar nerve block (IANB) by meta-analysis. MATERIALS AND METHODS: Studies were identified from Cochrane Library, Embase, Lilacs, PubMed, Scopus, and Web of Science databases up to May 2021. Randomized clinical trials comparing the anesthetic success rate of IANB and any other alternative anesthetic method were included. The quality of the selected studies was assessed by the Cochrane Risk of Bias 2.0 tool. Meta-analyses using Mantel-Haenszel method and random-effect models were performed to find the pooled estimates of risk ratio (RR) with 95% confidence interval (CI). The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation approach. RESULTS: Twenty-two studies were selected, which included fourteen anesthetic methods. Two studies were classified as high risk of bias, five as uncertain risk and fifteen as low risk. Vazirani-Akinosi nerve block (VANB) [RR = 1.27; p = 0.007; 95% CI, 1.07-1.52; I2 = 0%] and intraosseous injection (IOI) [RR = 1.48; p = 0.04; 95% CI, 1.02-2.15; I2 = 46%] had superior effectiveness compared to IANB, with low certainty of evidence, as well as buccal infiltrations associated with IANB (BI + IANB) [RR = 1.84; p = 0.004; 95% CI, 1.22-2.79; I2 = 52%], with very low certainty. CONCLUSION: Evidence suggests that buccal infiltrations associated with IANB, VANB, and IOI are more effective than IANB at anesthetizing posterior mandibular teeth with symptomatic irreversible pulpitis. CLINICAL SIGNIFICANCE: Alternative primary methods of anesthesia might be indicated for mandibular posterior teeth presenting symptomatic irreversible pulpitis.

A novel antimicrobial-containing nanocellulose scaffold for regenerative endodontics.

OBJECTIVES: The aim of this study was to evaluate bacterial nanocellulose (BNC) membranes incorporated with antimicrobial agents regarding cytotoxicity in fibroblasts of the periodontal ligament (PDLF), antimicrobial activity, and inhibition of multispecies biofilm formation. MATERIALS AND METHODS: The tested BNC membranes were BNC + 1% clindamycin (BNC/CLI); BNC + 0.12% chlorhexidine (BNC/CHX); BNC + nitric oxide (BNC/NO); and conventional BNC (BNC; control). After PDLF culture, the BNC membranes were positioned in the wells and maintained for 24 hours. Cell viability was then evaluated using the MTS calorimetric test. Antimicrobial activity against Enterococcus faecalis, Actinomyces naeslundii, and Streptococcus sanguinis (S. sanguinis) was evaluated using the agar diffusion test. To assess the antibiofilm activity, BNC membranes were exposed for 24 hours to the mixed culture. After sonicating the BNC membranes to remove the remaining biofilm and plating the suspension on agar, the number of colony-forming units (CFU)/mL was determined. Data were analyzed by 1-way analysis of variance and the Tukey, Kruskal-Wallis, and Dunn tests (α = 5%). RESULTS: PDLF metabolic activity after contact with BNC/CHX, BNC/CLI, and BNC/NO was 35%, 61% and 97%, respectively, compared to BNC. BNC/NO showed biocompatibility similar to that of BNC (p = 0.78). BNC/CLI showed the largest inhibition halos, and was superior to the other BNC membranes against S. sanguinis (p < 0.05). The experimental BNC membranes inhibited biofilm formation, with about a 3-fold log CFU reduction compared to BNC (p < 0.05). CONCLUSIONS: BNC/NO showed excellent biocompatibility and inhibited multispecies biofilm formation, similarly to BNC/CLI and BNC/CHX.

Success rate of endodontic treatments performed by undergraduate students of the university of southern santa catarina

Introduction: Apical periodontitis is an inflammatory disease of the periradicular tissues caused by microbial (re)contamination of the root canal system. Due to its direct relationship to the quality of endodontic treatment, it is extremely important to carry out longitudinal and cross-sectional studies, following-up treatments carried out in universities. Aim: To evaluate the success rate of endodontic treatments performed by undergraduate students of the University of Southern Santa Catarina - UNISUL, Pedra Branca, between August 2015 and July 2017. Materials and Methods: One hundred twenty-four patients with endodontic treatment were contacted. Of these, only 27 attended for treatment follow-up, adding up to a total of 32 treatments analyzed. All teeth were clinically and radiographically evaluated, and the potential indicators related to endodontic treatment success or failure were analyzed. The frequencies of each criterion were calculated, and the data analyzed using the Chi-Square test (α = 5%). Results: 9 cases (28.13%) were considered failure, either because they were associated with symptoms or because there was a periapical alteration. In addition, 88.88% of the failure cases had temporary restorative material. Association was observed only between the number of root canals and symptoms (P = 0.049). Two of the 3 treated teeth with multiple root canals showed symptoms at the follow-up. The endodontic success rate was 71.87%. Conclusion: The success rate of the 32 endodontic treatments performed by undergraduate students from UNISUL was 71.87%.

Calcium hydroxide induces mineralized tissue neoformation: a case report

Trauma in the anterior teeth is a relatively common occurrence during childhood, having as main consequence teeth with incomplete root development and open apices. Patient, male, leucoderma, 10 years old, attended the Dental Clinic of the Southern University of the State of Santa Catarina, reporting as main complaint fracture in the crown of element 11. After clinical and radiographic examination, it was possible to identify the incomplete apexogenesis of this tooth and the presence of necrotic pulp. Aiming to stimulate neoformation of mineralized tissue at the dental apex, the calcium hydroxide based dressing was used. He remained for eight months, always with radiographic control. Apexification was observed radiographically and proved through the use of an instrument introduced inside the canal. The use of calcium hydroxide as intracanal medication for eight months stimulated mineralized tissue neoformation in the apical region of element 11 and allowed endodontic treatment.

Intracanal Irrigating Solutions Prior to Calcium Hydroxide Medication and Its Effects on Root Dentin Strength.

The aim of this study was to assess the effects of intracanal irrigation with sodium hypochlorite (NaOCl) and ethylenediaminetetracetic acid (EDTA) prior to calcium hydroxide medication on the compressive strength of root dentin. Forty-eight roots with single and straight canals were instrumented with a crown-down technique using Flexofile files and Gates Glidden burs, under 0.9% sodium chloride (NaCl) irrigation. Root canals were randomly separated into 4 groups (n=12), according to the irrigating solution: Control Group, 0.9% NaCl; GroupNaOCl, 1% NaOCl; GroupEDTA, 17% EDTA; and GroupEDTA+NaOCl, 17% EDTA and 1% NaOCl. Solutions remained for 40 min, renewed every 10 min, except for GroupEDTA+NaOCl, where the solutions were alternated every 10 min. Canals were dried and filled with calcium hydroxide paste, and radiographed. Each canal was sealed and stored at 37 °C for 30 days. After this period, the roots were cut 1 mm below the cementoenamel junction and 6 mm apically from this point in order to obtain 6 mm-long cylinders. The compressive test was conducted with a crosshead speed of 1 mm/min. The means (±SD) (MPa) of compressive strength were: Control Group, 151.23±94.36; GroupNaOCl, 167.50±57.25; GroupEDTA, 108.79±99.88; GroupEDTA+NaOCl, 60.12±92.10. Significant statistical differences among groups were found (ANOVA and Tukey, a=5%, p=0.02). Control Group and GroupNaOCl showed higher means of compressive strength than GroupEDTA+NaOCl. Intracanal irrigation with 17% EDTA and 1% NaOCl produced a significant reduction of dentin compressive strength 30 days after medication with calcium hydroxide.

Intracanal Irrigating Solutions Prior to Calcium Hydroxide Medication and Its Effects on Root Dentin Strength

Abstract The aim of this study was to assess the effects of intracanal irrigation with sodium hypochlorite (NaOCl) and ethylenediaminetetracetic acid (EDTA) prior to calcium hydroxide medication on the compressive strength of root dentin. Forty-eight roots with single and straight canals were instrumented with a crown-down technique using Flexofile files and Gates Glidden burs, under 0.9% sodium chloride (NaCl) irrigation. Root canals were randomly separated into 4 groups (n=12), according to the irrigating solution: Control Group, 0.9% NaCl; GroupNaOCl, 1% NaOCl; GroupEDTA, 17% EDTA; and GroupEDTA+NaOCl, 17% EDTA and 1% NaOCl. Solutions remained for 40 min, renewed every 10 min, except for GroupEDTA+NaOCl, where the solutions were alternated every 10 min. Canals were dried and filled with calcium hydroxide paste, and radiographed. Each canal was sealed and stored at 37 °C for 30 days. After this period, the roots were cut 1 mm below the cementoenamel junction and 6 mm apically from this point in order to obtain 6 mm-long cylinders. The compressive test was conducted with a crosshead speed of 1 mm/min. The means (±SD) (MPa) of compressive strength were: Control Group, 151.23±94.36; GroupNaOCl, 167.50±57.25; GroupEDTA, 108.79±99.88; GroupEDTA+NaOCl, 60.12±92.10. Significant statistical differences among groups were found (ANOVA and Tukey, a=5%, p=0.02). Control Group and GroupNaOCl showed higher means of compressive strength than GroupEDTA+NaOCl. Intracanal irrigation with 17% EDTA and 1% NaOCl produced a significant reduction of dentin compressive strength 30 days after medication with calcium hydroxide.

Resumo O objetivo desse estudo foi avaliar o efeito da irrigação intracanal com hipoclorito de sódio (NaOCl) e ácido etilenodiamino tetracético (EDTA) previamente à medicação de hidróxido de cálcio na resistência à compressão da dentina radicular. Quarenta e oito raízes com canais únicos e retos tiveram os canais instrumentados pela técnica coroa-ápice com limas Flexofile e brocas Gates Glidden sob irrigação com solução salina (NaCl) a 0,9%. Os canais radiculares foram separados em 4 grupos (n=12), de acordo com a solução irrigadora: Grupo Controle, NaCl 0,9%; GrupoNaOCl, NaOCl 1%; GrupoEDTA, EDTA 17%; e GrupoEDTA+NaOCl, NaOCl 1% e EDTA 17%. As soluções permaneceram por 40 min, sendo renovadas a cada 10 min, exceto para o GrupoEDTA+NaOCl, onde as soluções foram alternadas a cada 10 min. Os canais foram secos, preenchidos com pasta de hidróxido de cálcio e radiografados. Cada canal foi selado e mantido a 37 °C por 30 dias. Após esse período, as raízes foram cortadas 1 mm abaixo da junção cemento-esmalte e 6 mm apicalmente a este corte, a fim de obter cilindros de 6 mm de comprimento. O teste de compressão foi realizado com velocidade de cruzeta de 1 mm/min. As médias (±SD) da resistência à compressão em MPa foram: Grupo Controle, 151.23±94.36; GrupoNaOCl, 167.50±57.25; GrupoEDTA, 108.79±99.88; GrupoEDTA+NaOCl, 60.12±92.10. Diferenças estatisticamente significativas foram encontradas entre os grupos (ANOVA e Tukey; a=0,05; p=0,02). O Grupo Controle e o GrupoNaOCl obtiveram maiores médias de resistência à compressão em relação ao GrupoEDTA+NaOCl. A irrigação intracanal com EDTA 17% e NaOCl 1% promoveu redução significativa da resistência à compressão da dentina, após 30 dias de medicação intracanal com hidróxido de cálcio.