The use of calcium hydroxide and mineral trioxide aggregate on apexification of a replanted tooth: a case report.

AIM: To report the outcome of the endodontic treatment of a reimplanted central maxillary incisor with open apex after 8 years and 7 months of follow-up. SUMMARY: This case report presents the treatment of a right central maxillary incisor of an 8-year old white male patient with history of traumatic avulsion and immediate replantation. The endodontic therapy consisted of periodical changes of calcium hydroxide dressing and a definitive root canal filling with mineral trioxide aggregate (MTA). The treatment was successful without pathologies up to 7 years of follow-up. After the institution of orthodontic treatment a localized and late root resorption was noticed at the last radiographic examination (8 years and 7 months postoperative follow-up). Moreover, the use of MTA promoted a mild crown grey discoloration.

Bioactivity of calcium aluminate endodontic cement.

INTRODUCTION: Calcium aluminate endodontic cement (CAEC) developed for use in root canal therapy has been produced with additives that improve handling properties and provide higher mechanical strength than mineral trioxide aggregate (MTA) according to prior studies. The aim of this study was to evaluate the bioactivity of CAEC containing accelerating additives (A-CAEC) in comparison with MTA, both in contact with simulated body fluid (SBF) solutions. METHODS: pH measurements were taken for set cement samples immersed in water or SBF solutions prepared according to the Kokubo and Rigo techniques. The surface of these materials kept in contact with SBF solutions were also evaluated by means of scanning electron microscopy, energy-dispersive X-ray analysis, and X-ray diffraction. RESULTS: Because of the calcium hydroxide dissociation, MTA cement is able to release more Ca(2+) ions and results in a higher pH increase compared with A-CAEC. This behavior enhances the supersaturation of Kokubo solution, resulting in the precipitation of calcium phosphate phases on the MTA surface. On the other hand, for MTA in Rigo SBF solution, the pH value attained was higher than for the Kokubo SBF solution as a result of the Mg(2+) ion precipitation, which inhibited the calcium phosphate phase formation. For A-CAEC, the optimal precipitation conditions of calcium phosphate phases are achieved in Rigo SBF solution. CONCLUSIONS: MTA and A-CAEC present bioactivity in contact with SBF solution although the composition of this solution defines the type of phase precipitated.

Synergistic effect of Er:YAG laser irradiation in combination with chlorhexidine on the viability of Enterococcus faecalis: an in vitro study.

OBJECTIVE: This study aimed to examine the potential synergistic effect of laser and chlorhexidine (CHX) applications on the growth of Enterococcus faecalis. BACKGROUND DATA: CHX has been recommended for root canal irrigation because of its antibacterial properties. Er:YAG 2.94??m laser irradiation was shown to be beneficial in disinfecting infected root canals. Producing minimal side effects is the goal of any clinical procedure. One means of achieving this is via a synergistic effect caused by simultaneously introducing two applications with reduced dosages, with no compromise on their biological effect. METHODS: Bacterial suspensions of E. faecalis supplemented with 0.01?0.0001% v/v CHX solutions were lased at energy levels between 300 and 500?mJ. Bacterial growth was continuously monitored for 18?h using a GENios apparatus. RESULTS: Laser irradiation between 350 and 500?mJ delayed initiation of bacterial growth for 6?h. A concentration of 0.0001% CHX did not delay bacteria growth. However, a combination of 0.0001% CHX and laser irradiation had a synergistic effect on bacterial growth. A maximal inhibition period of bacterial growth was observed at energy levels of 500?mJ with 0.0001% CHX. CONCLUSIONS: Laser combined with CHX has a synergistic effect in killing E. faecalis. A combined regimen of a low concentration of CHX with laser irradiation was found to be a potential means of inhibiting bacterial growth.

Endodontic and orthodontic management of traumatically intruded teeth with horizontal root fracture: a case report.

This report describes the case of an 8-year-old boy that was referred to endodontic and orthodontic treatment after suffering an injury that led to intrusion of the maxillary right permanent central incisor, palatal displacement of the upper right lateral incisor, and root fracture of both central incisors. Both injured teeth were immature and had open apices. The intruded tooth was repositioned by endodontic and orthodontic management. Endodontic therapy was performed in both teeth with periodical changes of calcium-hydroxide-based paste as root canal dressing and introduction of MTA as an apical barrier. The postoperative course was uneventful with clinical and radiographic success up to 3 and 1/2 years of follow up. In the present case, orthodontic repositioning combined with endodontic therapy constitued a viable alternative treatment for intrusive luxations in immature permanent teeth.

Accuracy of color measurement of endondontically treated teeth after aging / Precisão da medição de cor de dentes tratados endodonticamente após envelhecimento

Objective: The aim of this study was to compare the accuracy of three different modes of a spectrophotometer (Vita Classical, 3D-Master and CIE L*a*b* system) in the evaluation of color alteration in endodontically treated teeth. Material and Methods: The root canal treatment of forty-five sound human canines was performed. Color measurements were performed before the endodontic treatment (baseline), and after 6 months of water storage. Shade matching was performed using a spectrophotometer (Vita Easyshade) in three different modes: Vita Classical, 3D-Master and CIE L*a*b* coordinates. The color change (ΔE value) for the three methods were assessed in each sample and analyzed by multiple linear regression analysis. L*, a* and b* values were analyzed by t-test. The significance level was set at 5%. Results: According to the digital evaluation, no statistically significant differences were found between the CIE L*a*b*,Vita Classical and 3D-Mastermodes. However, a significant difference was found (p < 0.001) for the ΔE values, with the CIE L*a*b* mode presenting greater accuracy to detect color alterations. Conclusion: CIE L *a*b* method properly correlates to Vita Classical and 3D-Master modes. However, Easyshade can easier detect color changes if used in the CIE L*a*b* mode, which leads to more accurate results.

Objetivo: O objetivo deste estudo foi comparar a precisão de três modos diferentes de um espectrofotômetro (Vita Classical, 3D-Master e sistema CIE L*a*b*) na avaliação da alteração de cor em dentes tratados endodonticamente. Materiais e Métodos: O tratamento endodôntico de quarenta e cinco caninos humanos foi realizado. Medições de cor foram realizadas, antes do tratamento endodôntico (imediatamente), e após 6 meses de armazenamento em água. Análise de cor foi realizado utilizando um espectrofotômetro (Vita Easyshade) em três diferentes modos: Vita Classical, 3D-Master e sistema CIE L*a*b*. A mudança de cor (valor ΔE) para os três métodos foram avaliadas em cada amostra e analisados através de análise de regressão linear múltipla. Valores de L*, a* e b* foram analisados através do teste-t. O nível de significância estabelecido foi de 5%. Resultados: De acordo com a avaliação digital, não foram encontradas diferenças significativas entre os métodos CIE L*a*b*,Vita Classical e 3D-Master. No entanto, uma diferença significativa foi encontrada (p < 0,001) para os valores de ΔE, com o modo CIE L*a*b* apresentando uma maior precisão para detectar alterações de cor. Conclusão: O método CIE L *a*b* correlaciona corretamente para os modos Vita Classical e 3D-Master. No entanto, o Easyshade pode detectar alterações de cor, mais facilmente quando utilizado no modo CIE L *a*b*, permitindo resultados mais precisos.

Effects of a novel calcium aluminate cement on the early events of the progression of osteogenic cell cultures.

The present study evaluated the progression of osteogenic cell cultures exposed to a novel calcium aluminate cement (CAC+) in comparison with the gold standard mineral trioxide aggregate (MTA). Cells were enzimatically isolated from newborn rat calvarial bone, plated on glass coverslips containing either CAC+ or a control MTA samples in the center, and grown under standard osteogenic conditions. Over the 10-day culture period, roundening of sample edges was clearly noticed only for MTA group. Although both cements supported osteogenic cell adhesion, spreading, and proliferation, CAC+-exposed cultures showed significantly higher values in terms of total cell number at days 3 and 7, and total protein content and alkaline phosphatase activity at day 10. The present in vitro results indicate that the exposure to CAC+ supports a higher differentiation of osteogenic cells compared with the ones exposed to MTA. Further experimental studies should consider CAC+ as a potential alternative to MTA when the repair of mineralized tissues is one of the desired outcomes in endodontic therapy.

Root canal filling with cements based on mineral aggregates: an in vitro analysis of bacterial microleakage.

The aim of this study was to assess bacterial microleakage through 2 different cements used as root canal filling materials: mineral-trioxide-aggregate (White MTA, Angelus, Londrina, PR, Brazil); and an experimental material containing calcium aluminate plus additives (EndoBinder, University of São Carlos [UFSCar-Brazil], patent number PI0704502-6). Forty incisors were divided into 4 groups: (1) white-MTA, (2) calcium aluminate cement, and (3) positive and (4) negative control group. Falcon tubes were prepared for this experiment, divided into 2 separated chambers; the lower part was filled with RTF-transport media so that only the root apex was in contact with the transport media, whereas the coronal part was immersed in BHI containing Enterococcus faecalis to investigate bacterial microleakage. The evaluated materials used as root canal filling materials showed an absence of microbial growth. Both materials when used as the root canal filling were efficient in sealing root canals and preventing E. faecalis microleakage for the 30-day evaluation period using an in vitro model.

Influence of cervical preflaring on determination of apical file size in mandibular molars: SEM analysis.

This study investigated the influence of cervical preflaring with different rotary instruments on determination of the initial apical file (IAF) in mesiobuccal roots of mandibular molars. Fifty human mandibular molars whose mesial roots presented two clearly separated apical foramens (mesiobuccal and mesiolingual) were used. After standard access opening and removal of pulp tissue, the working length (WL) was determined at 1 mm short of the root apex. Five groups (n=10) were formed at random, according to the type of instrument used for cervical preflaring. In group 1, the size of the IAF was determined without preflaring of the cervical and middle root canal thirds. In groups 2 to 5, preflaring was performed with Gates-Glidden drills, ProTaper instruments, EndoFlare instruments and LA Axxes burs, respectively. Canals were sized manually with K-files, starting with size 08 K-files, inserted passively up to the WL. File sizes were increased until a binding sensation was felt at the WL and the size of the file was recorded. The instrument corresponding to the IAF was fixed into the canal at the WL with methylcyanoacrylate. The teeth were then sectioned transversally 1 mm short of the apex, with the IAF in position. Cross-sections of the WL region were examined under scanning electron microscopy and the discrepancies between canal diameter and the diameter of IAF were calculated using the tool "rule" (FEG) of the microscope's proprietary software. The measurements (microm) were analyzed statistically by Kruskal-Wallis and Dunn's tests at 5% significance level. There were statistically significant differences among the groups (p<0.05). The non-flared group had the greatest discrepancy (125.30 +/- 51.54) and differed significantly from all flared groups (p<0.05). Cervical preflaring with LA Axxess burs produced the least discrepancies (55.10 +/- 48.31), followed by EndoFlare instruments (68.20 +/- 42.44), Gattes Glidden drills (68.90 +/- 42.46) and ProTaper files (77.40 +/- 73.19). However, no significant differences (p>0.05) were found among the rotary instruments. In conclusion, cervical preflaring improved IAF fitting to the canals at the WL in mesiobuccal roots of maxillary first molars. The rotary instruments evaluated in this study did not differ from each other regarding the discrepancies produced between the IAF size and canal diameter at the WL.

Effects of a novel calcium aluminate cement on the early events of the progressionof osteogenic cell cultures

The present study evaluated the progression of osteogenic cell cultures exposed to a novel calcium aluminate cement (CAC+) in comparison with the gold standard mineral trioxide aggregate (MTA). Cells were enzimatically isolated from newborn rat calvarial bone, plated on glass coverslips containing either CAC+ or a control MTA samples in the center, and grown under standard osteogenic conditions. Over the 10-day culture period, roundening of sample edges was clearly noticed only for MTA group. Although both cements supported osteogenic cell adhesion, spreading, and proliferation, CAC+-exposed cultures showed significantly higher values in terms of total cell number at days 3 and 7, and total protein content and alkaline phosphatase activity at day 10. The present in vitro results indicate that the exposure to CAC+ supports a higher differentiation of osteogenic cells compared with the ones exposed to MTA. Further experimental studies should consider CAC+ as a potential alternative to MTA when the repair of mineralized tissues is one of the desired outcomes in endodontic therapy.

O objetivo do presente estudo foi avaliar a progressão de cultura de células osteogênicas expostas a um novo cimento de aluminato de cálcio (CAC+) em comparação ao agregado de trióxido mineral (MTA). As células foram obtidas por digestão enzimática de calvária de ratos recém-nascidos, plaqueadas sobre lamínulas de vidro contendo em sua área central discos de CAC+ ou MTA e crescidas em condições osteogênicas por até 10 dias. Durante a cultura primária, observou-se o arredondamento das bordas das amostras de cimento apenas para MTA. Embora ambos os cimentos tenham permitido a adesão, o espraiamento e a proliferação celulares, as culturas crescidas em contato com CAC+ exibiram valores maiores de número total de células em 3 e 7 dias, e de conteúdo de proteína total e atividade de fosfatase alcalina em 10 dias. Os resultados indicam que a exposição ao CAC+ permite o desenvolvimento de uma proporção maior de células em estágios mais avançados da diferenciação osteoblástica, quando comparado ao MTA. Deve-se considerar em futuros estudos experimentais a utilização do CAC+ como um material alternativo ao MTA especialmente quando um dos objetivos do tratamento endodôntico é o de reparação dos tecidos mineralizados da região periapical.

Obturação com MTA associada à cirurgia parendodôntica no retratamento de reabsorção radicular apical externa: relato de caso / Root canal filling using MTA in association with parendodontic surgery in the retreatment of an external apical root resorption: case report

Introdução e objetivo: O tratamento de reabsorções inflamatórias apicais deve ser direcionado ao combate da infecção endodôntica. Em determinados casos, a resolução clínica por meio de tratamento endodôntico convencional pode tornar-se inexequível em função das dificuldades de efetuar a instrumentação e a obturação adequadas da região apical. Nessas situações, técnicas alternativas de preparo do canal radicular e de obturação podem ser necessárias, além da instituição de tratamento cirúrgico complementar. Relato do caso: Este trabalho apresenta uma alternativa de retratamento de um caso de reabsorção radicular apical externa com o uso do tampão de MTA associado à cirurgia parendodôntica. Após remoção do material obturador, limpeza e desinfecção do canal radicular, foi instituída terapia com hidróxido de cálcio por 45 dias. Depois desse período, o canal foi obturado com MTA, e em uma sessão posterior foram feitas curetagem da lesão periapical e apicectomia. A proservação do caso deu-se 34 meses e demonstrou reparo da lesão periapical e íntimo contato do trabeculado ósseo com o MTA. Conclusão: O uso do MTA como material obturador, complementado pela cirurgia parendodôntica, mostrou-se como uma alternativa para o tratamento de dentes com reabsorção radicular apical externa.

Introduction and objective: The treatment of external apical root resorption should be directed to eliminate the endodontic infection. In some cases, the clinical resolution by conventional endodontic treatment cannot be performed, due to instrumentation and root canal filling complexity. In these cases, alternative instrumentation and obturation techniques may be necessary, additionally to apical surgery. Case report: This case report shows an alternative to external apical root resorption retreatment, using obturation with MTA associated to parendodontic surgery. After the removal of obturation material and the root canal cleaning and shaping, calcium hydroxide therapy was performed during 45 days. After that the canal was filled with MTA, and in a posterior session apical curettage and apicoectomy were performed. After 34 months, the periapical healing could be radiographically noticed, with close contact between trabecular bone and MTA. Conclusion: The use of MTA as a root canal filling material associated with parendodontic surgery seemed to be an adequate alternative to external apical root resorptions.

Cirurgia paraendodôntica utilizando o cimento de Portland como material retrobturador: relato de um caso clínico com cinco anos de acompanhamento / Paraendodontic surgery using Portland cement as retrofilling material: A 5-year follow-up case report

Cirurgia paraendodôntica utilizando o cimento de Portland como material retrobturador: relato de um caso clínico com cinco anos de acompanhamento

Influence of cervical preflaring on determinationof apical file size in mandibular molars: SEM analysis

This study investigated the influence of cervical preflaring with different rotary instruments on determination of the initial apical file (IAF) in mesiobuccal roots of mandibular molars. Fifty human mandibular molars whose mesial roots presented two clearly separated apical foramens (mesiobuccal and mesiolingual) were used. After standard access opening and removal of pulp tissue, the working length (WL) was determined at 1 mm short of the root apex. Five groups (n=10) were formed at random, according to the type of instrument used for cervical preflaring. In group 1, the size of the IAF was determined without preflaring of the cervical and middle root canal thirds. In groups 2 to 5, preflaring was performed with Gates-Glidden drills, ProTaper instruments, EndoFlare instruments and LA Axxes burs, respectively. Canals were sized manually with K-files, starting with size 08 K-files, inserted passively up to the WL. File sizes were increased until a binding sensation was felt at the WL and the size of the file was recorded. The instrument corresponding to the IAF was fixed into the canal at the WL with methylcyanoacrylate. The teeth were then sectioned transversally 1 mm short of the apex, with the IAF in position. Cross-sections of the WL region were examined under scanning electron microscopy and the discrepancies between canal diameter and the diameter of IAF were calculated using the tool "rule" (FEG) of the microscope's proprietary software. The measurements (µm) were analyzed statistically by Kruskal-Wallis and Dunn's tests at 5 percent significance level. There were statistically significant differences among the groups (p<0.05). The non-flared group had the greatest discrepancy (125.30 ± 51.54) and differed significantly from all flared groups (p<0.05). Cervical preflaring with LA Axxess burs produced the least discrepancies (55.10 ± 48.31), followed by EndoFlare instruments (68.20 ± 42.44), Gattes Glidden drills (68.90 ± 42.46)...

Este estudo investigou a influência do alargamento cervical feito com diferentes instrumentos rotatórios na determinação do instrumento apical inicial (IAI) das raizes mésio-vestibulares de molares inferiores. Foram utilizados 50 molares inferiores cujas raízes mesiais apresentavam dois forames apicais nitidamente separados (mésio-vestibular e mésio-lingual). Após o acesso à câmara pulpar de forma convencional e remoção do tecido pulpar, o comprimento de trabalho foi definido a 1 mm do ápice radicular. Os dentes foram divididos aleatoriamente em cinco grupos (n= 10) de acordo com o tipo de instrumento utilizado no alargamento cervical. No grupo 1, o IAI foi definido sem o prévio alargamento dos terços médio e cervical das raízes. Nos grupos 2 a 5, o terço cervical e médio do canal radicular foi alargado com as brocas de Gates-Glidden, instrumentos Pro Taper, Endo Flare e brocas LA Axxes, respectivamente. A determinação do IAI foi realizada manualmente com limas tipo K em ordem crescente de diâmetro a partir da lima 08 até se chegar ao instrumento que permitisse ao operador ter a sensação tátil do mesmo estar firmemente ajustado ao CRT. O instrumento que correspondeu ao IAI foi fixado no interior do canal radicular com cianocrilato de metila. Com o IAI posicionado, os dentes foram seccionados transversalmente até 1 mm do ápice. As seções transversais do CRT foram observadas através da microscopia eletrônica de varredura e os desajustes entre o diâmetro do canal e o diâmetro do IAI foram calculados com a função "régua" (FEG) do software do próprio microscópio. Os resultados foram avaliados estatisticamente pelo testes de Kruskal-Wallis e Dunn ao nível de significância de 5 por cento. Houve diferenças estatisticamente significantes entre os grupos (p<0,05). O grupo sem alargamento apresentou o maior desajuste (125,30 ±51,54) e diferiu significativamente dos demais grupos (p<0,05). O alargamento cervical com as brocas LA Axxess apresentou...

Uso de antiinflamatórios näo-esteroidais (AINEs) no controle da resposta inflamatória inespecífica: uma revisäo / The use of non-steroidal anti-inflammatory drugs (NSAIDs) for the control of non-specific inflammatory reactions: a review

Situaçöes patológicas ou clínicas que desencadeiam reaçäo inflamatória inespecífica, gerando dor e desconforto, requerem administraçäo de fármacos antiinflamatórios como coadjuvantes terapêuticos. Embora a inflamaçäo constitua reaçäo fisiopatológica de defesa e reparaçäo, quando fora de controle se autoperpetua, cronifica-se e acarreta lesäo tecidual indesejada e desnecessária. Dentro deste panorama, os fármacos säo usados no sentido de modular seu desenvolvimento, procurando mantê-la em níveis compatíveis com boa evoluçäo clínica. Conquanto o melhor meio para o controle da resposta inflamatória seja a eliminaçäo de suas causas, o uso paliativo de antiinflamatórios, principalmente do grupo dos näo-esteroidais (AINEs), é recurso coadjuvante de valor na terapêutica de diversos estados mórbidos odontológicos. Em anos recentes, a melhor compreensäo sobre a ativaçäo da cascata do ácido araquidônico no fenômeno inflamatório propiciou a introduçäo de novos medicamentos na prática clínica. O tema é revisto neste trabalho, intencionando elucidar algumas características peculiares ao uso de AINEs, tanto os clássicos quanto os de introduçäo mais recente em terapêutica

Biologia molecular-técnica PCR. Monitoração do efeito de curativos de demora à base de hidróxido de cálcio na microbiota de canais radiculares em dentes de humanos portadores de lesão periapical crônica / PCR technique on monitoring the effect of temporary dressing based on calcium hydroxide on microbiota of the root canals of human teeth with chronic periapical periodontitis

No presente estudo foi monitorada a microbiota do canal radicular de 30 dentes de humanos portadores de lesão periapical crônica. Foram utilizados curativos de demora à base de hidróxido de cálcio entre sessões: Calen (Grupo I), Calen PMCC (Grupo II) e Calasept (Grupo III), que foram mantidos nos canais radiculares por aproximadamente 30 dias. O material colhido dos canais radiculares, antes e após a realização da terapêutica endodôntica, foi submetido a teste laboratorial baseado na biologia molecular: Reação em Cadeia da Polimerase (PCR). Como controle positivo da presença bacteriana, foi utilizado primer 16S rDNA. As seguintes espécies bacterianas foram monitoradas: Porphyromonas endodontalis, Porphyromonas gingivalis, Prevotella intermedia, Prevotella nigrescens (bacilos pigmentados de negro), e Bacteroides forsythus, microrganismos marcantes na patologia de processos infecciosos dos tecidos pulpoperiapicais. Os resultados evidenciaram diminuição das espécies microbianas, aqui monitoradas de forma indireta à partir da presença de bandas, ou amplicons (produtos do PCR), quando do uso de curativos de demora à base de hidróxido de cálcio. Com relação à eficácia particular a cada material, os Grupos I, II e III não demonstraram entre si diferenças estatisticamente significantes.