Premixed calcium silicate-based root canal sealers have better biological properties than AH Plus: A systematic review and meta-analysis of in vivo animal studies and in vitro laboratory studies.

Objectives: The aim was to determine whether premixed calcium silicate-based root canal sealers have better biological properties than AH Plus. Materials and Methods: Searches of studies published up to January 2023 were performed in the PubMed/MEDLINE and EMBASE and via other methods (databases of the International Endodontic Journal, Journal of Endodontics, and gray literature). The inclusion criteria were in vivo animal and in vitro studies that analyzed the response in the dorsal subcutaneous tissue of rats, cell viability, and genotoxicity. Systematic Review Centre for Laboratory Animal Experimentation Risk of Bias (RoB) tool for in vivo studies and modified CONSORT checklist for in vitro were appraised. Meta-analysis was performed using the Stata. Results: Fifty-two studies were included. In the RoB, in vivo studies fulfilled 20%-50% of the items and in vitro 60%-100%. The studies included in the meta-analysis demonstrated better histocompatibility with the premixed calcium silicate-based sealers at 30 days and greater cell viability with these sealers when used in undiluted extracts in experimental period of 72 h and in extracts with 1:2 and 1:4 dilution in 24 and 72 h. In contrast, no difference between materials was found concerning genotoxicity. Conclusion: Premixed calcium silicate-based root canal sealers have better histocompatibility and are less cytotoxic than the epoxy resin-based sealer AH Plus, demonstrating favorable biological behavior.

The use of sonic and ultrasonic activation of endodontic sealer to improve sealer filling quality in the root canal: a scoping review.

This scoping review aimed to map whether the use of sonic and ultrasonic methods to activate the endodontic sealer improves the sealer filling quality in the root canal, considering the bond strength and intratubular penetration to the root dentin as evaluation criteria. The study protocol was prospectively registered and is available online ( https://osf.io/x5fma/ ). Reporting was based on PRISMA Extension for Scoping Reviews. The search was performed in Embase, PubMed, Scopus, and Web of Science. We selected studies without time and language restrictions that used sonic or ultrasonic methods to activate endodontic sealer, whose outcomes were bond strength and intratubular penetration. Three researchers independently selected the articles and collected data. Of 1422 articles, 19 were read in full and 13 studies were included. The vast majority of studies opted for direct activation of the endodontic sealer. The most investigated sealers were the epoxy resin-based sealers, and the ultrasonic activation method was the most explored. For the bond strength outcome, there was a trend toward higher values when the sealer was activated ultrasonically, but the findings seem to be divergent. The sonic activation was not effective for its intended purpose. For the outcome of intratubular penetration, the vast majority of studies indicate that the use of sonic and ultrasonic methods to activate the endodontic sealer is capable of increasing intratubular penetration. The use of sonic and ultrasonic methods to directly activate the endodontic sealer can increase the intratubular penetration of the sealer, but their benefits on the bond strength are uncertain.

In silico toxicity and immunological interactions of components of calcium silicate-based and epoxy resin-based endodontic sealers.

OBJECTIVES: The present study aimed to determine in silico toxicity predictions of test compounds from hydraulic calcium silicate-based sealers (HCSBS) and AH Plus and computationally simulate the interaction between these substances and mediators of periapical inflammation via molecular docking. MATERIALS AND METHODS: All chemical information of the test compounds was obtained from the PubChem site. Predictions for bioavailability and toxicity analyses were determined by the Molinspiration Cheminformatics, pkCSM, ProTox-II and OSIRIS Property Explorer platforms. Molecular docking was performed using the Autodock4 AMDock v.1.5.2 program to analyse interactions between proteins (IL-1ß, IL-6, IL-8, IL-10 and TNF-α) and ligands (calcium silicate hydrate, zirconium oxide, bisphenol-A epoxy resin, dibenzylamine, iron oxide and calcium tungstate) to establish the affinity and bonding mode between systems. RESULTS: Bisphenol-A epoxy resin had the lowest maximum dose tolerated in humans and was the test compound with the largest number of toxicological properties (hepatotoxicity, carcinogenicity and irritant). All systems had favourable molecular docking. However, the ligands bisphenol-A epoxy resin and dibenzylamine had the greatest affinity with the cytokines tested. CONCLUSION: In silico predictions and molecular docking pointed the higher toxicity and greater interaction with mediators of periapical inflammation of the main test compounds from AH Plus compared to those from HCSBS. CLINICAL RELEVANCE: This is the first in silico study involving endodontic materials and may serve as the basis for further research that can generate more data, producing knowledge on the interference of each chemical compound in the composition of different root canal sealers.

Efficacy of calcium hypochlorite in disinfection of gutta-percha cones contaminated with Candida albicans.

This study aimed to compare the efficacy of 2.5% sodium hypochlorite (NaOCl), 2.5% calcium hypochlorite [Ca(OCl)2], and 2% chlorhexidine (CHX) in the rapid disinfection of gutta-percha cones contaminated with Candida albicans. The minimum inhibitory and minimum fungicidal concentrations of each solution for C. albicans were determined and the ability of each solution to destroy and inhibit biofilm in culture wells was tested. In addition, ninety-eight gutta-percha cones contaminated with the fungal suspension were disinfected according to the type of solution (2.5% NaOCl, 2.5% Ca(OCl)2 or 2% CHX) in its different application methods (without agitation, ultrasonic agitation or agitation with Easy Clean), and regarding the exposure time to each irrigating solution (1 or 5 min). Next, the samples were checked for turbidity and evaluation of viable colonies. The compounds that showed the best performance in biofilm destruction were NaOCl and Ca(OCl)2 at a concentration of 2xMIC (p < 0.001). Regarding inhibited biofilm, the only compound that was effective at all MIC concentrations tested was 2.5% Ca(OCl)2 (p < 0.0001). Regarding the viable colonies, all solutions were effective concerning the control group, for all application methods, in 1 and 5 min (p < 0.05). The densitometer reading showed that CHX was the only effective solution in all application methods performed (p < 0.05). The results demonstrate that all tested solutions were effective in the rapid decontamination of cones contaminated with C. albicans.

Effect of sodium hypochlorite and calcium hypochlorite on the apical sealing ability of endodontic sealers

Aim: This study aimed to compare the influence of sodium hypochlorite (NaOCl) and calcium hypochlorite [Ca(OCl)2 ] on the apical sealing capacity of AH Plus (Dentsply Maillefer) and Bio-C Sealer (Angelus) endodontic sealers. Methods: Sixty permanent human lower incisors were randomly allocated (http://www.randomized.org), according to the irrigant used, into three groups (n=20): 0.9% sodium chloride (NaCl/Control); 2.5% NaOCl; and 2.5% Ca(OCl)2 . The root canal was prepared with rotary files under 10 mL of the solution corresponding to the experimental group. Each group was subdivided into two (n=10) according to the sealer used for filling: AH Plus (Dentsply Maillefer) or Bio-C Sealer (Angelus). Then, all samples were immersed in black India ink for one week. After the storage period, the roots were then grooved longitudinally and split, and the ink penetration was measured from the apical part to the coronal part of the root canal into which the ink penetrated using a stereomicroscope. Data were analyzed by one-way ANOVA and Tukey's post-hoc tests. Results: There was no statistical difference in ink penetration between the different endodontic sealers tested for the same irrigating solution (p > 0.05). However, when the Bio-C Sealer (Angelus) was used, the group treated with 2.5% Ca(OCl)2 was associated with lower values of apical leakage, compared to 2.5% NaOCl (p < 0.05). For the AH Plus sealer (Dentsply Maillefer), there was no difference between the irrigants (p > 0.05). Conclusions: Associating Ca(OCl)2 irrigant with Bio-C Sealer (Angelus) seems to be a good option to reduce apical leakage

Demographics, smoking status, and systemic health factors associated with apical periodontitis in a Brazilian rural population: a cross-sectional study.

OBJECTIVE: To determine whether the systemic diseases diabetes mellitus (DM) and arterial hypertension (AH), and smoking status are associated with apical periodontitis (AP) in a representative rural population. MATERIALS AND METHODS: Cross-sectional study using a representative sample of individuals obtained from a population-based epidemiological survey carried out in the rural area of the city of Rosário do Sul, RS, Brazil, from March 2015 to May 2016. Data were collected through structured questionnaires and clinical examination. Binary logistic regression analysis was performed to identify variables independently associated with AP. RESULTS: Of the 584 individuals included in the study, 353 (60.4%) had AP. The presence of AP was independently associated with age ≥ 40 years (odds ratio [OR] = 1.867, 95% confidence interval [CI]: 1.193-2.923, p = 0.006), non-white ethnicity (OR = 1.509, 95% CI: 1.029-2.115, p = 0.035), active or former smoker (OR = 2.087, 95% CI: 1.241-3.510, p = 0.006) and DM or prediabetes (OR = 1.676, 95% CI: 1.150-2.443, p = 0.007). CONCLUSION: The study identified significant associations between AP and demographics, smoking status, and systemic disease in a Brazilian rural population. CLINICAL RELEVANCE: The study emphasized the significance of comprehending and managing associated factors in preventing and treating AP.

Root filling quality and bond strength of endodontic sealers to human and bovine dentin / Qualidade da obturação e resistência de união de cimentos endodônticos à dentina humana e bovina

Objetivo: Este estudo teve como objetivo comparar a qualidade da obturação e a resistência de união de dois cimentos endodônticos, AH Plus e Bio-C Sealer, em dentes humanos e bovinos. Métodos: Os canais radiculares de 60 dentes unirradiculares [30 humanos (H) e 30 bovinos (B)] foram preparados e obturados por condensação lateral da guta-percha e AH Plus (grupos AP-H e AP-B) ou Bio-C Sealer (grupos BC-H e BC-B). Seis fatias de 1,5 mm de espessura foram obtidas de cada raiz. Os espécimes foram observados em estereomicroscópio para avaliar a qualidade da obturação, considerando possíveis espaços vazios no material obturador. Posteriormente, as fatias radiculares foram avaliadas em termos de resistência de união por push-out e modo de falha. Os dados foram analisados pelos testes de Mann-Whitney e coeficientes de correlação de Spearman (α=5%). Resultados: A qualidade de obturação fornecida por AP e BC foi semelhante em ambos os substratos de dentina. No entanto, ao comparar dentes humanos e bovinos, os escores de espaços vazios foram maiores nas amostras bovinas, para ambos os cimentos. AP teve maior resistência de união à dentina humana e bovina do que BC. No entanto, não houve diferença significativa na resistência de união entre os substratos dentinários, para ambos os cimentos testados. Além disso, houve uma correlação positiva e moderada entre os valores de resistência de união de dentes humanos e bovinos. O modo de falha misto foi o mais prevalente. Conclusão: AP e BC fornecem qualidade de obturação semelhante, mas o primeiro apresenta maiores valores de resistência de união à dentina humana e bovina. A utilização de dentes bovinos como substitutos de amostras humanas parece ser adequada em estudos relacionados à resistência de união, mas não naqueles que testam a qualidade da obturação endodôntica.(AU)

Objective: This study aimed to compare the filling quality and bond strength of two endodontic sealers, AH Plus and Bio-C Sealer, in human and bovine teeth. Methods: The root canals of 60 [30 human (H) and 30 bovine (B)] single-rooted teeth were prepared and filled by lateral condensation of gutta-percha and AH Plus (groups AP-H and AP-B) or Bio-C Sealer (groups BC-H and BC-B). Six 1.5-mm-thick slices were obtained from each root. The specimens were observed under a stereomicroscope to assess filling quality, considering possible voids within the filling material. Subsequently, root slices were evaluated in terms of push-out bond strength and failure mode. Data were analyzed by Mann-Whitney tests and Spearman correlation coefficients (α=5%). Results: The filling quality provided by AP and BC was similar in both dentin substrates. However, when comparing human and bovine teeth, void scores were greater in the bovine samples, for both sealers. AP had higher bond strength to human and bovine dentin than BC. However, there was no significant difference in bond strength between dentin substrates, for both sealers tested. Also, there was a positive and moderate correlation between the bond strength values of human and bovine teeth. The mixed failure mode was the most prevalent. Conclusion: AP and BC provide similar filling quality, but the first presents higher bond strength values to human and bovine dentin. The use of bovine teeth as substitutes for human samples seems adequate in studies related to bond strength, but not in those testing root canal filling quality.(AU)

Prevalence of apical periodontitis in people living with HIV in Southern Brazil / Prevalência de periodontite apical em pessoas vivendo com HIV no Sul do Brasil

Objective: This cross-sectional study aimed to describe the prevalence of apical periodontitis (AP) in people living with HIV (PLHIV) over 50 years old and explore its association with sociodemographic, medical, and oral characteristics. Methods: Data from 59 PLHIV were collected, and the periapical area of 1018 teeth was evaluated through periapical radiographs (Rx) using the periapical index (PAI). The presence and quality of root fillings and restorations (coronal fillings and crowns) were assessed with Rx, and caries presence was based on Rx and clinical data. Viral load (VL) and T CD4 counts were also analyzed. Results: AP prevailed in 71% of individuals and 8% of teeth. Family income of >5 Brazilian minimum wages (OR=0.06, 95% CI=0.005-0.62) and having at least one root-filled tooth (OR=14.55, 95% CI=1.45-145.72) were associated with AP prevalence, whereas VL and T CD4 were not. Caries, root filling, and restorations were associated with AP occurrence. Conclusion: PLHIV presented a high AP prevalence, but intrinsic factors related to HIV infection were not associated with AP in the studied subjects. PLHIV would benefit from oral health policies to prevent AP, as the results indicate that the endodontic disease in the present sub-population might be related to social problems.(AU)

Objetivo: este estudo transversal teve como objetivo descrever a prevalência de periodontite apical (PA) em pessoas vivendo com HIV (PVHIV) acima de 50 anos de idade, e explorar sua associação com características sociodemográficas, médicas e bucais. Métodos: os dados de 59 PVHIV foram coletados e a região periapical de 1018 dentes foi avaliada através de radiografias periapicais (Rx) usando o Índice Periapical (PAI). A presença e qualidade das obturações radiculares e restaurações (restaurações diretas e coroas) também foram avaliadas no Rx; a presença de cárie foi baseada em dados clínicos e radiográficos. Carga Viral (CV) e contagem de linfócitos T CD4 também foram avaliados. Resultados: a prevalência de PA nos indivíduos foi de 71%, e 8% dos dentes apresentaram PA. Renda familiar >5 salários mínimos (OR=0.06, 95% CI=0.005-0.62) e ter pelo menos um dente com obturação endodôntica (OR=14.55, 95% CI=1.45-145.72) foram associados com a prevalência de PA, enquanto que CV e T-CD4 não foram. A presença de cárie, obturação endodôntica e restaurações foram associadas com a presença de PA no dente. Conclusão: PVHIV apresentaram uma alta prevalência de PA, mas fatores intrínsecos relacionados à infecção pelo HIV não foram associados com PA nos sujeitos avaliados. PVHIV se beneficiariam de políticas públicas de saúde para prevenir a PA, uma vez que os resultados indicam que a doença endodôntica na presente subpopulação pode ser relacionada a problemas sociais.(AU)

Effect of sodium/calcium hypochlorite on adhesion and adaptation of fiber posts luted with a dual resin cement.

This study aimed to evaluate the effect of different concentrations of sodium hypochlorite (NaOCl) and calcium hypochlorite [Ca(OCl)2] on the bond strength and adaptation of glass fiber posts luted with a dual-curing resin cement. Fifty decoronated premolars were sectioned 14 mm from the apex and endodontically treated. The root canal filling was partially removed. The specimens were divided into 5 groups (n=10) according to the irrigant for post space irrigation: 0.9% sodium chloride (NaCl), (control); 2.5% NaOCl; 5.25% NaOCl; 2.5% Ca(OCl)2; and 5.25% Ca(OCl)2. For each group, irrigation was performed with 5 ml of solution. Afterward, the posts were luted with a dual-curing resin cement. One slice from each third was obtained and submitted to the push-out test and failure modes analysis. An additional slice from the middle third was submitted to confocal images for analysis of adaptation failures (gaps). Two-way ANOVA, Tukey's post-hoc, Kruskal-Wallis with Bonferroni adjusted, and chi-square tests, analyzed data. The group treated with 5.25% NaOCl showed lower bond strength values and generated more cohesive failures compared to the control (p < 0.05). Bond strength decreased from coronal to apical in the post space (p < 0.001). The groups treated with NaOCl had the highest percentages of gaps compared to the control (p < 0.05). Regardless of concentration, Ca(OCl)2 did not influence the bond strength and the occurrence of gaps (P > 0.05). Ca(OCl)2 is a good option for irrigating the post space before luting a fiber post with a dual-curing resin cement.

Effect of calcium hypochlorite and sodium thiosulfate on the bond strength to pulp chamber dentin: A laboratory investigation.

This study aimed to compare the effect of sodium hypochlorite (NaOCl) and calcium hypochlorite [Ca(OCl)2 ] on the bond strength to pulp chamber dentin when followed or not by the use of sodium thiosulfate (Na2 S2 O3 ). The pulp chamber of fifty human molars were divided into five groups (n = 10) according to the immersion protocol: 2.5% NaOCl; 2.5% NaOCl + 5% Na2 S2 O3 ; 2.5% Ca(OCl)2 ; 2.5% Ca(OCl)2 + 5% Na2 S2 O3 ; and 0.9% sodium chloride (NaCl; control). Subsequently, the samples were restored with resin composite. Three sticks each were obtained and subjected to microtensile testing. SEM/EDS analyses of the pulp chamber roof (n = 8) were carried out for mineral quantification. Elemental analysis data were investigated via one-way ANOVA and Tukey's post hoc, and bond strength data by post hoc pairwise comparisons using the Kruskal-Wallis test. Use of 2.5% NaOCl was associated with the lowest value of bond strength, while 2.5% Ca(OCl)2 had similar bond strength to that of the 0.9% NaCl control. Using 5% Na2 S2 O3 was able to increase the bond strength after 2.5% NaOCl, but not after 2.5% Ca(OCl)2 . The group treated only with 2.5% Ca(OCl)2 had a higher Ca/P ratio on the dentin surface. Dentin treated with Ca(OCl)2 was not affected by Na2 S2 O3 and showed bond strength similar to the 0.9% NaCl.

Effect of sodium/calcium hypochlorite on adhesion and adaptation of fiber posts luted with a dual resin cement

Abstract This study aimed to evaluate the effect of different concentrations of sodium hypochlorite (NaOCl) and calcium hypochlorite [Ca(OCl)2] on the bond strength and adaptation of glass fiber posts luted with a dual-curing resin cement. Fifty decoronated premolars were sectioned 14 mm from the apex and endodontically treated. The root canal filling was partially removed. The specimens were divided into 5 groups (n=10) according to the irrigant for post space irrigation: 0.9% sodium chloride (NaCl), (control); 2.5% NaOCl; 5.25% NaOCl; 2.5% Ca(OCl)2; and 5.25% Ca(OCl)2. For each group, irrigation was performed with 5 ml of solution. Afterward, the posts were luted with a dual-curing resin cement. One slice from each third was obtained and submitted to the push-out test and failure modes analysis. An additional slice from the middle third was submitted to confocal images for analysis of adaptation failures (gaps). Two-way ANOVA, Tukey's post-hoc, Kruskal-Wallis with Bonferroni adjusted, and chi-square tests, analyzed data. The group treated with 5.25% NaOCl showed lower bond strength values and generated more cohesive failures compared to the control (p < 0.05). Bond strength decreased from coronal to apical in the post space (p < 0.001). The groups treated with NaOCl had the highest percentages of gaps compared to the control (p < 0.05). Regardless of concentration, Ca(OCl)2 did not influence the bond strength and the occurrence of gaps (P > 0.05). Ca(OCl)2 is a good option for irrigating the post space before luting a fiber post with a dual-curing resin cement.

Resumo Este estudo teve como objetivo avaliar o efeito de diferentes concentrações de hipoclorito de sódio (NaOCl) e hipoclorito de cálcio [Ca(OCl)2] na resistência de união e adaptação de pinos de fibra de vidro cimentados com um cimento resinoso dual. Cinquenta pré-molares tiveram suas coroas removidas, foram seccionados a 14 mm do ápice e tratados endodonticamente. A obturação do canal radicular foi parcialmente removida. Os espécimes foram divididos em 5 grupos (n=10) de acordo com o irrigante para irrigação do espaço do pino: cloreto de sódio 0.9% (NaCl), (controle); NaOCl 2.5%; NaOCl 5.25%; Ca(OCl)2 2.5%; e Ca(OCl)2 5.25%. Para cada grupo, a irrigação foi realizada com 5 ml da solução. Posteriormente, os pinos foram cimentados com um cimento resinoso dual. Uma fatia de cada terço foi obtida e submetida ao teste push-out e análise dos modos de falha. Um corte adicional do terço médio foi submetido a imagens confocais para análise de falhas de adaptação (gaps). Os dados foram analisados pelos testes ANOVA de duas vias, post-hoc de Tukey, Kruskal-Wallis com ajuste de Bonferroni e qui-quadrado. O grupo tratado com NaOCl 5.25% apresentou menores valores de resistência de união e gerou mais falhas coesivas em relação ao controle (p < 0.05). A resistência de união diminuiu de coronal para apical no espaço do pino (p < 0.001). Os grupos tratados com NaOCl apresentaram os maiores percentuais de gaps em relação ao controle (p < 0.05). Independentemente da concentração, o Ca(OCl)2 não influenciou a resistência de união e a ocorrência de gaps (P > 0.05). O Ca(OCl)2 é uma boa opção para irrigar o espaço do pino antes de cimentar um pino de fibra com um cimento resinoso dual.

Influence of height discrepancy between pulp chamber floor and crestal bone in the mechanical fatigue performance of endodontically-treated teeth restored with resin composite endocrowns.

OBJECTIVE: To explore and characterize the effect of the discrepancy between crestal bone height (CB) and pulp chamber floor (PCF) in the fatigue performance of endodontically-treated teeth rehabilitated with an endocrown restoration. MATERIALS AND METHODS: A total of 75 human molars free of defects, caries history or cracks were selected, then endodontically treated and randomly allocated into 5 groups (N = 15) according to the difference between PCF and CB, as follows: PCF 2 mm above, PCF 1 mm above, PCF leveled, PCF 1 mm below and PCF 2 mm below. Endocrown restorations were made with composite resin (Tetric N-Ceram, shade B3, Ivoclar) in 1.5 mm thickness and luted with a resin cement (Multilink N, Ivoclar) onto the dental elements. Monotonic testing was performed to define the fatigue parameters, and a cyclic fatigue test was used until failure of the assembly. The collected data were submitted to statistical survival analysis (Kaplan-Meier followed by Mantel-Cox and Weibull), fractographic analysis and finite element analysis (FEA) were performed as complementary analyzes. RESULTS: The PCF 2 mm below and PCF 1 mm below groups presented the best results regarding fatigue failure load (FFL) and number of cycles for failure (CFF) (p < 0.05), but presented no difference between each other (p > 0.05). The PCF leveled and PCF 1 mm above groups presented no statistical difference between them (p > 0.05), but performed better than the PCF 2 mm above group (p < 0.05). The rate of favorable failures of PCF 2 mm above, PCF 1 mm above, PCF leveled, PCF 1 mm below and PCF 2 mm below groups were 91.7%, 100%, 75%, 66.7% and 41.7%, respectively. FEA showed different stress magnitudes according to the pulp-chamber design. CONCLUSION: The insertion level of the dental element to be rehabilitated with an endocrown interferes in the mechanical fatigue performance of the set. The discrepancy between the CB height and the PCF has a direct effect, where the higher the PCF in relation to the CB, the greater the risk of mechanical failure of the restored dental element.

Effect of glide path instruments in cyclic fatigue resistance of reciprocating instruments after three uses.

The present study aims to evaluate the effect of different glide path instruments on the cyclic fatigue resistance of reciprocating endodontic instruments after three uses in mandibular molars. Eighteen Wave One Gold Primary reciprocating instruments were selected and randomly divided into three groups according to the glide path instrument: G1 - manual file K #15, G2 - Wave One Glider reciprocating instrument, and G3 (control group) - glide path was not performed. The reciprocating instruments were tested on mandibular molars and subdivided into three other groups: a new instrument, an instrument with a previous single-use, and an instrument with two previous uses. After the endodontic instrumentation, the instruments were subjected to the cyclic fatigue resistance test using an appropriate tool. The data were submitted to the Shapiro-Wilk test, and subsequently the Kruskal-Wallis test with a significance level of 5%. The results showed no statistical difference between the groups. Thus, it was concluded that the creation of a glide path did not affect the cyclic fatigue resistance of the reciprocating instrument. In addition, the reuse of final preparation instruments up to two times proved to be safe since no fractures were observed in the tested instruments.

Interactions Between Calcium Hypochlorite and Irrigants Commonly Used in Endodontic Practice: A Chemical Analysis.

INTRODUCTION: This study aimed to identify possible products resulting from chemical interactions between calcium hypochlorite (Ca[OCl]2) and other irrigants for endodontic use using electrospray ionization quadrupole time-of-flight mass spectrometry. METHODS: The 5.25% Ca(OCl)2 was associated with either 70% ethanol solution, distilled water, saline solution (0.9% sodium chloride), 5% sodium thiosulfate, 10% citric acid, 17% ethylenediaminetetraacetic acid (EDTA), or 2% chlorhexidine (CHX). The reaction ratio was 1:1 and the products obtained were analyzed by electrospray ionization quadrupole time-of-flight mass spectrometry. RESULTS: The interactions between Ca(OCl)2 and CHX generated an orange-brown precipitate, without identification of para-chloroaniline and between Ca(OCl)2 and sodium thiosulfate, a milky-white precipitate. Furthermore, when the oxidizing agent was associated with EDTA and citric acid, chlorine gas was released. As for the other associations, 70% ethanol, distilled water, and saline solution, no precipitation or gas release occurred. CONCLUSIONS: The orange-brown precipitate occurs due to the chlorination of guanidine nitrogens, and the milky-white precipitate is due to the partial neutralization of the oxidizing agent. The release of chlorine gas occurs due to the low pH of the mixture, which results in the rapid formation and decomposition of chlorine. In this context, an intermediate rinsed with distilled water, saline solution, and ethanol between Ca(OCl)2 and CHX, citric acid, and EDTA seems to be appropriate to prevent the formation of by-products when these irrigants need to be used in the canal. Furthermore, if it is necessary to use sodium thiosulfate, a larger volume of the solution must be used compared to that used for the oxidizing solution.

Effect of glide path instruments in cyclic fatigue resistance of reciprocating instruments after three uses

Abstract The present study aims to evaluate the effect of different glide path instruments on the cyclic fatigue resistance of reciprocating endodontic instruments after three uses in mandibular molars. Eighteen Wave One Gold Primary reciprocating instruments were selected and randomly divided into three groups according to the glide path instrument: G1 - manual file K #15, G2 - Wave One Glider reciprocating instrument, and G3 (control group) - glide path was not performed. The reciprocating instruments were tested on mandibular molars and subdivided into three other groups: a new instrument, an instrument with a previous single-use, and an instrument with two previous uses. After the endodontic instrumentation, the instruments were subjected to the cyclic fatigue resistance test using an appropriate tool. The data were submitted to the Shapiro-Wilk test, and subsequently the Kruskal-Wallis test with a significance level of 5%. The results showed no statistical difference between the groups. Thus, it was concluded that the creation of a glide path did not affect the cyclic fatigue resistance of the reciprocating instrument. In addition, the reuse of final preparation instruments up to two times proved to be safe since no fractures were observed in the tested instruments.

Resumo O objetivo do presente estudo foi avaliar a relação de diferentes instrumentos de glide path na resistência à fadiga cíclica de instrumentos endodônticos reciprocantes de preparo final após três utilizações em molares inferiores. Foram selecionados 18 instrumentos reciprocantes Wave One Gold Primary e divididos de maneira randomizada em três grupos: G1 - glide path utilizado foi uma lima manual K #15, G2 - glide path utilizado foi um instrumento reciprocante Wave One Glider, e G3 (controle) - sem utilização de glide path. Os instrumentos foram testados em molares inferiores e subdivididos em outros três grupos: instrumento novo, instrumento com um uso prévio e instrumento com dois usos prévios. Após os testes, os instrumentos foram submetidos ao teste de resistência à fadiga cíclica por meio de uma ferramenta própria para esse uso. Os dados encontrados foram submetidos ao teste de Shapiro-Wilk para avaliar a normalidade na distribuição da amostra, e posteriormente ao teste de Kruskal-Wallis com nível de significância de 5%. Os resultados demonstraram não haver diferença estatística entre os grupos testados. Com isso, concluiu-se que a criação de um glide path não possuiu efeito na resistência à fadiga cíclica do instrumento reciprocante de preparo final. O instrumento reciprocante de preparo final foi utilizado, e posteriormente reutilizado de maneira segura em três dentes posteriores, visto a não ocorrência de fratura em nenhum dos grupos testados.

Apical periodontitis and associated factors in a rural population of southern Brazil: a multilevel analysis.

OBJECTIVES: This study aims to evaluate the association between apical periodontitis (AP) and sociodemographic/clinical factors in a probability sample of individuals living in a rural area of southern Brazilian. MATERIALS AND METHODS: A cross-sectional study was conducted involving 584 non-edentulous adult individuals who had undergone a full-mouth radiographic survey. Periapical status was analysed using the periapical index (PAI). Endodontic status was evaluated considering the occurrence of voids in the filling material and the root filling length. Crown status was classified based on the presence of caries, restorations, and prosthetic crowns. Sociodemographic variables, frequency of dental care, and periodontal disease were also registered. The data were analysed using hierarchical multilevel Poisson regression analysis. The multilevel structure was composed of three models: sociodemographic variables, clinical variables, and clinical variables adjusted by sociodemographic variables (α = 5%). RESULTS: The prevalence of AP in the sample was 60.45%. AP was significantly associated with age, skin colour, schooling, periodontal disease, and frequency of dental care (P < 0.005). Among the 10,396 teeth evaluated, 868 (8.35%) had AP, which was significantly associated with tooth group, dental arch, crown status, and endodontic treatment (P < 0.005). CONCLUSIONS: The prevalence of AP was high in the population studied. An older age, black/brown skin colour, low level of schooling, infrequent dental care, severe periodontal disease, mandibular teeth, posterior teeth, inadequate crown status, and having undergone endodontic treatment were significantly associated with the outcome. Clinical relevance This study about a rural probability sample reinforces that AP is still a recurrent oral health problem.

Outcome of endodontic treatments performed by Brazilian undergraduate students: 3- to 8-year follow up.

Objectives: This study aimed to evaluate the success rate of endodontic treatments performed by undergraduate students and the factors associated with the outcome. Materials and Methods: A follow-up of 3 to 8 years after root canal filling was carried out in 91 patients. At the follow-up visits, medical and dental history questionnaires were applied along with clinical and radiographic examinations. Data collected in the clinical exam included: the presence of pain, swelling, sinus tract, mobility, tenderness to palpation and percussion, periodontal probing profile, and type/quality of coronal restoration. Postoperative and follow-up radiographs were digitalized and analyzed by 2 trained and calibrated examiners to assess periapical healing. The treatment outcome was based on strict clinical and radiographic criteria and classified as success (absence of any clinical and radiographic sign of apical periodontitis) or failure (other combination). Logistic regression was used to investigate the impact of clinical and radiographic variables on endodontic treatment outcomes at a 5% significance level. Results: The success rate of endodontic treatments was 60.7%. The only risk factor significantly associated with failure was the presence of a periapical lesion on the postoperative radiograph (odds ratio, 3.35; 95% confidence interval, 1.17-9.54). Conclusions: The success rate of endodontic treatments performed by undergraduate students was low and was jeopardized by the presence of a periapical lesion on the postoperative radiograph.

Does ultrasonic activation improve the bond strength and root canal filling quality of endodontic sealers?

Abstract This study aimed to investigate the effect of ultrasonic activation (UA) of three endodontic sealers on the bond strength to root dentin and root canal filling quality. Ninety six bovine incisors were instrumented and root canal filling was carried out using AH Plus (AP), Sealer Plus (SP), or Sealer Plus BC (BC), with or without UA (n=16/group). Two 1.5-mm slices were obtained from each root third. The first slice was subjected to push-out testing and failure mode analysis, while the second was observed under a stereomicroscope for filling quality assessment. Data were analyzed by Kruskal-Wallis, Mann-Whitney and Friedman tests (α=0.05). SP showed higher bond strength and fewer voids than BC in the apical third and when root thirds data were pooled. SP also had higher bond strength compared with AH Plus in the apical third. UA improved the bond strength when BC was used but did not affect the filling quality of any sealer. There were no significant differences between the ultrasonically activated sealers regarding bond strength and filling quality. When root thirds were compared, the bond strength was similar along the root, but there was a tendency to worsen filling quality, with more voids, in the apical segment. In conclusion, UA was effective in increasing the bond strength of the calcium silicate-based sealer but did not improve its filling quality. For the epoxy resin-based sealers, these properties were not affected by UA.

Resumo Este estudo teve como objetivo investigar o efeito da ativação ultrassônica de três cimentos endodônticos na resistência de união à dentina radicular e na qualidade da obturação do canal radicular. Noventa e seis incisivos bovinos foram instrumentados e a obturação dos canais radiculares foi realizada com AH Plus (AP), Sealer Plus (SP) ou Sealer Plus BC (BC), com ou sem AU (n=16/grupo). Duas fatias de 1,5 mm foram obtidas de cada terço radicular. A primeira fatia foi submetida ao teste push-out e análise de modo de falha, enquanto a segunda foi observada em um estereomicroscópio para avaliação da qualidade da obturação. Os dados foram analisados ​​por testes de Kruskal-Wallis, Mann-Whitney e Friedman (α=0,05). SP mostrou maior resistência de união e menos espaços vazios na massa obturadora do que BC no terço apical e quando os dados dos terços radiculares foram agrupados. SP também apresentou maior resistência de união em comparação ao AH Plus no terço apical. A AU melhorou a resistência de união quando BC foi usado, mas não afetou a qualidade da obturação de nenhum dos cimentos. Não houve diferença significante entre os cimentos ativados por ultrassom em relação à resistência de união e qualidade da obturação. Quando comparados os terços radiculares, a resistência de união foi semelhante ao longo da raiz, mas houve uma tendência de pior qualidade no preenchimento, com mais vazios, no terço apical. Concluindo, a AU foi eficaz em aumentar a resistência de união do cimento à base de silicato de cálcio, mas não melhorou a qualidade da obturação. Para os cimentos à base de resina epóxi, essas propriedades não foram afetadas pela AU.

Does ultrasonic activation improve the bond strength and root canal filling quality of endodontic sealers?

This study aimed to investigate the effect of ultrasonic activation (UA) of three endodontic sealers on the bond strength to root dentin and root canal filling quality. Ninety six bovine incisors were instrumented and root canal filling was carried out using AH Plus (AP), Sealer Plus (SP), or Sealer Plus BC (BC), with or without UA (n=16/group). Two 1.5-mm slices were obtained from each root third. The first slice was subjected to push-out testing and failure mode analysis, while the second was observed under a stereomicroscope for filling quality assessment. Data were analyzed by Kruskal-Wallis, Mann-Whitney and Friedman tests (α=0.05). SP showed higher bond strength and fewer voids than BC in the apical third and when root thirds data were pooled. SP also had higher bond strength compared with AH Plus in the apical third. UA improved the bond strength when BC was used but did not affect the filling quality of any sealer. There were no significant differences between the ultrasonically activated sealers regarding bond strength and filling quality. When root thirds were compared, the bond strength was similar along the root, but there was a tendency to worsen filling quality, with more voids, in the apical segment. In conclusion, UA was effective in increasing the bond strength of the calcium silicate-based sealer but did not improve its filling quality. For the epoxy resin-based sealers, these properties were not affected by UA.

Low-dose Multidetector Computed Tomographic and Cone-beam Computed Tomographic Protocols for Volumetric Measurement of Simulated Periapical Lesions.

INTRODUCTION: The purpose of this study was to evaluate the accuracy of low-dose multidetector computed tomographic (LD-MDCT) imaging for the volumetric measurement of simulated periapical lesions. METHODS: Eighteen monoradicular teeth were introduced in bone blocks, and periapical lesions were simulated at the periapical region of each tooth. All teeth were imaged using 4 acquisition protocols: large (dentoalveolar) field of view (FOV) cone-beam computed tomographic (CBCT) imaging (120 kV, 5 mA, and 0.2-mm voxel), small (dental) FOV CBCT imaging (90 kV, 10 mA, and 0.2-mm voxel), standard multidetector computed tomographic imaging (120 kV, 50 mA, and 0.62-mm voxel), and LD-MDCT imaging (120 kV, 10 mA, and 0.62-mm voxel). Tomographic images were evaluated by a single trained and calibrated examiner (intraclass correlation coefficient = 0.991) using ITK-SNAP segmentation software (University of Pennsylvania, Philadelphia, PA). The gold standard was obtained by the impressions of the lesions with regular fluid addition silicone and individual weighing using a precision analytical scale. Data were evaluated by the repeated measures analysis of variance test; the significance level was defined as P < .05. RESULTS: No statistical differences (P > .05) were found among the groups regardless of the device, milliamperage, FOV, or voxel size. CONCLUSIONS: LD-MDCT shows performance comparable with other standard reference methods for measuring the volume of periapical lesions and can be a useful and safe protocol in clinical situations in which CBCT imaging is not available, such as in cases of patients admitted to hospitals.