Endodontic Treatment of Primary Molars with Antibiotic Paste: A Report of 38 Cases.

OBJECTIVE: This study presents 38 cases of primary molars with necrotic pulps treated with antibiotics-based paste. CASE REPORT: The technique consisted of necrotic tissue removal of the pulp chamber, using spoons excavators and low speed drills. Pulp cavity was washed with saline solution and dried with sterile cotton balls. Then an antibiotic paste composed of chloramphenicol, tetracycline, zinc oxide and eugenol - CTZ paste - was inserted at the entrance of root canals. Patients were evaluated clinically and radiographically at different times. The criteria that defined clinical success were the lack of periapical abscess and mobility compatible with chronological age. Radiographic assessments consisted in absence of radiolucency in the region of root bifurcation and pathological bone resorption. CONCLUSION: There were 100% and 93% of clinical and radiographic success, respectively. The results suggest that the CTZ paste is an optional therapy for pulp of primary molars.

Comparative evaluation of antimicrobial efficacy of various root canal filling materials along with aloevera used in primary teeth: a microbiological study.

AIM: this study was conducted to evaluate the antimicrobial effectiveness of 6 root canal filling materials and a negative control agent against 18 strains of bacteria isolated from infected root canals of primary molar teeth using agar diffusion assay. MATERIALS: Aloevera with sterile water Zinc oxide and Eugenol, Zinc oxide-Eugenol with aloevera, Calcium hydroxide and sterile water, Calcium hydroxide with sterile water and aloevera, Calcium hydroxide and Iodoform (Metapex) and Vaseline (Control). MIC and MBC of aloevera was calculated. RESULTS: All materials except Vaseline showed varied antimicrobial activity against the test bacterias. The zones of inhibition were ranked into 4 inhibition categories based on the proportional distribution of the data. All the 18 bacterial isolates were classified under 2 groups based on Gram positive and Gram negative aerobes. Statistical analysis was carried out to compare the antimicrobial effectiveness between materials tested with each of the bacterial groupings. CONCLUSION: Aloevera + Sterile Water was found to have superior antimicrobial activity against most of the microorganisms followed by ZOE + Aloevera, calcium hydroxide + Aloevera, ZOE, calcium hydroxide, Metapex in the descending order and Vaseline showed no inhibition.

Influence of the addition of microsphere load amoxicillin in the physical, chemical and biological properties of an experimental endodontic sealer.

AIM: To develop an endodontic sealer with amoxicillin-loaded microsphere and to evaluate its properties. METHODS: Experimental sealer was obtained by mixing 70wt% UDMA, 15wt% GDMA and 15wt% BISEMA. In addition, CQ, DHEPT and PB were incorporated at 1 mol% and 0.01wt% BHT and 10wt% YbF3. Microspheres were produced by drying in spray dryer. Two experimental groups (10 and 15wt% of microspheres) and one control group (without microspheres) were formulated. The sealers were evaluated for the degree of conversion (n=3), degradation in solvent (n=3), drug release profile (n=3), antimicrobial activity (n=3), flow (n=3), film thickness (n=3) and cytotoxicity (n=3). Data were analyzed by ANOVA and Tukey with significance level of 5%. RESULTS: Microespheres presented a mean size of 2.664µm. Immediate degree of conversion ranged from 51.73% to 55.13% and the 24h degree of conversion ranged from 60.79% to 73.80%. Upon solvent degradation 54.44% and 56.21% reduction in hardness were observed for 10% and 15% concentrations respectivelly. The drug release profile showed an average release of 73.76% of the drug in 96h. Significant reduction in antimicrobial activity was observed for 10% concentration after 24h, 48h and 96h compared to control. The flow and film thickness showed values in accordance to the ISO 6876. Cytotoxicity showed high cellular viability. CONCLUSION: The addition of up to 10% of microspheres containing amoxicillin presented antimicrobial activity and did not alter the properties of the experimental endodontic cement. CLINICAL SIGNIFICANCE: Amoxicillin microspheres with its antimicrobial activity in root canal sealers could reduce reintervations in endodontics when persistent bacteria or reinfection takes place in root canal system.

Human pulp reaction to dentine bonded amalgam restorations: a histologic study.

OBJECTIVE: The aim of this study was to investigate the human pulp response to Scotchbond Multi Purpose Plus (SMPP) bonding agent in non-exposed Class V cavities. METHODS: SMPP was placed in 24 of 40 cavites according to manufacturer's instructions and the cavities were restored with amalgam. The remaining 16 cavities were capped with a calcium hydroxide formulation (Dycal) sealed with zinc-oxide eugenol, and restored with the amalgam. After extraction at 10 and 35 days, the teeth were fixed, sectioned and stained for light microscopy. RESULTS: All Dycal-capped teeth, at both 10 and 35 days, exhibited no pulp inflammation and no demonstrable bacteria. Six cases sealed with SMPP at 10 days showed no pulp inflammation or stained bacterial profiles. The remaining six teeth demonstrated mild to moderate inflammatory pulpal responses and five out of these six cases exhibited stained bacterial profiles. Nine out of 12 teeth showed no inflammatory pulp responses at 35 days, the remaining three cases exhibited mild to moderate pulp inflammation without stained bacteria. CONCLUSIONS: None of the teeth sealed with SMPP presented severe inflammatory pulpal reactions histologically. SMPP did not exhibit significant deleterious effects on the human pulp tissue during the test periods.

Pulpal response to cavity preparation by an erbium, chromium:YSGG laser-powered hydrokinetic system.

The near red-pulsed erbium, chromium:yttrium-scandium-gallium-garnet laser hydrokinetic system, or Er,Cr:YSGG laser HKS, is effective in cutting dental hard tissues. In this longitudinal study, the authors studied the continuously erupting open-apex incisors of New Zealand albino rabbits and the constricted apex teeth of beagles to determine the effects of HKS-produced lesions at various energy levels and of preparations produced by a tapered fissure bur on dental pulp. No pulpal inflammatory responses could be identified either immediately or 30 days after surgery in HKS preparations that removed enamel and dentin without pulp exposure.

Intraalveolar transplantation of teeth. IV. Endodontic considerations.

Twenty-six teeth with crown-root fractures have been subjected to intraalveolar transplantation. In 13 teeth the endodontic treatment was instituted before transplantation and in another 13 teeth 3-4 weeks after transplantation. Bacteriological tests showed that endodontic treatment after transplantation was preferable with statistically fewer treatments and more reliable results. The results thus points in favour of a late endodontic treatment with controlled aseptic conditions.

Influence of the spatulation of two zinc oxide-eugenol-based sealers on the obturation of lateral canals.

The objective of this research was to evaluate, in vitro, the importance of the correct manipulation of endodontic sealers, correlating it with flow rate and with the consequent obturation of root canals. Twenty-four human canines were prepared, 1 mm from the apex, with K-files up to size 50, by means of the step-back technique. Six lateral canals were then drilled in each tooth, with size 10 file fixed to a low-speed handpiece. The teeth were randomly divided into 4 groups, and root canals were obturated either with the Endométhasoneregister mark or target sealer or Grossman sealer, prepared at ideal or incorrect clinical consistency. After obturation by means of the lateral condensation technique, the teeth were radiographed and evaluated as to the number of sealed lateral canals. Statistical analysis revealed significant differences (p < 0.001) between the tested sealers, and indicated the higher capacity of the well-manipulated Grossman sealer to fill lateral canals. It can be concluded that the flow rate of a sealer and its correct manipulation are very important for the satisfactory obturation of lateral canals.

Cytotoxicity and proliferative effects of Iodoform-containing root canal-filling material on RAW 264.7 macrophage and RKO epithelial cell lines.

OBJECTIVE: The present study investigated the effect of the Iodoform-containing root canal filling material on the viability of cultured macrophages and epithelial cells, and on cytokine secretion. DESIGN: The effect of Endoflas F.S. on the proliferation of a RAW 264.7 macrophage cell line and on a RKO epithelial cell line, and on the production of tumour necrosis factor alpha (TNFα) from macrophages was examined. Cell vitality was evaluated using a colourimetric XTT (sodium 2,3-bis(2-methoxy-4-nitro-5-sulfophenyl)-5-[(phenylamino)-carbonyl]-2H-tetrazolium inner salt) assay. The presence of cytokines was determined by two-site enzyme-linked immunosorbent assay (ELISA). RESULTS: Direct exposure of Endoflas F.S. and its media, up to a dilution of 1/8, decreased the viability of macrophages and epithelial cells by ∼70% compared to control media (P<0.05). Media dilution from 1/16 to 1/1024 demonstrated a proliferative effect, increasing cell viability by about 60% compared to media without Iodoform-containing root canal filling material. CONCLUSIONS: Direct and indirect exposure to high concentrations of iodoform-containing root canal filling material showed a cytotoxic effect on macrophages and epithelial cells, while low concentrations induced cell proliferation.

Efectividad clínica y radiográfica de la pasta antibiótica CTZ en pulpotomías de molares primarios: ensayo clínico aleatorio controlado / Clinical and radiographic effectiveness of antibiotic paste CTZ in primary molars pulpotomy: ramdomized controlled clinical trial

El objetivo de este trabajo fue evaluar clínica y radiográficamente la efectividad de la pasta antibiótica CTZ en pulpotomías de molares primarios. Se realizó un ensayo clínico aleatorio controlado, en 40 molares primarios de 40 preescolares con edades entre 3 y 6 años. Los pacientes fueron seleccionados y asignados aleatoriamente a dos grupos: Formocresol (n=20), CTZ (Cloranfenicol-Tetraciclina-Oxido de Zinc Eugenol, n=20). Los dientes fueron restaurados con ionómero de vidrio y coronas metálicas de acero preformadas. La evaluación clínica y radiográfica fue realizada a los 3 y 6 meses. Se utilizó el programa SPSS v.17 para el análisis de los datos, y la aplicación del Test Exacto de Fisher al 5 %. El comportamiento clínico a los 3 meses mostró 75 % de éxito para los molares tratados con formocresol y 70 % para el CTZ. Radiográficamente se obtuvo 90 % de éxito para el grupo con formocresol y 100 % para la pasta CTZ. A los 6 meses el éxito clínico del formocresol fue de 85 % y del CTZ 80 %. El éxito radiográfico mostrado fue 65 % para los atendidos con formocresol y 80 % para el CTZ (p > 0,05). No se observaron diferencias significativas entre los grupos de tratamiento. La pasta CTZ es una alternativa en el tratamiento de pulpotomías de molares temporales. Ofrece un efecto antimicrobiano, estabilización del proceso de reabsorción radicular, sin ocasionar daños a la formación del diente permanente.

The objective of this study to evaluate the clinical and radiographic effectiveness of antibiotic paste CTZ in pulpotomy of primary molars. A randomized controlled clinical trial was performed, in 40 molars of 40 patients aged 3 to 6 years. Were selected and randomly assigned to two groups: Formocresol (n=20), CTZ (Chloramphenicol-Tetracycline-Zinc Oxide Eugenol, n=20). The teeth were restored with glass ionomer and performed steel metal crowns. Clinical and radiographic evaluation procedure was performed at 3 and 6 months. SPSS v.17 program for data analysis, and application of the Fisher exact test was used 5 %. The clinical behavior at 3 months showed 75 % success rate for molars treated with formocresol and 70 % for the CTZ. Radiographically 90 % success rate for the group with formocresol and 100 % for the CTZ paste was obtained. At 6 months formocresol clinical success was 85 % and 80 % CTZ. Radiographic success was shown 65 % for those treated with formocresol and 80 % for the CTZ (p>0.05). No significant differences in the results shown were observed. CTZ paste is an alternative in the treatment of pulpotomy of molars. It provides an antimicrobial effect, stabilizing the process of root resorption, without causing damage to the permanent tooth formation.

Subcutaneous connective tissue reaction to methacrylate resin-based and zinc oxide and eugenol sealers.

INTRODUCTION: An evaluation was made of the connective tissue reaction in rats after subcutaneous implantation of methacrylate resin-based sealers (EndoREZ [Ultradent Products, Inc, South Jordan, UT] with a polymerization accelerator and RealSeal [Sybron Dental Specialties, Orange, CA]) and Pulp Canal Sealer (Sybron Dental Specialties), a zinc oxide and eugenol-based sealer used as the control. METHODS: Silicone tubes containing the test materials were implanted in 24 Wistar rats. Solid silicone rods of the same size served as the negative controls. After 10, 30, and 90 days, the animals (n = 8 per period) were euthanized and the implants with surrounding tissues dissected and processed for routine histological evaluation. A four-category evaluation system was used to measure and record the microscopic observations according to the thickness of a fibrous capsule, the vascular changes, and the various types of inflammatory cells. RESULTS: Initially, a severe inflammatory reaction was observed of the soft tissues in direct contact with both EndoREZ/Accelerator and Real Seal. The severity decreased over time and was resolved at the end of the experiment. Pulp Canal Sealer showed a severe tissue reaction for all observation periods. The negative controls showed an initial mild to moderate inflammatory reaction. After 30 days, healthy fibrous connective tissue was observed, which increased over time. After 10 days, no statistically significant differences between the experimental groups were observed. After 90 days, EndoREZ and RealSeal were statistically significantly less toxic than Pulp Canal Sealer (p > 0.05). CONCLUSIONS: After 90 days, both methacrylate resin-based sealers were considered biologically acceptable when implanted in subcutaneous connective tissues of the rat. Pulp Canal Sealer remained toxic for the duration of the study.

Comparision of biocompatibility and cytotoxicity of two new root canal sealers.

The aim of this study was to investigate the remote organ toxicity and connective tissue reaction of two new root canal sealers ("GuttaFlow(®)" and "EndoREZ(®)") and to compare them with zinc oxide eugenol sealer using biochemical and histopathological parameters. A total of 60 white albino Wistar rats were used in the study. 0.1ml of GuttaFlow(®), EndoREZ(®) or Kerr Pulp Canal Sealer(®) were administered subcutaneously into the mid-dorsal thoracic region of rats (15 in each group). Control rats were given saline only. Rats were decapitated after 24h, on day 7 and on day 30 of the experiment and tissue samples from lung, liver, kidney and skin were removed for the determination of malondialdehyde (MDA) and glutathione (GSH) levels. In parallel, tissues were also examined histologically. Serum aspartate aminotransferase (AST), alanine aminotransferase (ALT) levels, and creatinine and blood urea nitrogen (BUN), concentrations (BUN) were measured to assess liver and kidney functions, respectively. Tumor necrosis factor (TNF) and lactate dehydrogenase (LDH) were also assayed in serum samples. No statistical differences were found among the control and EndoREZ(®), GuttaFlow(®) and Kerr Pulp Canal sealers regarding tissue MDA, GSH levels or serum parameters (p>0.05) at all time points examined. Both of the new root canal sealers showed good compatibility and acceptable tissue toxicity.