Using manual versus mechanized glide path instruments and ProTaper Gold versus ProTaper Next systems in curved canals: micro-CT study

Abstract The aim of this study was to evaluate the root canal shaping effect of ProTaper Gold (PTG) versus ProTaper Next (PTN) instrumentation systems, and of a manual #15 K-type file (K15) versus the ProGlider (PG) mechanized instrument for glide path creation, in severely curved mesial canals. Twenty-four mandibular molars with two separate mesial canals were anatomically matched using computed tomographic scanning, and then divided into two groups (n=12) according to the glide path instrument used, either K15 or PG. In all teeth, the PTG system was used to prepare the mesiobuccal canal, and the PTN, the mesiolingual canal. The teeth were scanned by computed microtomography, before and after root canal preparation, and the values of the initial volume, final volume, volumetric variation, untouched walls, and canal transportation variables were determined. The data were analyzed using the two-way ANOVA test, and the Tukey test for multiple comparisons. There was no significant difference among the study groups regarding volumetric variation or root canal transportation, either in the cervical, middle or apical thirds, or in the entire root canal (p>0.05). In the apical third, the percentage of untouched walls was significantly higher in groups using K15 than in those using PG (p<0.05), namely 33.144% and 23.285%, respectively, irrespective of the instrumentation system. In the other regions, there was no difference between K15 and PG regarding this variable. It was concluded that PG was associated with a lower rate of untouched walls in the apical region than K15.

Antibacterial ability of different activated irrigation after root canal preparation: intratubular analyses

Abstract This study assessed the intratubular antibacterial ability of different activated irrigations after chemical mechanical preparation. Seventy-two palatal root canals of upper molars were infected with Enterococcus faecalis for 4 weeks, and then initial bacterial collection from the main root canal was performed. The root canals were prepared by using a WaveOne Gold large (45/.05) and distributed into 6 groups according to the activation of the final irrigation: ultrasonic activation (UA), XP-Endo Finisher (25/.00), XP Clean (25/.02), EasyClean (25/.04) in reciprocating motion and continuous rotary motion (ECRot), and conventional irrigation. After final irrigation, another bacterial collection from the main root canal was performed, and the root was sectioned transversely in three-thirds and stained for analysis by confocal laser microscopy. Intratubular bacteria were collected through dentin powder and plated for bacterial viability analysis. Intergroup and intragroup comparisons were performed by using analysis of variance and repeated measures analysis of variance, respectively, both at 5% significance. ECRot had higher antibacterial ability than UA (p<0.05), and both were superior to the other groups (p<0.05) in both methodologies. It can be concluded that activation of final irrigation enhances the disinfection of the root canal system, and activators have different efficacies

Resumo Este estudo avaliou a capacidade antibacteriana intratubular de diferentes irrigações ativadas após o preparo químico-mecânico. Setenta e dois canais palatinos de molares superiores foram contaminados com Enterococcus faecalis por 4 semanas, e então a coleta bacteriana inicial do canal principal foi realizada. Os canais foram preparados com WaveOne Gold large (45/.05) e distribuídos em 6 grupos de acordo com a ativação da irrigação final: ativação ultrassônica (UA), XP-Endo Finisher (25/.00), XP Clean (25/.02), EasyClean (25/.04) em movimento reciprocante e em movimento rotatório contínuo (ECRot) e irrigação convencional. Após a irrigação final, outra coleta bacteriana do canal principal foi realizada, e a raiz foi seccionada transversalmente em três terços e corada para análise por microscopia laser confocal. Bactérias intra tubulares foram coletadas através de pó de dentina e cultivadas para análise de viabilidade bacteriana. As comparações entre grupos e intragrupos foram realizadas usando análise de variância e análise de variância de medidas repetidas, respectivamente, ambas com 5% de significância. ECRot apresentou maior capacidade antibacteriana que UA (p<0,05), e ambos foram superiores aos demais grupos (p<0,05) em ambas as metodologias. Pode-se concluir que a ativação da irrigação final melhora a desinfecção do sistema de canais radiculares, e os ativadores têm eficácias diferentes.

Root canal curvature influences uncontrolled removal of dentin and cleaning efficacy after ultrasonic activation

Abstract This study evaluated the correlation between root canal curvature and the effects of ultrasonic irrigation in the following parameters: volume of uncontrolled dentin removal (UDRVol), maximum depth of dentin defects, removal of accumulated hard tissue debris (AHTD), and canal transportation in prepared curved root canals. Twenty-four human permanent mandibular molars were divided into two groups according to root canal curvature: moderate curvature (MC: mean 25°); and severe curvature (SC: mean 48°). The specimens were scanned using an X-ray microcomputed scanner (Skyscan 1172) before and after cleaning and shaping and after the final irrigation protocol with ultrasonic irrigation. There was a moderate correlation between the degree of root canal curvature and the volume of remaining AHTD (p<0.05) and between the degree of root canal curvature and maximum depth of defects due to uncontrolled removal of dentin (p<0.05). The teeth in the SC group had a greater maximum depth of defects on the dentin wall in the apical third than the teeth in the MC group (p <0.05). Both groups had a significant reduction of AHTD in all canal thirds, but the amount of remaining AHTD in the middle and apical thirds and the whole canal was significantly greater in the SC than in the MC group (p <0.05). Canal transportation was not influenced by the canal curvature in all thirds (p >0.05). This study concluded that root canal curvature affects significantly the uncontrolled removal of dentin and remaining AHTD volume after the final irrigation protocol with ultrasonic irrigation.

Resumo Este estudo avaliou a correlação entre a curvatura do canal radicular e os efeitos da irrigação ultrassônica nos seguintes parâmetros: volume de remoção não controlada de dentina (UDRVol), profundidade máxima do desgaste de dentina, remoção de debris de tecido duro acumulado (AHTD) e transporte em canais radiculares curvos. Vinte e quatro molares inferiores humanos permanentes foram divididos em dois grupos de acordo com a curvatura do canal radicular: curvatura moderada (MC: média de 25°); e curvatura acentuada (SC: média de 48°). Os espécimes foram digitalizados usando um scanner microcomputador de raios X (Skyscan 1172) antes e depois da limpeza e modelagem e após a irrigação ultrassônica. Houve uma correlação moderada entre o grau de curvatura do canal radicular e o volume de AHTD remanescente (p<0,05) e entre o grau de curvatura do canal radicular e a profundidade máxima de defeitos devido à remoção descontrolada de dentina (p<0,05). Os dentes do grupo SC apresentaram maior profundidade máxima de defeitos na parede dentinária no terço apical do que os dentes do grupo MC (p<0,05). Ambos os grupos tiveram uma redução significativa de AHTD em todos os terços do canal, mas a quantidade de AHTD remanescente nos terços médio e apical e em todo o canal foi significativamente maior no grupo SC do que no grupo MC (p <0,05). O transporte do canal não foi influenciado pela curvatura do canal em todos os terços (p > 0,05). Este estudo concluiu que a curvatura do canal radicular afeta significativamente a remoção descontrolada de dentina e o volume remanescente de AHTD após a irrigação ultrassônica.

Evaluation of different methods of calcium hydroxide removal from root canals with simulated internal resorptions / Avaliação de diferentes métodos de remoção de hidróxido de cálcio de canais radiculares com reabsorções internas simuladas

Objective: This study evaluated different methods of calcium hydroxide (CH) removal from root canals with simulated internal resorptions using microcomputed tomography (micro-CT). Material and Methods: Sixty acrylic resin blocks with simulated root canals and internal resorptions were prepared using a Reciproc R25 file and then filled with CH. The blocks were divided into five test groups (n=12) according to the method used for CH removal: hand files (HF), Easy Clean (EC), passive ultrasonic irrigation (PUI), XP-Endo Finisher (XP), XP-Endo Finisher + PUI (XP+PUI). The blocks were scanned using a SkyScan 1172 scanner before and after CH removal to measure the volume and percentage of CH removal. The OriginPro 2017 software was used for statistical analyses. The level of significance was set at p<0.05 for all tests. Results: No method under study removed all CH. All methods had similar results in the cervical third (P>0.05). The percentage of CH removal was significantly greater in the area of internal resorption and along the total length of the canal in the XP+PUI group (P<0.05). The best results of CH removal were found in the apical third of roots in the XP+PUI and PUI groups (P>0.05). Conclusion: No method removed all CH from the root canals, but the combined XP+PUI method removed more CH than the other methods, especially from the area of the internal resorption(AU)

Objetivo: Este estudo avaliou diferentes métodos de remoção de hidróxido de cálcio (CH) de canais radiculares com reabsorções internas simuladas por meio de microtomografia computadorizada (micro-CT). Material e Métodos: Sessenta blocos de resina acrílica com canais radiculares simulados e reabsorções internas foram preparados com lima Reciproc R25 e posteriormente preenchidos com CH. Os blocos foram divididos em cinco grupos de teste (n=12) de acordo com o método utilizado para remoção de CH: limas manuais (HF), Easy Clean (EC), irrigação ultrassônica passiva (PUI), XP-Endo Finisher (XP), XP -Endo Finalizador + PUI (XP + PUI). Os blocos foram escaneados usando um scanner SkyScan 1172 antes e depois da remoção do CH para medir o volume e a porcentagem de remoção do CH. O software OriginPro 2017 foi utilizado para análises estatísticas. O nível de significância foi estabelecido em p<0,05 para todos os testes. Resultados: Nenhum método em estudo removeu todos o CH. Todos os métodos tiveram resultados semelhantes no terço cervical (P>0,05). A porcentagem de remoção de CH foi significativamente maior na área de reabsorção interna e ao longo do comprimento total do canal no grupo XP+PUI (P<0,05). Os melhores resultados de remoção de CH foram encontrados no terço apical das raízes nos grupos XP+PUI e PUI (P>0,05). Conclusão: Nenhum método removeu todo o CH dos canais radiculares, mas o método combinado XP+PUI removeu significativamente mais CH do que os outros métodos, especialmente da área de reabsorção interna (AU)

Extrusão apical de irrigantes em dentes imaturos utilizando diferentes dispositivos de irrigação por pressão negativa / Apical extrusion of irrigants in immature teeth using different negative pressure irrigation devices

Objetivo: O objetivo deste estudo foi avaliar a extrusão apical de irrigantes em dentes imaturos simulados, comparando a irrigação convencional com outros dispositivos de irrigação por pressão negativa. Materiais e Métodos: 48 amostras de dentes imaturos simulados foram montadas em um modelo adaptado para conter o irrigante extravasado e distribuídas igualmente em 4 grupos (n=12) de acordo com o dispositivo de irrigação utilizado: Grupo Irrigação Convencional (IC), Grupo EndoVac (EV), Grupo Pulp Sucker (PS) e Grupo Ivac (IV). As amostras foram irrigadas com 15mL de solução irrigadora, sendo 10mL de NaOCl a 2,5% e 5mL de EDTA a 17% intercalados. As amostras foram pesadas em balança de precisão antes e depois dos procedimentos de irrigação, sendo a diferença entre os pesos final e inicial considerado o volume de irrigante extravasado. Os dados foram coletados e analisados estatisticamente pelos testes de Kruskal-wallis e exato de Fisher. Resultados: Os grupos que utilizaram pressão negativa promoveram significativamente menor volume de irrigante extravasado que o grupo IC (p<0,05), não havendo diferenças significativas quando comparados entre si (p>0,05). Houve diferenças significativas na associação entre os grupos e a extrusão de irrigante, sendo o grupo PS menos associado a extrusão de irrigante (p<0,005). Discussão: Estudos anteriores apontam os dispositivos de pressão negativa como opções seguras diante de extravasamento de irrigantes quando comparados à irrigação convencional. Conclusão: A irrigação convencional promoveu significativamente maior volume de extrusão de irrigante quando comparada aos dispositivos de irrigação por pressão negativa. O sistema PulpSucker mostrou extravasamento de irrigante em um número significativamente menor de amostras.

Aim: The aim of this study was to evaluate the apical extrusion of irrigants in simulated immature teeh, comparing convencional irrigation with other negative pressure irrigation devices. Materials and methods: 48 samples of simulated immature teeth were set up in an adapted model to contain the extravasated irrigant and evenly distributed into 4 groups (n=12) according to the device used: Convencional Irrigation Group (CI), EndoVac Group (EV), Pulp Sucker Group (PS) and Ivac Group (IV). The samples were irrigated with 15mL of irrigant solution, consisting of 10mL NaOCl 2,5% and 5mL EDTA 17%, in na alternating sequence. The samples' weights were measured using a precision scale before and after the irrigation procedures, with the difference between de final and initial weights considered the volume of extravasated irrigant. Data were collected and statistically analyzed by Kruskal-wallis and Fisher exact tests. Results: The groups that used negative pressure devices significantly promoted a lower volume of extruded irrigant than the CI group (p<0,05), with no significant differences between the negative pressure groups (p>0,05). There were signficant differences in the association between the groups and irrigant extrusion, with the PS group showing significantly less association with irrigant extrusion (p<0,005). Discussion: Previous studies have indicated that negative pressure devices are safe alternatives to convencional irrigation when considering irrigant extrusion. Conclusion: Conventional irrigation promoted a significantly greater volume of irrigant extrusion when compared to negative pressure irrigation devices. The PulpSucker system showed irrigant extravasation in significantly fewer samples.

Optimization of automated preparation of long oval-shaped root canals using supplementary instrumentation

Abstract This study compared the preparation of long oval-shaped root canals using WaveOne Gold and XP-endo Shaper systems, both supplemented or not with manual instrumentation. Twenty-four long oval-shaped canals of mandibular incisors were distributed into two groups according to the instrumentation: WaveOne Gold Primary or XP-endo Shaper systems. All root canals were manually instrumented with a size 25 K-file after automated preparation. The specimens were scanned by using a micro-CT device (17.42 µm) before and after automated preparation and manual instrumentation. The increased surface of the root canal and the percentage of untouched areas were assessed. Both WaveOne Gold and XP-endo Shaper systems increased the root canal surface and had similar untouched areas (p>0.05). Supplementary instrumentation increased the surface of the root canal and decreased the untouched walls (p<0.05). WaveOne Gold and XP-endo Shaper systems provided a similar preparation of long oval-shaped canals and manual instrumentation improved their preparation.

Resumo Este estudo comparou o preparo de canais radiculares ovais longos usando os sistemas WaveOne Gold e XP-endo Shaper, ambos complementados ou não com instrumentação manual. Vinte e quatro canais longos e ovais de incisivos inferiores foram distribuídos em dois grupos de acordo com a instrumentação: sistemas WaveOne Gold Primary ou XP-endo Shaper. Todos os canais foram instrumentados manualmente com uma lima K tamanho 25 após preparo automatizado. Os espécimes foram escaneados usando um dispositivo de micro-CT (17,42 µm) antes e após o preparo automatizado e instrumentação manual. O aumento de superfície do canal radicular e a porcentagem de áreas intocadas foram avaliadas. Ambos os sistemas WaveOne Gold e XP-endo Shaper aumentaram a superfície do canal radicular e apresentaram áreas intocadas semelhantes (p>0,05). A instrumentação complementar aumentou a superfície do canal radicular e diminuiu o percentual de áreas intocadas (p <0,05). Os sistemas WaveOne Gold e XP-endo Shaper tiveram o preparo de canais ovais longos semelhantes, e a instrumentação manual melhorou o preparo.

Mechanism of action of Bioactive Endodontic Materials

Abstract A continuous search for bioactive materials capable of supporting the replacement of damaged pulp tissue, with effective sealing potential and biocompatibility, has represented the attention of studies over the last decades. This study involves a narrative review of the literature developed by searching representative research in PUBMED/MEDLINE and searches in textbooks associated with the mechanism of action of bioactive materials (calcium hydroxide, mineral trioxide aggregate (MTA), and calcium silicate cements). The reflective analysis of the particularities of the chemical elements of these materials, considering the tissue and antibacterial mechanism of action, allows a better understanding of the characteristics and similarities in their tissue responses. Calcium hydroxide paste remains the antibacterial substance of choice as intracanal dressing for the treatment of root canal system infections. Calcium silicate cements, including MTA, show a favorable biological response with the stimulation of mineralized tissue deposition in sealed areas when in contact with connective tissue. This is due to the similarity between the chemical elements, especially ionic dissociation, the potential stimulation of enzymes in tissues, and the contribution towards an alkaline environment due to the pH of these materials. The behavior of bioactive materials, especially MTA and the new calcium silicate cements in the biological sealing activity, has been shown to be effective. Contemporary endodontics has access to bioactive materials with similar properties, which can stimulate a biological seal in lateral and furcation root perforations, root-end fillings and root fillings, pulp capping, pulpotomy, apexification, and regenerative endodontic procedures, in addition to other clinical conditions.

Resumo Uma busca contínua de materiais bioativos com capacidade de substituir o tecido pulpar danificado, com efetiva capacidade de selamento e biocompatibilidade, tem representado a atenção e foco de muitos estudos ao longo das últimas décadas. Este estudo envolve uma revisão narrativa da literatura desenvolvida por meio de pesquisas representativas encontradas no PUBMED/MEDLINE e pesquisas em livros didáticos associadas ao mecanismo de ação de materiais bioativos (hidróxido de cálcio, agregado de trióxido mineral (MTA) e cimentos de silicato de cálcio). A presente análise reflexiva das particularidades dos elementos químicos destes materiais bioativos, considerando o mecanismo de ação tecidual e antibacteriano, possibilita um melhor entendimento das características e similaridades no comportamento tecidual. A pasta de hidróxido de cálcio continua sendo a substância antibacteriana de escolha como medicação intracanal para o tratamento das infecções do sistema de canais radiculares. Este fato se deve a disponibilidade química de íons cálcio e hidroxila do hidróxido de cálcio aos tecidos, e a inibição enzimática bacteriana. Os cimentos de silicato de cálcio, dentre os quais inclui o MTA, apresentam uma resposta biológica favorável ao estímulo à deposição de tecido mineralizado nas áreas seladas e em contato com tecido conjuntivo. Este fato é decorrente da similaridade entre os elementos químicos, em especial devido a dissociação iônica, ao potencial estímulo de enzimas teciduais, e a contribuição com um meio alcalino decorrente do pH destes materiais. O comportamento dos materiais bioativos, em especial o MTA e os novos cimentos de silicato de cálcio na atividade de selamento biológico mostraram efetivos. A endodontia contemporânea atualmente conta com o potencial de materiais bioativos com propriedades análogas capaz de estimular o selamento biológico em perfurações radiculares laterais e de furca, em obturações radiculares, capeamento pulpar, pulpotomia, apicificação e procedimentos endodônticos regenerativos, além de outras condições clínicas.

Influence of heat treatment of nickel-titanium instruments on the accuracy of an electronic apex locator integrated with endodontic motor.

Context: Manufacturers have produced a wide variety of nickel-titanium (NiTi) alloys, but the available literature is limited on the accuracy of some integrated electronic apex locators (EAL) used with different NiTi heat treatments in working length (WL) determination. Aim: This study aims to evaluate ex vivo , the influence of different heat treatments of NiTi instruments, and the diameter of the apical preparation on the accuracy of an EAL used during root canal preparation using an integrated EAL and motor unit. Materials and Methods: Nineteen extracted human mandibular incisors were included in the study. The WL control was determined by the visual method. Instruments of Mtwo, Reciproc, Reciproc Blue, WaveOne Gold, Twisted File Adaptive, and Hyflex CM systems, with diameters from 0.25 mm to 0.50 mm, were used to measure WL during root canal preparation. The electrical resistivity of instruments with a diameter of 0.25 mm from each system was evaluated using an Inductance, Capacitance, and Resistance (LCR) meter. Statistical Analysis Used: Data were statistically analyzed using Fisher's exact test and Kruskal-Wallis test. Results: The different heat treatments and different diameters did not influence the precision of the EAL (P > 0.05). Conclusion: The heat treatment and the diameter of the apical preparation did not influence the accuracy of WL determination by an EAL integrated with the endodontic motor.

Remoção de obturações endodônticas de Endosequence BC/CPoint em canais radiculares curvos usando instrumentos rotatórios ou reciprocantes / Removal of Endosequence BC/CPoint endodontic fillings in curved root canals using rotary or reciprocating instruments

Objetivo: O presente estudo usou micro-CT para avaliar a quantidade de material obturador remanescente em canais radiculares curvos que tinham sido obturados com cimento Endosequence BC/Cpoint ou com cimento AH/ guta-percha, depois do retratamento utilizando instrumentos rotatórios ou reciprocantes. Métodos: Sessenta canais mesiovestibulares de molares superiores foram instrumentados até MTwo #35.04. As amostras foram randomicamente alocadas em quatro grupos (n=15): os canais do G1 e G2 foram obturados com AH/guta-percha, e os canais do G3 e G4 foram obturados com BC/Cpoint. O material obturador foi removido usando instrumentos rotatórios ou reciprocantes ­ G1 e G3: R25 Reciproc + reinstrumentação com R40; e G2 e G4: Sistema ProTaper Universal Retratamento + reinstrumentação com MTwo 40.06. Micro-CTs foram usadas para medir a quantidade de material obturador remanescente (mm3 ) para o canal inteiro e para cada terço, em dois momentos: 1) após a remoção do material obturador; e 2) após a reinstrumentação. Resultados: Após a remoção do material obturador, BC/CPoint permaneceu mais dentro do canal do que AH/guta-percha quando o canal inteiro (29,92% x 19,25%, p=0,0290) e o terço apical foram analisados. Após a reinstrumentação, BC/CPoint permaneceu mais do que AH/guta-percha somente no terço apical. Protocolos de tratamento com instrumentos rotatórios ou reciprocantes removeram material obturador sem diferença para AH/guta-percha (G1 e G2: p> 0,05) e BC/CPoint (G3 e G4: p> 0,05). Conclusões: BC/Cpoint é mais difícil de ser removido de canais radiculares curvos do que AH/guta-percha. Instrumentos rotatórios e reciprocantes têm habilidade similar na remoção de material obturador (AU).

Objective: This study used micro-CT to evaluate the amount of remaining filling material in curved root canals obturated with Endosequence BC Sealer/Cpoint or AH/gutta-percha after a rotary or reciprocating retreatment. Methods: Sixty mesiobuccal canals of maxillary molars were instrumented up to MTwo #35.04. Samples were randomly assigned to four groups (n=15): canals from G1 and G2 were filled with AH/gutta-percha, and canals from G3 and G4 were filled with BC/Cpoint. Filling material was removed using rotary or reciprocating instruments: G1 and G3: R25 Reciproc + re-shaping with R40; and G2 and G4: ProTaper Universal Retreatment system + re-shaping with MTwo 40.06. Micro-CT was used to measure the remaining amount of filling material (mm3 ), for the whole canal, and for each third, in two moments: 1) after filling removal and 2) after canal re-shaping. Results: After filling removal, BC/CPoint remained more into the canal than AH/Gutta-percha when the whole canal (29.92% x 19.25%, p = 0.0290) and the apical third were analyzed. After re-shaping, BC/CPoint remained more than AH/Gutta-percha only in the apical third. Rotary or reciprocating retreatment protocols removed filling material without difference for AH/gutta-percha (G1 and G2: p > 0.05) and BC/CPoint (G3 and G4: p > 0.05). Conclusion: BC/Cpoint is more difficult to be removed from curved root canals than AH/gutta-percha. Reciprocating and rotary instruments have similar ability to remove filling material (AU).

Resistência à fadiga cíclica dos instrumentos Reciproc e Mtwo nos movimentos rotatório e reciprocante / Resistance to cyclic fatigue of Reciproc and Mwto files on continuous rotation and reciprocating movements

Objetivo: O objetivo do presente estudo foi avaliar a influência da liga (NiTi convencional e M-Wire) e do movimento (reciprocante e rotação contínua) na resistência à fadiga cíclica. Métodos: Quinze limas Reciproc R25 (VDW GmbH, Munique, Alemanha) foram usadas em movimento reciprocante (MR), enquanto trinta limas Mtwo 25.07 (VDW GmbH, Munique, Alemanha) foram usadas em MR (n=15) ou em rotação contínua (RC) (n=15). Os instrumentos foram submetidos a ensaios dinâmicos movidos por motor elétrico, que permitiram reproduzir o movimento de pecking motion, a 300rpm de velocidade. Os instrumentos simularam a instrumentação de um canal radicular curvo com 40o e 5mm de raio de curvatura. A fratura dos instrumentos foi detectada por um sensor digital, e o tempo e o número de ciclos foram registrados. Os dados foram analisados estatisticamente pelos testes ANOVA e de Tukey (p<0,05). Resultados: Os instrumentos Reciproc R25 movidos por MR alcançaram número significativamente maior (p<0,05) de ciclos antes da fratura (1.777,68±334,2 ciclos), quando comparados aos instrumentos MT 25.07 movidos por MR (610,67±126,3 ciclos) ou RC (432,23±183,2 ciclos). Conclusões: O movimento reciprocante mostrou resistência à fadiga cíclica significativamente maior, e os instrumentos de NiTi M-Wire apresentaram maior resistência à fadiga cíclica do que os instrumentos rotatórios de NiTi convencional (AU).

Objective: The aim of present study was to evaluate the influence of alloy (conventional NiTi and M-Wire NiTi) and movement (reciprocating movement and continuous rotation) on resistance to cyclic fatigue. Methods: Fifteen Reciproc R25 files (VDW GmbH, Munich, Germany) were used in reciprocation motion (RM), while thirty MTwo 25/.07 files (VDW GmbH, Munich, Germany) were used either in RM (n=15) or in continuous rotation (CR) (n=15). The files were submitted to dynamic assays device moved by electric engine that allowed the reproduction of pecking motion under 300 rpm of speed. The files act simulating the instrumentation of a curved root canal with 40º and 5-mm of curvature radius. The fracture was detected by the device sensor and the time and number of cycles were obtained. Data were statistically analyzed by ANOVA and Tukeys tests (p<0.05). Results: The Reciproc R25 instruments moved by RM reached significantly higher number (p<0.05) of cycles before fracture (1777.68 ± 334.2 cycles) when compared with MTwo 25/.07 instruments moved by RM (610.67 ± 126.3 cycles) or CR (432.23 ± 183.2 cycles). Conclusions: The reciprocation motion showed significantly greater cyclic fatigue resistance and the M-Wire NiTi files showed higher cyclic fatigue resistance than conventional NiTi rotary files (AU).

Spontaneous Bisphosphonate-related Osteonecrosis Associated with a Tooth that Had a Necrotic Pulp: A Case Report.

This study reports the endodontic treatment performed in a patient who presented with spontaneous bone exposure in the mandible while using intravenous bisphosphonate medication (Zometa , Novartis Pharmaceuticals Co., Basel, Switzerland). A 63-year-old female patient was referred to a private dental clinic at Fortaleza, Brazil. The patient reported that one year before, she had undergone chemotherapy for the treatment of lung cancer and associated bone metastasis. Among the medications administered was the zolendronic acid, with dosage of 4 mg every 21 days. In the oral exam, the presence of extensive bone exposure was observed in the lingual region near tooth 37. The patient reported severe pain on palpation in the region; in the pulpal sensitivity test with cold stimulus, there was an absence of pain, characteristic of pulp necrosis. Radiographically, no periapical lesion was observed. Thus, endodontic treatment was performed, and instrumentation with Reciproc R25 files in the mesial root canals and R40 in the distal canal was done, alongside with abundant 2.5% sodium hypochlorite irrigation. Interappointment medication with calcium hydroxide was maintained for 15 days. In the second session, there was the spontaneous detachment of the exposed cortical bone fragment. The root canals were filled with gutta-percha and Endosequence BC Sealer cement. After two years, complete tissue repair was observed, and the patient presented with normal periapical tissues and the tooth in masticatory function. It may be concluded that a possible relationship between pulp and periapical infections and osteonecrosis exists in patients who use bisphosphonates.

Knowledge about Coronavirus disease 19 (COVID-19) and its professional repercussions among Brazilian endodontists

Abstract The aim of this study was to assess Brazilian endodontists' level of knowledge about the coronavirus disease (COVID-19) and examine its professional repercussions. The link to the online survey that was created for this study was shared with Brazilian endodontists through social networking applications. The questionnaire contained questions that pertained to COVID-19 and its impact on dental practice. The collected data were analyzed using t-test, chi-square analysis, and analysis of variance, and the level of significance was set at 0.05. A total of 2,135 participants responded to the questionnaire, and all five Brazilian regions were represented in the sample. A total of 98.50% of endodontists reported that dental procedures can transmit COVID-19. Complete social distancing was practiced by 96.68% of the participants, and approximately 25% knew someone who had COVID-19. Moreover, in their daily practice, 72.13% of them implemented biosecurity measures that are ineffective in preventing COVID-19. Furthermore, 91.7% of them reportedly suspended elective dental procedures. Only 55.69% of them reported that they performed only emergency procedures in their workplaces. Those who believed that COVID-19 cannot be transmitted during dental procedures were less knowledgeable about the symptoms of COVID-19 (p = 0.0095). Endodontists who believed that personal protective equipment cannot prevent contamination were more knowledgeable about the symptoms of COVID-19 than their counterparts (p = 0.0003). The participating Brazilian endodontists demonstrated adequate knowledge about the risk of contamination during dental procedures and the main symptoms of COVID-19. Only some professionals reported providing emergency dental care during the pandemic.

Torsional fatigue strength of reciprocating and rotary pathfinding instruments manufactured from different NiTi alloys

Abstract To evaluate the torsional properties of engine-driven pathfinding instruments manufactured from different NiTi alloys - R-Pilot (tip size 12.5;.04 taper; M-Wire) and One G (tip size 14;.03 taper; Conventional NiTi). A total of 40 NiTi instruments from engine-driven pathfinding instruments (n = 20) were used. The torsion tests followed ISO 3630-1 (1992). Three millimeters of each instrument tip was fastened to a small load cell by a lever arm linked to the axis of torsion. During the test, the torsion testing machine software measured the maximum torsional strength and angle of rotation (0) before instrument failure. The fractured surface of each instrument was assessed by scanning electron microscopy (SEM). In addition, a supplementary examination was performed to measure the cross-sectional area and the metal mass volume of each instrument 3 mm from the tip. Data were analyzed using a t-test, with significance level set at 5%. R-pilot had significantly higher torsional strength than did One G (p < 0.05). Regarding the angle of rotation to fracture, One G had higher angles than did R-Pilot (p < 0.05). The supplementary examination showed that R-Pilot had the highest cross-sectional area and volume of metal mass at 3 mm from the tip (p < 0.05). R-pilot (M-Wire NiTi alloy) had a significantly higher torsional strength and One-G (superelastic NiTi alloy) had the highest angle of rotation to fracture.

Comparison of rRNA-based reverse transcription PCR and rDNA-based PCR for the detection of streptococci in root canal infections

Abstract Objective The rDNA-based method is unable to distinguish between alive and dead cells. Alternatively, bacterial viability can be assessed by molecular methods based on ribosomal RNA (rRNA). Therefore, this study aimed to detect viable streptococci in root canal samples using rRNA-based reverse transcription polymerase chain reaction (RT-PCR), compared to an rDNA-based PCR assay. Methodology Microbiological root canal samples were obtained from 32 teeth with primary endodontic infections before (S1) and after chemomechanical preparation (S2), and after removal of intracanal medication (S3). RNA and DNA were extracted, and complementary DNA (cDNA) was synthesized from RNA using RT reaction. cDNA and genomic DNA were subjected to PCR with primers complementary to the 16S rRNA sequences of Streptococcus spp. McNemar's test was used to compare the detection rate of both assays (P<0.05). Results Streptococci were detected in 28.12% (9/32) and 37.5% (12/32) of S1 samples using rRNA- and rDNA-based PCR assays, respectively. In contrast, they were detected in only 6.25% (2/32) of S2 samples using rRNA-based RT-PCR, compared to 15.62% (5/32) using rDNA-based PCR. Finally, in S3 samples, streptococci were not detected by rRNA, whereas rDNA-based PCR still detected the bacteria in 12.5% (4/32) of the samples. The total number of PCR-positive reactions in the rDNA-based PCR was higher than in the rRNA-based assay (P<0.05). Conclusions The rRNA-based RT-PCR showed a lower detection rate of streptococci when compared to the rDNA-based PCR, suggesting that the latter may have detected dead cells of streptococci in root canal samples.

Influence of cross-section and number of use in cyclic fatigue resistance of rotary instruments

Aim: The aim of present study was to evaluate if the cross-section and the number of use have influence in cyclic fatigue resistance of rotary files. Methods: K3 Endo (group K) and EndoSequence (group E) files, 25/.04, 25 mm, were subdivided into 3 subgroups (n=12) according to the number of uses, 1, 3 and 5 uses, totalizing 72 files. The files were submitted to dynamic assays device moved by an electric engine, using 300 rpm of speed that permitted the reproduction of pecking motion. The files run within a temperate steel ring's groove, simulating an instrumentation of a curved root canal with 40-degrees and 5-mm of curvature radius. The fracture of file was detected by sensor of device and the time and the number of cycles was acquired. The data were analyzed statistically by two-way ANOVA (p<0.05). Results: There were no statistical significant differences in regard to the number of uses (p>0.05). K3 Endo files showed greater resistance to cyclic fatigue than EndoSequence instruments (p<0.01). Conclusion: It may be concluded that the cross-section of instruments presented significant influence in cyclic fatigue resistance and the number of uses up to 5 times had no influence in cyclic fatigue resistance in both NiTi rotation systems evaluated

Nickel-titanium instruments in endodontics: a concise review of the state of the art.

The introduction of automated instrumentation in endodontics represented a major advance in progress for this specialty, with improvements in the quality and predictability of root canal preparation and a significant reduction in procedural errors. In recent years, endodontic instruments have undergone a series of changes brought about by modifications in design, surface treatments, and thermal treatments. In addition, new movements have also been incorporated to offer greater safety and efficiency, optimizing the properties of the NiTi alloy, especially through eccentric rotary motion. An understanding of the mechanical properties of these new NiTi instruments and their effect on the clinical performance of root canal preparation is essential if dental practitioners are to select the instruments that provide optimal clinical outcomes, especially in curved or flattened canals. The objective of this literature review is to present and discuss the characteristics of the NiTi alloys used in the major instrumentation systems available in the market, as well as the influence of the metallurgical and mechanical properties of NiTi instruments and the movements that drive them, to enable more accurate and predictable planning of root canal preparation.

Effect of rewetting solutions on micropush-out dentin bond strength of new bioceramic endodontic material

Abstract To evaluate the influence of rewetting solutions on bond strength to root dentin of conventional gutta-percha (GP) or niobium phosphate glass-based gutta-percha (GNb) associated with a bioceramic sealer. The root canals of 80 human mandibular premolars were prepared using nickel-titanium instruments and irrigation with sodium hypochlorite and EDTA. The teeth were randomly divided into four groups according to the gutta-percha used: GNb or GP associated with EndoSequence BC Sealer (BC) and the solution for rewetting dentin before filling (distilled water; phosphate buffer saline solution - PBS; simulated body fluid - SBF; or no solution). The root canals were filled with a single cone using warm vertical condensation. Micropush-out bond strengths associated with the filling materials in slices from middle root thirds was determined 30 days after root filling. The failure mode was analyzed with stereoscopic lens. The data were statistically analyzed by two-way ANOVA and Holm-Sidak test (p < 0.05). There was significant difference in the types of gutta-percha (p < 0.001) and in the different rewetting solutions (p = 0.003). The interaction between gutta-percha and rewetting solutions was not significant (p = 0.53). The SBF solution provided an increase in bond strength for both gutta-percha solutions. The GNb+BC (3.42 MPa) association increased bond strength when compared with GP+BC (2.0 MPa). The use of SBF as a dentin rewetting solution increased bond strength in the groups studied. Association of GNb with bioceramic sealer was beneficial, increasing the bond strength to dentin when compared with the association with GP.

Ions Release and pH of Calcium Hydroxide-, Chlorhexidine- and Bioactive Glass-Based Endodontic Medicaments

Abstract This study evaluated pH and release of calcium, sodium and phosphate ions from different medications in human dentin. Fifty premolars were prepared and randomly divided into groups: (CHX) - 2% chlorhexidine gel; (CHX + CH) - CHX + calcium hydroxide PA; (CH) - CH + propylene glycol 600; (NPBG) - experimental niobium phosphate bioactive glass + distilled water; (BG) - bioactive glass (Bio-Gran) + distilled water. The specimens were immersed in deionized water and the pH variations were measured. The quantification of ions in the solutions was made by inductively coupled plasma - atomic emission spectroscopy (ICP/AES) at 10 min, 24 h, 7, 14, 21 and 30 days. The results were analyzed by ANOVA and Tukey`s test, with a significance level of 5%. CH had the highest level of calcium ions release at 30 days, while CHX and BG released more sodium ions. BG, NPBG and CHX released a higher amount of phosphate ions. The pH of CH was significantly higher compared with the other groups. CH favored the greatest increase of pH and calcium ions release. The bioactive glasses released more sodium and phosphate ions and presented an alkaline pH immediately and after 30 days.

Resumo Este estudo avaliou o pH e a liberação de íons cálcio, sódio e fosfato de diferentes medicamentos em dentina humana. Cinquenta pré-molares foram preparados e divididos aleatoriamente em grupos: (CHX) - clorexidina gel 2%; (CHX + CH) - CHX + hidróxido de cálcio PA; (CH) - CH + propilenoglicol 600; (NPBG) - vidro experimental nióbio fosfato bioativo + água destilada; (BG) - vidro bioativo (Bio-Gran) + água destilada. Os espécimes foram submersos em água deionizada e as variações de pH foram mensuradas. A quantificação dos íons nas soluções foi feita por espectrometria de emissão atômica com plasma indutivamente acoplado (ICP - AES) nos tempos de 10 min, 24 h, 7, 14, 21 e 30 dias. Os resultados foram analisados por ANOVA e teste Tukey, com um nível de significância de 5%. Verificou-se que CH a teve a maior liberação íons de cálcio ao final de 30 dias, enquanto CHX e BG liberaram mais íons de sódio. BG, NPBG e CHX apresentaram a maior liberação de íons fosfato. O pH de CH foi significativamente maior em comparação com os outros grupos testados. O grupo CH aumentou o pH e a liberação de íons cálcio. Os vidros bioativos obtiveram uma maior liberação de íons sódio e fosfato e apresentaram pH alcalino imediato e ao final de 30 dias.

Late Effects of Head and Neck Radiotherapy on Pulp Vitality Assessed by Pulse Oximetry.

INTRODUCTION: Radiation therapy (RT) of malignant tumors in the head and neck area may have damaging effects on surrounding tissues. The aim of this investigation was to evaluate the long-term effects of ionizing radiation on pulp vitality by measuring pulp oxygenation levels (%SpO2) in patients with history of RT of intraoral and oropharyngeal tumors 4-6 years after treatment. METHODS: In an experimental group RT (n = 90, history of RT) and a control group CON (n = 90, no history of RT), pulp vitality was assessed by measuring %SpO2 by using pulse oximetry and pulp sensitivity by cold thermal testing. All anterior teeth without history of endodontic therapy of the participants in group RT were measured (n = 693), regardless of the quadrant and the irradiated area. An equal number of anterior teeth were tested in group CON. RESULTS: There was no significant difference between the %SpO2 levels in group RT (92.7%; standard deviation, ± 1.83) and group CON (92.6%; standard deviation, ± 1.80). All teeth in RT and CON groups showed a positive response to the thermal test. All tested teeth were considered vital. CONCLUSIONS: Pulp %SpO2 was found to be within normal limits 4-6 years after RT. This suggests that RT may not have a long-term influence on pulp vitality, and reported short-term changes in pulpal microcirculation because of RT may be temporary.

Micro-Computed Tomographic Evaluation of 2 Nickel-Titanium Instrument Systems in Shaping Root Canals.

INTRODUCTION: Cleaning and shaping without making procedural errors have always been a challenge in endodontics, particularly when the root canals are curved. Several rotary instruments have been developed to minimize such errors. The purpose of this study was to compare the shaping ability of 2 rotary file systems, BioRace (BR; FKG, La Chaux-de-Fonds, Switzerland) and ProTaper Next (PTN; Dentsply Maillefer, Ballaigues, Switzerland), during the preparation of curved root canals in extracted teeth using micro-computed tomographic imaging. METHODS: A total of 20 first and second human mandibular molars with 2 separate mesial canals were scanned before and after root canal preparations using the SkyScan 1176 X-ray microtomograph (Bruker microCT, Kontich, Belgium) at a resolution of 17.42 µm. Canals were prepared using the BR and PTN systems. The percentage of dentin removed after preparation, root canal volume increase, untreated canal walls, structure model index, degree of canal transportation, and centering ability were also measured. RESULTS: There were no significant differences between the 2 groups in the removed dentin after preparation and determination of the root canal volume, percentage of untreated canal walls, structure model index, degree of canal transportation, and centering ability (P > .05). CONCLUSIONS: In conclusion, within the limitations of this ex vivo study, instrumentation of moderately curved mesial roots with 2 independent root canals and foramina using the BR and PTN rotary file systems were equally effective. Both instrumentation systems caused negligible procedural errors with minimal apical transportation.