Protocolo com produtos químicos para o enfrentamento do biofilme em linhas d'água de equipos odontológicos: perspectiva física, química, mecânica e biológica / Protocol with chemical products to combat biofilm on dental unit waterlines: physical, chemical, mechanical, and microbiological perspective

A biossegurança na odontologia visa o enfrentamento da contaminação cruzada e o biofilme em linhas d'água de equipos odontológicos. O objetivo deste estudo foi investigar, na perspectiva física, química, mecânica e biológica, um protocolo de uso de produtos químicos com possível aplicabilidade nas linhas d'água de equipos odontológicos para melhoria e manutenção da qualidade da água. O protocolo com produtos químicos (Produto A - ácido cítrico + cloreto de sódio; Produto B - bicarbonato de sódio + cloreto de sódio; Produto AB - ácido cítrico + bicarbonato de sódio + cloreto de sódio) foi empregado em corpos de prova de aço inoxidável que, posteriormente, foram submetidos aos ensaios de microdureza e corrosão. Ainda, ensaios de cor, microdureza, rugosidade e de atividade antibiofilme [biomassa total (cristal violeta), atividade metabólica (XTT), viabilidade por meio de corante fluorescente e microscopia confocal de varredura à laser, bem como morfologia estrutural do biofilme por microscopia eletrônica de varredura (MEV)] foram realizados em corpos de prova de poliuretana. As cepas padrão empregadas para avaliar a atividade antibiofilme monoespécie foram Pseudomonas aeruginosa (ATCC 27853), Staphylococcus aureus (ATCC 29923) e Escherichia coli (ATCC 25922). Com relação à alteração da microdureza no aço inoxidável, após a imersão simulada por 1 e 2 anos nos Produtos (A+B+AB), não houve diferença dos resultados com o grupo controle (água). Decorrida a exposição aos produtos e grupo controle, a maioria das amostras de aço inoxidável apresentou tendência à corrosão. Ainda, houve alterações de cor, microdureza e rugosidade nas superfícies de poliuretana após a imersão simulada por 1 e 2 anos dos produtos e do grupo controle. A avaliação da biomassa dos biofilmes indicou que o Produto A (p=0,003) e o Produto AB (p=0,019) reduziram significativamente o biofilme de P. aeruginosa em comparação com o controle. Por outro lado, a avaliação da biomassa do biofilme formado por S. aureus sugeriu que o Produto B (p=0,018) promoveu maior ação antibiofilme. Em relação aos biofilmes formados por E. coli, o Produto A (p=0,001) e o uso sequencial dos Produtos A+B+AB (p=0,021) mostraram os melhores resultados. Para o XTT em comparação com o controle, os tratamentos com o Produto A (p=0,001), o Produto AB (p<0,001) e o uso sequencial dos Produtos A+B+AB (p=0,002) reduziram significativamente a atividade metabólica do biofilme de P. aeruginosa. No biofilme formado por S. aureus, contrariando os resultados observados na avaliação da biomassa, o Produto B não promoveu alterações significantes na atividade metabólica (Produto A: p<0,001; Produto AB: p=0,007; uso sequencial dos Produtos A+B+AB: p<0,001). Considerando o biofilme formado por E. coli, observou-se que o Produto B (p=0,046), o Produto AB (p<0,001) e o uso sequencial dos Produtos A+B+AB (p<0,001) promoveram redução da atividade metabólica. Observou-se redução significativa do biofilme total após o emprego dos produtos (p<0,001), em relação ao controle. Apesar da redução significativa, ainda se observou agregados de biofilme residual, cobrindo extensa porção das superfícies, mesmo após o uso dos produtos. Considerando a quantidade de células vivas de P. aeruginosa e E. coli, o Produto A e o Produto B, isolados ou em conjunto demostraram resultados semelhantes. Além disso, o Produto AB e o uso sequencial dos Produtos A+B+AB não promoveu diferença na quantidade de células vivas de S. aureus, em comparação ao controle, indicando que a combinação dos produtos não potencializou a atividade antibiofilme. Em conclusão, os produtos analisados nesta pesquisa mostraram potencial inovador para o enfrentamento do biofilme linha d'água dos equipos odontológicos, preservando as propriedades físicas, químicas e mecânicas dos materiais.

Biosafety in dentistry aims to combat cross-contamination and biofilm on dental unit waterlines. The aim of this study was to investigate, from a physical, chemical, mechanical, and biological perspective, a protocol for the use of chemical products with possible applicability in dental unit waterlines to improve and maintain water quality. The protocol with chemicals (Product A - citric acid + sodium chloride; Product B - sodium bicarbonate + sodium chloride; Product AB - citric acid + sodium bicarbonate + sodium chloride) was used in stainless steel specimens which, later, were subjected to microhardness and corrosion tests. Moreover, color, microhardness, roughness and antibiofilm activity tests [total biomass (crystal violet), metabolic activity (XTT), viability by means of fluorescent dye and confocal laser scanning microscopy, as well as structural morphology of biofilm by scanning electron microscopy (SEM)] were performed on polyurethane specimens. The standard strains used to assess monospecies antibiofilm activity were Pseudomonas aeruginosa (ATCC 27853), Staphylococcus aureus (ATCC 29923) and Escherichia coli (ATCC 25922). Regarding the microhardness change in stainless-steel, after simulated immersion for 1 and 2 years in Products (A+B+AB), there was no difference in the results with the control group (water). After exposure to the products and control group, most stainless-steel samples showed a tendency to corrosion. Furthermore, there were changes in color, microhardness, and roughness on the polyurethane surfaces after simulated immersion for 1 and 2 years of the products and the control group. Biofilm biomass evaluation indicated that Product A (p=0.003) and Product AB (p=0.019) significantly reduced P. aeruginosa biofilm compared to the control. On the other hand, the evaluation of the biomass of the biofilm formed by S. aureus suggested that Product B (p=0.018) promoted greater antibiofilm action. Regarding biofilms formed by E. coli, Product A (p=0.001) and the sequential use of Products A+B+AB (p=0.021) showed the best results. For XTT compared to the control, treatments with Product A (p=0.001), Product AB (p<0.001) and sequential use of Products A+B+AB (p=0.002) significantly reduced metabolic activity from the biofilm of P. aeruginosa. In the biofilm formed by S. aureus, contrary to the results observed in the biomass assessment, Product B did not promote significant changes in metabolic activity (Product A: p<0.001; Product AB: p=0.007; sequential use of Products A+B+ AB: p<0.001). Considering the biofilm formed by E. coli, it was observed that Product B (p=0.046), Product AB (p<0.001) and the sequential use of Products A+B+AB (p<0.001) promoted a metabolic activity reduction. There was a significant reduction in the total biofilm after using the products (p<0.001), compared to the control. Despite the significant reduction, residual biofilm aggregates were still observed, covering a large portion of the surfaces, even after using the products. Considering the amount of living cells of P. aeruginosa and E. coli, Product A and Product B, alone or together, showed similar results. In addition, Product AB and the sequential use of Products A+B+AB did not promote difference in the amount of living S. aureus cells, compared to the control, indicating that the combination of products did not enhance the antibiofilm activity. In conclusion, the products analyzed in this research showed innovative potential for facing the biofilm on dental unit waterline, preserving the physical, chemical, and mechanical properties of the materials.

Effect of Different Denture Base Cleansers on Surface Roughness of Heat Polymerised Acrylic Materials with Different Curing Process / Efecto de diferentes limpiadores para dentaduras en la rugosidad de la superficie de acrílicos polimerizados por calor con diferentes procesos de curado

Abstract Avoiding biofilm formation on dentures is associated with maintaining the surface properties of acrylic-based dentures. The aim of the study is to investigate the effects of two different cleaning agents (Corega and Klorhex 0.2% chlorhexidine gluconate) on surface roughness of the denture regarding efficacy of curing procedures. A total of sixty disc-shaped specimens were prepared with two different methods as long and short curing processes. The specimens were divided into subgroups according to the immersion solutions (distilled water, Corega tablet group and Klorhex 0.2% chlorhexidine gluconate group) (n=10). The samples were kept in a solution for 8 hours per day during a month. The average Ra1 (before exposure to the cleanser agent) and Ra2 (after exposure to the cleanser agent) of each sample was measured. A two- way ANOVA and post hoc Tukey test was used for statistical analysis. The solutions significantly increased the Ra values in both acrylic groups (p0.05). The long-term curing time is highly effective in decreasing the surface roughness of the acrylic base material.

Resumen Evitar la formación de biopelículas en las prótesis dentales se asocia con el mantenimiento de las propiedades de la superficie de las prótesis de base acrílica. El objetivo del estudio es investigar los efectos de dos agentes de limpieza diferentes (Corega y Klorhex 0,2% gluconato de clorhexidina) en la rugosidad de la superficie de la dentadura postiza en cuanto a la eficacia de los procedimientos de curado. Se prepararon un total de sesenta muestras en forma de disco con dos métodos diferentes como procesos de curado largos y cortos. Las muestras se dividieron en subgrupos según las soluciones de inmersión (agua destilada, grupo de pastillas Corega y grupo de gluconato de clorhexidina al 0,2%) (n=10). Las muestras se mantuvieron en una solución durante 8 horas al día durante un mes. Se midió el promedio de Ra1 (antes de la exposición al agente de limpieza) y Ra2 (después de la exposición al agente de limpieza) de cada muestra. Para el análisis estadístico se utilizó un ANOVA de dos vías y una prueba post hoc de Tukey. Las soluciones aumentaron significativamente los valores de Ra en ambos grupos acrílicos (p 0,05). El tiempo de curado a largo plazo es muy eficaz para disminuir la rugosidad de la superficie del material de base acrílica.

Eficácia de agentes químicos na desinfecção de tubetes anestésicos odontológicos / Effectiveness of chemical agents in disinfecting dental anesthetic cartridges

Durante o atendimento odontológico, o paciente pode ser exposto a várias fontes de contaminações, por isso a equipe odontológica deve sempre implementar ações de biossegurança. Materiais não autoclaváveis, como os tubetes anestésicos, necessitam ser desinfetados previamente ao seu uso, pois não são estéreis, podendo transmitir patógenos entre os pacientes. Este estudo objetivou avaliar e comparar a eficácia de três soluções desinfetantes na redução da carga microbiana em tubetes de anestésicos odontológicos. Os tubetes anestésicos (n = 31) foram escolhidos aleato-riamente e submetidos a diferentes métodos e agentes desinfetantes (Álcool 70%, Dióxido de Cloro 7%; Cloreto de benzalcônio 5,2% com Polihexametileno biguanida 3,5%). Após a desinfecção por métodos de imersão ou fricção, os tubetes foram semeados em meio de cultura contendo caldo tripticase de soja e incubados (48h/37 ºC). Amostras do meio de cultura líquido foram repicadas e semeadas em ágar tripticase de soja, incubado durante 48h a 37 ºC. O crescimento microbiano foi observado pela presença de unidades formadoras de colônias (UFCs) crescidas no ágar. O estudo concluiu que os produtos Álcool 70% e Cloreto de benzalcônio 5,2% com Polihexametileno biguanida 3,5% demostraram ser mais eficazes na eliminação da carga microbiana dos tubetes pelo método de fricção, e que realmente os tubetes anestésicos tem sua superfície externa contaminada. O estudo comprovou ser o método de fricção do agente desinfetante mais eficaz na redução da carga microbiana comparado a imersão. Dos agentes testados, o Dióxido de Cloro 7% não demonstrou um nível de desinfecção satisfatório.

During dental care, the patient may be exposed to various sources of contamination, so the dental team should always implement biosecurity actions. Non-autoclavable materials such as anesthetic cartridges need to be di-sinfected prior to use because they are not sterile and can transmit pathogens between patients. This study aimed to evaluate and compare the effectiveness of three disinfectant solutions to reduce microbial load in dental anesthetic cartridges. Anesthetic cartridges (n = 31) were randomly chosen and submitted to different methods and disinfectants (70% Alcohol, 7% Chlorine Dioxide; 5.2% Benzalkonium Chloride with 3.5% Polyhexamethylene Biguanide). After immersion or friction methods of disinfection, the tubes were seeded in culture medium containing trypticase soy broth and incubated (48h/37 ºC). Samples of liquid culture medium were picked and seeded in trypticase soy agar, incubated for 48h at 37 ºC. Microbial growth was observed by the number of colonies forming units (CFUs) grown on the agar. The study concluded that 70% Alcohol and 5.2% Benzalko-nium Chloride with 3.5% Polyhexamethylene biguanide have been shown to be most effective in eliminating the microbial contamination of the cartridges by the friction method, and that the anesthetic cartridges actually have contamination of their external surface. The study proved that the friction method is most effective in reducing microbial load compared to immersion. Of the agents tested, 7% Chlorine Dioxide did not show a satisfactory level of disinfection.

Decontamination of Gutta-percha Cones employed in Endodontics / Descontaminação de cones de guta-percha empregados em endodontia

ABSTRACT The guttapercha cones used in endodontic treatment are produced in aseptic conditions and their composition includes zinc oxide, which is responsible for antibacterial activity. However, there is the possibility of microbial contamination by manipulation, aerosol or during storage. Although several chemical agents have been tested for their decontamination, there is no consensus on the best disinfection protocol to be used. The aim of this study was to evaluate the decontamination of guttapercha cones contaminated with the bacteria Enterococcus faecalis, by using chlorhexidine digluconate (CHX) and sodium hypochlorite (NaClO) at different concentrations for short exposure times. For this purpose, guttapercha cones (size 40) were selected at random from a sealed box and immersed for 1 min in a microbial suspension. Then they were immersed in specific Petri dishes for different groups containing: CHX 2%, NaClO 1% or NaClO 2.5% for 30 s or 1 min, and subsequently placed in tubes containing BHI broth. After incubating the tubes for 48 h, it was observed that 1% and 2.5% NaClO and 2% CHX were effective for decontaminating the cones at those exposure time intervals. Microbial growth was detected in one of the replicates of the group with CHX applied for 30 s. To prevent the possibility of failures at this stage, the exposure time of guttapercha cones to the decontaminating agent should not be reduced.

RESUMO Os cones de gutapercha utilizados no tratamento endodôntico são produzidos em condições assépticas e possuem óxido de zinco em sua composição, responsável pela atividade antibac te riana. No entanto, existe a possibilidade de contaminação microbiana por manipulação, aerossol ou seu armazenamento. Embora vários agentes químicos já tenham sido testados para sua descontaminação, não há consenso sobre o melhor proto colo de desinfecção a ser usado. Nosso objetivo foi avaliar a descontaminação de cones de gutapercha contaminados com a bactéria Enterococcus faecalis, utilizando digluconato de clorexidina (CHX) e hipoclorito de sódio (NaClO) em diferentes concentrações e tempos de exposição curtos. Para esse fim, 40 cones de gutapercha foram selecionados aleatoriamente, de uma caixa selada e imersos por 1 min em uma suspensão microbiana. Em seguida, foram imersos em placas de Petri específicas para diferentes grupos contendo: CHX 2%, NaClO 1% ou 2,5%, nos tempos de exposição de 30s e 1min e subseqüentemente imersos em tubos contendo caldo BHI. Após incubação dos tubos por 48 h, observouse que NaClO 1% e 2,5% e CHX 2% foram eficazes para a descontaminação dos cones nesses intervalos de tempo de exposição. Em uma das réplicas do grupo com CHX aplicado por 30s foi detectado crescimento microbiano. O tempo de exposição dos cones de gutapercha ao agente de desconta minação não deve ser reduzido para evitar a possibilidade de falhas nesse estágio.

Micrographic evaluation of different widia compositions of orthodontic pliers submitted to peracetic acid and intensive use / Avaliação micrográfica de diferentes composições de widia de alicates ortodônticos submetido ao ácido peracético e uso intensivo

Introduction: The sterilization and disinfection procedures should be adapted to the chemical profile of the metal alloys present in the instruments. Objective: This study aimed to perform a micrographic assessment on the surface characteristics of the widia of orthodontic pliers with two alloy compositions subjected to the action of 0.2% peracetic acid and intensive use. Material and method: Twenty distal cutting pliers were divided into two groups (n=10) according to widia composition (%wt): W1- 85% to 87% of tungsten carbide (TC) and other components in the proportion of 13% to 15% and W2 - 87.5% to 88.5% of tungsten carbide and 11.5% to 12.5% for other components. All the pliers were assessed in a stereoscopic magnifying glass (32x) after three treatments: before use (T0); after cutting 100 segments of rectangular stainless-steel wires - intensive use (T1); and after 100 sterilization cycles in 0.2% peracetic acid and intensive use (T2). The cutting sites of all pliers were standardized. Widia regions were defined by line "A" representing T1 and line "B" representing T2. A frequency distribution table and Fisher's exact test (α=0.05) was performed. We assessed two widia from each composition and treatment in SEM and energy-dispersive X-ray spectroscopy (EDS/SEM). Result: The results showed that W1 pliers presented significantly fewer defects after the sterilization cycles with peracetic acid and intensive use than W2 pliers (p=0.0198). There were no differences between both pliers after intensive use (p=1.000). Conclusion: The SEM images and EDS analyses showed changes in widia surfaces after the different treatments. Widia composition affected the resistance of the orthodontic pliers after sterilization cycles with 0.2% peracetic acid and intensive use.

Introdução: Os procedimentos de esterilização e desinfecção devem ser adaptados ao perfil químico das ligas metálicas presentes nos instrumentos. Objetivo: O objetivo do estudo foi realizar uma avaliação micrográfica das características da superfície da widia de alicates ortodônticos com duas composições de ligas submetidas à ação de ácido peracético a 0,2% e uso intensivo. Material e método: Vinte alicates de corte distal foram divididos em dois grupos (n=10), de acordo com a composição widia (% em peso): W1- 85% a 87% de carboneto de tungstênio e outros componentes na proporção de 13% a 15% e W2 - 87,5% a 88,5% de carboneto de tungstênio e 11,5% a 12,5% para outros componentes. Os alicates foram avaliados em uma lupa estereoscópica (32x) após três tratamentos: antes do uso (T0); após corte de 100 segmentos de fios retangulares de aço inoxidável- uso intensivo (T1); após 100 ciclos de esterilização em ácido peracético a 0,2% e uso intensivo (T2). Os locais de corte dos alicates foram definidos pela linha "A" representando T1 e pela linha "B" representando T2. Foi realizada uma tabela de distribuição de frequências e o teste exato de Fisher (α=0,05). As widias foram avaliadas em MEV e Espectroscopia de Energia Dispersiva. Resultado: Os alicates W1 apresentaram defeitos significativamente menores após os ciclos de esterilização com ácido peracético e uso intensivo do que os alicates W2 (p=0,0198). Não houve diferenças entre os dois alicates após uso intensivo (p=1.000). Conclusão: As imagens de MEV/EDS mostraram alterações nas superfícies widia após os diferentes tratamentos. A composição widia afetou a resistência do alicate ortodôntico após ciclos de esterilização com ácido peracético a 0,2% e uso intensivo.

Hipoclorito de sodio al 5% Vs digluconato de clorhexidina. Desinfectantes antimicro-bianos del sistema de irrigación odontológico / 5% sodium hypochlorite Vs chlorhexidine digluconate. Antimicrobial disinfectants of the dental irrigation system

El presente estudio comprende el análisis y la eliminación de los microorganismos presentes en los sistemas de irrigación de las unidades dentales de la Universidad Nacional de Chimbo-razo, el mismo tiene como finalidad la reducción de contaminación microbiana. Se procedió a tomar muestras del agua del sistema de irrigación que recorre por la jeringa triple de diez unidades dentales escogidas al azar, la recolección se realizó en un solo día, en envases estéri-les y fueron trasladados de manera inmediata hacia los laboratorios de la facultad de Ciencias Químicas de la UNACH- L.S.A. El análisis de la carga microbiana se realizó a través de un procedimiento in vitro en el laboratorio con cultivos sembrados en agar nutritivo de marca comercial Difco, se interpretaron los resultados, se verificó si estos valores están dentro de los parámetros internacionales para el uso y consumo humano, confirmando que existen valores mayores a las 200 UFC/ml. Finalmente, se procedió a la desinfección del agua, la que se realizó con hipoclorito de sodio al 5% y con digluconato de clorhexidina al 2%, cinco unidades detales para cada desinfectante respectivamente, se repitió el procedimiento de recolección de muestras así como también de análisis microbiológico post desinfección, se verificaron los resultados y se comparó la efectividad entre los desinfectantes empleados en la investigación, obtenido ausencia de UFC/ml para cada sustancia utilizada, dando el mante-nimiento al agua de los sistemas de irrigación.

A comparative observational study was carried out in the Dental Clinic of Universidad Nacional de Chimborazo (UNACH), during the academic period October 2015 - February 2016. The object of study was given by the existing microbial load in the irrigation system of 10 dental units; as well as the effect of 5% sodium hypochlorite and chlorhexidine diglucona-te on it. The samples were collected in two moments: after disinfection and after procedure performed. The intakes were made at the distal end of the irrigation systems of the triple syringe of the dental units, eliminating the amount of water that runs through the whole pipe and then obtaining the sample without interrupting the water flow in a sterile bottle. A total of 10 samples were collected, one from each dental unit, immediately closing the bottle and transferring them to the UNACH laboratory for processing. Before carrying out the disinfec-tion process, the laboratory results showed microbial contamination figures in the irrigation systems of the dental units above the acceptable values of CFU (Colony Forming Units). The use of 5% sodium hypochlorite and 2% chlorhexidine digluconate showed the effectiveness of these substances as antimicrobials in the disinfection of irrigation systems of dental units with similar levels of effectiveness in this regard.

Cleaning of used rotary nickel-titanium files in an ultrasonic bath by locally intensified acoustic cavitation.

AIM: To compare the pre-sterilization cleaning of rotary Ni-Ti files of different sizes previously used a. ex vivo and b. clinically by a washer-disinfector, a regular ultrasonic bath, and the same ultrasonic bath in combination with a recently developed cavitation intensifying method. METHODOLOGY: Two sets of two hundred rotary Ni-Ti files, one previously used ex vivo and another one used clinically, were collected from the undergraduate and postgraduate clinics of the Academic Centre for Dentistry Amsterdam (ACTA). The instruments were immersed in an enzymatic solution and subsequently cleaned either by a washer-disinfector, a regular ultrasonic bath combined with a glass beaker, the same bath combined with a beaker lined with two cavitation intensifying sheets or with two standard plastic sheets. The positive control consisted of used files that did not undergo any cleaning and the negative control included new unused files. The instruments were then stained to reveal remaining protein material and scored under a stereoscopic microscope. The results were analysed by nonparametric statistical tests (α = 0.05). RESULTS: No significant difference was found between the combination of the ultrasonic bath and the regular glass beaker and the same ultrasonic bath with the beaker lined with the cavitation intensifying sheets. The washer-disinfector left significantly more debris compared to the latter group when clinically used files were evaluated (P ≤ 0.001). The effect of instrument size on cleaning was not consistent. CONCLUSION: None of the tested methods was able to remove all residual protein material from the files; however, it could be noted that this study did not follow the reprocessing protocol provided by the manufacturer.

Surface detail reproduction and dimensional accuracy of molds: influence of disinfectant solutions and elastomeric impression materials / Reprodução de detalhes da superfície e estabilidadedimensional de moldes: influência das soluçõesdesinfetantes e elastômeros

This study compared the surface detail reproduction anddimensional accuracy of molds after disinfection using 2% sodium hypochlorite, 2% chlorhexidine digluconate or 0.2% peracetic acid to those of molds that were not disinfected, forfour elastomeric impression materials: polysulfide (Light Bodied Permlastic), polyether (Impregum Soft), polydimethylsiloxane(Oranwash L) and polyvinylsiloxane (Aquasil Ultra LV). Themolds were prepared on a matrix by applying pressure, using aperforated metal tray. The molds were removed followingpolymerization and either disinfected (by soaking in one of thesolutions for 15 minutes) or not disinfected. The samples werethus divided into 16 groups (n=5). Surface detail reproductionand dimensional accuracy were evaluated using opticalmicroscopy to assess the 20 ­µm line over its entire 25 mm length. The dimensional accuracy results (%) were subjectedto analysis of variance (ANOVA) and the means were comparedby Tukey’s test (α=5%). The 20 ­µm line was completelyreproduced by all elastomeric impression materials, regardlessof disinfection procedure. There was no significant difference between the control group and molds disinfected with peraceticacid for the elastomeric materials Impregum Soft (polyether)and Aquasil Ultra LV (polyvinylsiloxane). The high­leveldisinfectant peracetic acid would be the choice material for disinfection.

Este estudo comparou a reprodução de detalhes da superfície e estabilidade dimensional de moldes obtidos após desinfecção utilizando hipoclorito de sódio 2%, digluconato de clorexidina 2%, ou ácido peracético 0,2% a moldes que não foram desinfetados com quatro elastômeros: polissulfeto (Light Bodied Permlastic), polieter (Impregum Soft), silicona reação porcondensação (Oranwash L) e silicona reação por adição (Aquasil Ultra LV). Os moldes foram preparados sobre matriz conten dolinhas de 20, 50 e 75 µm realizado sob pressão com moldeirade metal perfurada. Os moldes foram removidos após a polimerização e desinfetados (utilizando uma das soluções porimersão, armazenados em frascos fechados durante 15 minutos)ou não desinfetados. Assim, as amostras foram divididas em 16grupos (n=5). A reprodução detalhes da superfície e a precisão dimensional foram avaliadas usando microscopia óptica na linha 20 µm com 25 mm de comprimento, de acordo com a norma ISO 4823. Os resultados de precisão dimensional (%) foram submetidos à análise de variância (A NOVA) e as médias comparadas pelo teste de Tukey com 5% de nível de significância. A linha de 20 µm foi completamente reproduzida por todos os elastômeros, independentemente do processo de desinfecção. Não houve diferença estatisticamente significativa entre o grupo controle e moldes desinfetados com acido peracético para os elastômeros Impregum Soft (polieter) e Aquasil Ultra LV (siliconareação por adição). O desinfetante de alto nível ácido peracético seria o material de escolha para a desinfecção.

Assessment of the amount of residual sodium hypochlorite after chemical disinfection of heat-polymerized resins / Evaluación de la cantidad de hipoclorito de sodio residual después de la desinfección química de resina termo-polimerizadas

Aim To evaluate the release of sodium hypochlorite from three different commercial brands of heat-polymerized acrylic resin immersed in water and submitted to mechanical or chemical polishing after disinfection with hypochlorite at different concentrations. Material and methods Fifty-four disk-shaped specimens (n = 18) were made for each resin (Lucitone 550, QC-20, and Classico) and assigned to two groups according to the type of polishing. Specimens were divided in three sub-groups in relation to sodium hypochlorite concentration (1%, 2.5%, and 5.25%), and the groups were immersed for 10-min periods in each sodium hypochlorite concentration. The electrochemical method used for detecting the release of sodium hypochlorite in each specimen was the cyclic voltammetry. Results In the specimens of Clássico resin polished mechanically and immersed in 5.25% sodium hypochlorite, as well as Lucitone and QC-20 resins immersed in 2.5%, the amounts of disinfectant solution released in the four 15-min water exchanges were higher than the four 60-min exchanges. Conclusion There were differences in hypochlorite release from the three commercial brands of denture-base acrylic resins subjected to mechanical polishing. However, no hypochlorite release from the same resins was observed when they were subjected to chemical polishing.

Objetivo Evaluar la liberación de hipoclorito de sodio de 3 marcas comerciales diferentes de resinas termo-polimerizadas sumergidas en agua, y sometidas a pulido mecánico o químico después de la desinfección con hipoclorito a diferentes concentraciones. Material y métodos Cincuenta y cuatro especímenes en forma de disco (n = 18) fueron confeccionados para cada resina (Lucitone 550, QC-20 y Clássico) y asignados a 2 grupos de acuerdo con el tipo de pulido. Las muestras se dividieron en 3 subgrupos en relación con la concentración de hipoclorito de sodio (1, 2,5 y 5,25%), y los grupos se sumergieron durante períodos de 10 min en cada concentración de hipoclorito de sodio. El método electroquímico usado para la detección de la liberación de hipoclorito de sodio en cada espécimen fue a través de voltametría cíclica. Resultados En las muestras pulidas mecánicamente de resina Clássico inmerso en hipoclorito de sodio al 5,25%, así como en las resinas Lucitone y QC-20 inmersas a 2,5%, la cantidad de solución desinfectante liberada en los 4 intercambios de agua de 15 min fue superior a los 4 de 60 min. Conclusión Hubo diferencias en la liberación de hipoclorito de las 3 marcas comerciales de resinas acrílicas sometidas a pulido mecánico. Sin embargo, no se observó liberación de hipoclorito en las mismas resinas cuando se sometieron a pulido químico.

Potential of curcumin-mediated photodynamic inactivation to reduce oral colonization.

OBJECTIVE: The present study assessed the susceptibility of salivary pathogens to photodynamic inactivation (PDI), mediated by a water-soluble mixture of curcuminoids (CRM) and LED light. METHODS: A 10mL sample of unstimulated saliva was collected from volunteers. The inoculum was prepared using 9mL of saline and 1mL of saliva. Inoculum suspensions were divided into 14 groups and treated according to the description below. Groups that received the PDI treatment (light for 1min or 5min and 1.5g/L or 3.0g/L of CRM concentration) were called C1.5L1.8, C1.5L9.0, C3.0L1.8, C3.0L9.0. To evaluate the CRM decontamination alone, the C1.5/1,C1.5/5,C3.0/1 and C3.0/5 groups were assessed. Likewise, light alone was evaluated through the L1.8 and L9.0 groups. Chlorhexidine at 0.12% (CLX) for 1 or 5min was used for the positive control groups (CLX1 and CLX5, respectively); saline was used for 1 or 5min (CTR1, CTR5, respectively) for the negative control groups. After the tests, serial dilutions were performed, and the resulting samples were plated on blood agar in microaerophilic conditions. The number of colony forming units (CFU/mL) was determined and log10-transformed. Data were analyzed using a One-way Analysis of Variance with Welch correction, followed by the Games Howell's test (α=0.05). Log reduction (LR) measure for antimicrobial efficacy was also calculated using data from the CTR5 as untreated samples. RESULTS: The CHX5 showed the best antimicrobial result, followed by the CLX1. The antimicrobial effect of CRM was more pronounced when associated with light (PDI), but significantly lower than the CLX5 effect. The C3.0L9.0 protocol showed similar results to the CLX1. CONCLUSION: The results show that PDI with CRM at the studied concentrations is as effective for oral decontamination in clinical dental care conditions as the CLX at 0.12% for 1min.

Kinetics of Inactivation of Bacillus subtilis subsp. niger Spores and Staphylococcus albus on Paper by Chlorine Dioxide Gas in an Enclosed Space.

UNLABELLED: Bacillus subtilis subsp. niger spore and Staphylococcus albus are typical biological indicators for the inactivation of airborne pathogens. The present study characterized and compared the behaviors of B. subtilis subsp. niger spores and S. albus in regard to inactivation by chlorine dioxide (ClO2) gas under different gas concentrations and relative humidity (RH) conditions. The inactivation kinetics under different ClO2 gas concentrations (1 to 5 mg/liter) were determined by first-order and Weibull models. A new model (the Weibull-H model) was established to reveal the inactivation tendency and kinetics for ClO2 gas under different RH conditions (30 to 90%). The results showed that both the gas concentration and RH were significantly (P < 0.05) and positively correlated with the inactivation of the two chosen indicators. There was a rapid improvement in the inactivation efficiency under high RH (>70%). Compared with the first-order model, the Weibull and Weibull-H models demonstrated a better fit for the experimental data, indicating nonlinear inactivation behaviors of the vegetative bacteria and spores following exposure to ClO2 gas. The times to achieve a six-log reduction of B. subtilis subsp. niger spore and S. albus were calculated based on the established models. Clarifying the kinetics of inactivation of B. subtilis subsp. niger spores and S. albus by ClO2 gas will allow the development of ClO2 gas treatments that provide an effective disinfection method. IMPORTANCE: Chlorine dioxide (ClO2) gas is a novel and effective fumigation agent with strong oxidization ability and a broad biocidal spectrum. The antimicrobial efficacy of ClO2 gas has been evaluated in many previous studies. However, there are presently no published models that can be used to describe the kinetics of inactivation of airborne pathogens by ClO2 gas under different gas concentrations and RH conditions. The first-order and Weibull (Weibull-H) models established in this study can characterize and compare the behaviors of Bacillus subtilis subsp. niger spores and Staphylococcus albus in regard to inactivation by ClO2 gas, determine the kinetics of inactivation of two chosen strains under different conditions of gas concentration and RH, and provide the calculated time to achieve a six-log reduction. These results will be useful to determine effective conditions for ClO2 gas to inactivate airborne pathogens in contaminated air and other environments and thus prevent outbreaks of airborne illness.

Reconstruction of Peri-implant Osseous Defects: A Multicenter Randomized Trial.

There is a paucity of data for the effectiveness of reconstructive procedures in the treatment of peri-implantitis. The objective of this study was to compare reconstruction of peri-implant osseous defects with open flap debridement (OFD) plus porous titanium granules (PTGs) compared with OFD alone. Sixty-three patients (36 female, 27 male; mean age 58.4 y [SD 12.3]), contributing one circumferential peri-implant intraosseous defect, were included in a multinational, multicenter randomized trial using a parallel-group design. After OFD and surface decontamination using titanium brushes and hydrogen peroxide, 33 defects received PTGs. The implants were not submerged. All patients received adjunctive perioperative systemic antibiotics. The primary outcome variable (defect fill) was assessed on digitalized radiographs. Clinical measurements of probing depth (PPD), bleeding on probing (BoP), suppuration, and plaque were taken by blinded examiners. After 12 mo, the test group (OFD plus PTG) showed a mean radiographic defect fill (mesial/distal) of 3.6/3.6 mm compared with 1.1/1.0 in the control group (OFD). Differences were statistically significant in favor of the test group (P < 0.0001). The OFD plus PTG group showed a mean reduction in PPD of 2.8 mm compared with 2.6 mm in the OFD group. BoP was reduced from 89.4% to 33.3% and from 85.8% to 40.4% for the test and control groups, respectively. There was no significant difference in complete resolution of peri-implantitis (PPD ≤4 mm and no BoP at six implant sites and no further bone loss), because this finding was accomplished at 30% of implants in the test group and 23% of implants in the control group. Reconstructive surgery using PTGs resulted in significantly enhanced radiographic defect fill compared with OFD. However, limitations in the lack of ability to discern biomaterial from osseous tissue could not be verified to determine new bone formation. Similar improvements according to clinical measures were obtained after both surgical treatment modalities (ClinicalTrials.gov NCT02406001).

Evaluation of toothbrush disinfection via different methods

The aim of this study was to compare the efficacy of using a dishwasher or different chemical agents, including 0.12% chlorhexidine gluconate, 2% sodium hypochlorite (NaOCl), a mouthrinse containing essential oils and alcohol, and 50% white vinegar, for toothbrush disinfection. Sixty volunteers were divided into five experimental groups and one control group (n = 10). Participants brushed their teeth using toothbrushes with standard bristles, and they disinfected the toothbrushes according to instructed methods. Bacterial contamination of the toothbrushes was compared between the experimental groups and the control group. Data were analyzed by Kruskal–Wallis and Duncan's multiple range tests, with 95% confidence intervals for multiple comparisons. Bacterial contamination of toothbrushes from individuals in the experimental groups differed from those in the control group (p < 0.05). The most effective method for elimination of all tested bacterial species was 50% white vinegar, followed in order by 2% NaOCl, mouthrinse containing essential oils and alcohol, 0.12% chlorhexidine gluconate, dishwasher use, and tap water (control). The results of this study show that the most effective method for disinfecting toothbrushes was submersion in 50% white vinegar, which is cost-effective, easy to access, and appropriate for household use.

Applicability of knowledge of graduates in dentistry: use of irreversible hydrocolloid / Aplicabilidad del conocimiento de licenciados en odontología: el uso de hidrocoloide irreversible

The objective of this study was to evaluate the knowledge applied by dental students on the procedures of disinfection, tempering and pouring of irreversible hydrocolloid impressions. This study was conducted through a questionnaire to 86 undergraduate students, of both genders, of the eighth and ninth period of the School of Dentistry, Pontifical Catholic University, Belo Horizonte, MG. The questionnaire contained 12 multiple choice questions about clinical and laboratory procedures for dental impression. Analyzed data were descriptively and qualitatively. Most subjects (70%) stated they did disinfection of dental impression with 1% sodium hypochlorite spray. However, they did it in open containers (75.4%) and with time control (68.6%). The ratio water / powder is randomly conducted by most students (60.5%), and tap water is the one most commonly used (95.3%). The mixing of the calcium sulfate is done manually by nearly all students (97.7%), and use vibrator during the pouring of the calcium sulfate is common among undergraduates (60.5%). The setting of the calcium sulfate takes place predominantly exposed to air (93%) and the removal of the model is made ??between 30 and 60 min after pouring by 84.9% of students. These results point to the need for awareness of students of adopting practices transmitted during the undergraduate degree. It is also necessary to investigate the possible causes of knowledge transmission problems and how to effectively adopt good clinical practices.

El objetivo fue evaluar el conocimiento aplicado por estudiantes de odontología en los procedimientos de desinfección, templado y vaciado de las impresiones de hidrocoloides irreversibles. Este estudio se llevó a cabo a través de un cuestionario a 86 estudiantes de pregrado, de ambos sexos, del octavo y noveno período de la Escuela de Odontología de la Pontificia Universidad Católica, Belo Horizonte, MG. El cuestionario contenía 12 preguntas de opción múltiple acerca de los procedimientos clínicos y de laboratorio para impresión dental. Los datos fueron analizados de manera descriptiva y cualitativa. La mayoría de los sujetos (70%) declararon que hicieron desinfección de la impresión dental con pulverización de hipoclorito de sodio al 1%. Sin embargo, lo hicieron en recipientes abiertos (75,4%) y con un control de tiempo (68,6%). La relación agua/polvo se realizó de manera aleatoria por la mayoría de los estudiantes (60,5%), utilizando principalmente agua del grifo (95,3%). La mezcla del sulfato de calcio se realiza manualmente por casi todos los estudiantes (97,7%) y el uso del vibrador durante el vertido del sulfato de calcio es común (60,5%). El ajuste del sulfato de calcio tiene lugar predominantemente en exposición al aire (93%), la remoción del modelo se hace entre 30 y 60 min después del vaciado por un 84,9% de los estudiantes. Estos resultados apuntan a la necesidad de que los estudiantes tomen conciencia de las prácticas transmitidas durante la licenciatura. También es necesario investigar las posibles causas de los problemas de transmisión de conocimiento y cómo aplicar efectivamente las buenas prácticas clínicas.

Sterilizing elastomeric chains without losing mechanical properties. Is it possible?

OBJECTIVE: To investigate the effects of different sterilization/disinfection methods on the mechanical properties of orthodontic elastomeric chains. METHODS: Segments of elastomeric chains with 5 links each were sent for sterilization by cobalt 60 (Co60) (20 KGy) gamma ray technology. After the procedure, the elastomeric chains were contaminated with clinical samples of Streptococcus mutans. Subsequently, the elastomeric chains were submitted to sterilization/disinfection tests carried out by means of different methods, forming six study groups, as follows: Group 1 (control - without contamination), Group 2 (70°GL alcohol), Group 3 (autoclave), Group 4 (ultraviolet), Group 5 (peracetic acid) and Group 6 (glutaraldehyde). After sterilization/disinfection, the effectiveness of these methods, by Colony forming units per mL (CFU/mL), and the mechanical properties of the material were assessed. Student's t-test was used to assess the number of CFUs while ANOVA and Tukey's test were used to assess elastic strength. RESULTS: Ultraviolet treatment was not completely effective for sterilization. No loss of mechanical properties occurred with the use of the different sterilization methods (p > 0.05). CONCLUSION: Biological control of elastomeric chains does not affect their mechanical properties. .

OBJETIVO: verificar os efeitos de diferentes métodos de esterilização/desinfecção nas propriedades mecânicas de elásticos ortodônticos em cadeia. MÉTODOS: segmentos de elástico em cadeia com 5 elos cada foram enviados para esterilização em radiação gama com cobalto 60 (20 KGy). Após esterilização, esses foram contaminados com amostras clínicas de Streptococcus mutans. Passado esse período, foram submetidos aos testes de esterilização/desinfecção por diferentes métodos, formando seis grupos de estudo, assim denominados: Grupo 1 (controle - sem ter sido contaminado), Grupo 2 (álcool 70°GL), Grupo 3 (autoclave), Grupo 4 (ultravioleta), Grupo 5 (ácido peracético) e Grupo 6 (glutaraldeído). Após esterilização/desinfecção, avaliou-se a efetividade desses métodos, por meio de contagem de unidades formadoras de colônias por mL (UFC/mL), e as propriedades mecânicas desses materiais. Utilizou-se o teste t de Student para avaliar o número de UFC, além do ANOVA e, posteriormente, do teste de Tukey para avaliação da força. RESULTADOS: verificou-se que o ultravioleta não obteve eficácia total quanto à esterilização. E não ocorreu perda das propriedades mecânicas dos elásticos, com os diferentes métodos de esterilização utilizados (p > 0,05). CONCLUSÃO: o controle biológico de elásticos em cadeia não interfere nas suas propriedades mecânicas. .

Treatment of periimplant mucositis: a systematic review of randomized controlled trials.

OBJECTIVE: To determine the most effective treatment for periimplant mucositis in patients with dental implants compared with a control group. MATERIALS AND METHODS: A PubMed (MEDLINE) literature search was made of articles published up until October 2013. Randomized controlled trials (RCTs) were stratified according to their level of quality using the Jadad scale and levels of evidence (University of Oxford). RESULTS: The combinations of search terms resulted in a list of 371 titles. Of these, 114 references were finally reviewed. Finally, 7 RCTs fulfilled the inclusion criteria and were thus selected for inclusion in the systematic review. Chlorhexidine, the administration of azithromycin, and glycine powder air polishing are not effective for the treatment of periimplant mucositis. The only effective treatment seems to be the use of toothpaste with 0.3% triclosan. CONCLUSION: Definitions of periimplant mucositis vary in the literature, and no clear criteria have been established regarding the diagnosis and treatment of this disorder. It highlights our lack of uniform treatment and need to establish additional research to fully provide effective treatments for this common condition. More, larger, and longer-term RCTs are needed in this periimplant disease.

The effect of the local use of chlorhexidine in surgical treatment of experimental peri-implantitis in dogs.

AIM: To evaluate the effect of surgical treatment of experimental peri-implantitis at implants with different surface characteristics using different anti-infective procedures. MATERIAL AND METHODS: Four implants with different surface characteristics (A: TiOblast, B: OsseoSpeed, C: AT-I, D: TiUnite) were installed in a randomized order in each side of the mandible in 6 labrador dogs 3 months after tooth extraction. Experimental peri-implantitis was induced 3 months later. Surgical treatment of peri-implantitis was performed. The implants were cleaned with gauze soaked in either saline (control) or chlorhexidine (test). Clinical and radiographical examinations were performed and microbiological samples were taken during a 6-month period after surgery. Biopsies were obtained and prepared for histological analysis. RESULTS: Clinical signs of soft tissue inflammation were reduced after surgical therapy in most test and control sites. While the analysis of bone level alterations in radiographs together with histological and microbiological assessments of resolution of peri-implantitis lesions failed to demonstrate statistically significant differences between test and control procedures, the evaluations disclosed significant differences between implant D and implants A, B and C on treatment outcome. CONCLUSION: It is suggested that (i) the local use of chlorhexidine has minor influence on treatment outcome, (ii) resolution of peri-implantitis following surgical treatment without the adjunctive use of local and systemic antimicrobial agents is possible and (iii) the results are influenced by implant surface characteristics.

Effect of cleanser solutions on the color of acrylic resins associated with titanium and nickel-chromium alloys.

This study evaluated the effect of cleanser solutions on the color of heat-polymerized acrylic resin (HPAR) and on the brightness of dental alloys with 180 immersion trials. Disk-shaped specimens were made with I) commercially pure titanium, II) nickel-chromium-molybdenum-titanium, III) nickel-chromium molybdenum, and IV) nickel-chromium-molybdenum beryllium. Each cast disk was invested in the flasks, incorporating the metal disk into the HPAR. The specimens (n=5) were then immersed in solutions containing: 0.05% sodium hypochlorite, 0.12% chlorhexidine digluconate, 0.500 mg cetylpyridinium chloride, a citric acid tablet, one of two different sodium perborate/enzyme tablets, and water. The color measurements (∆E) of the HPAR were determined by a colorimeter in accordance with the National Bureau of Standards. The surface brightness of the metal was visually examined for the presence of tarnish. The results (ANOVA; Tukey test-α=0.05) show that there was a significant difference between the groups (p<0.001) but not among the solutions (p=0.273). The highest mean was obtained for group III (5.06), followed by group II (2.14). The lowest averages were obtained for groups I (1.33) and IV (1.35). The color changes in groups I, II and IV were slight but noticeable, and the color change was considerable for group III. The visual analysis showed that 0.05% sodium hypochlorite caused metallic brightness changes in groups II and IV. It can be concluded that the agents had the same effect on the color of the resin and that the metallic alloys are not resistant to the action of 0.05% sodium hypochlorite.

Can oil lubricated dental handpieces be sterilized?: Part 2. Literature review.

UNLABELLED: A literature search revealed six laboratory-based microbial challenge studies which support the opinion that oil contamination does not prevent successful sterilization of the lumen of dental handpieces. However, a detailed appraisal of these papers revealed lack of detail in the cleaning methods used prior to sterilization and none of the papers considered the risks of prion contamination. CLINICAL RELEVANCE: An examination of the evidence base on sterilization of oil-lubricated handpieces is of potential value to dental clinicians and their teams.

Comparing the efficacy of hyper-pure chlorine-dioxide with other oral antiseptics on oral pathogen microorganisms and biofilm in vitro.

This study examines the antibacterial properties of sodium hypochlorite (NaOCl), chlorhexidine gluconate (CHX), Listerine®, and high purity chlorine dioxide (Solumium, ClO2) on selected common oral pathogen microorganisms and on dental biofilm in vitro. Antimicrobial activity of oral antiseptics was compared to the gold standard phenol. We investigated Streptococcus mutans, Lactobacillus acidophilus, Enterococcus faecalis, Veillonella alcalescens, Eikenella corrodens, Actinobacillus actinomycetemcomitans and Candida albicans as some important representatives of the oral pathogens. Furthermore, we collected dental plaque from the upper first molars of healthy young students. Massive biofilm was formed in vitro and its reduction was measured after treating it with mouthrinses: CHX, Listerine® or hyper pure ClO2. Their biofilm disrupting effect was measured after dissolving the crystal violet stain from biofilm by photometer. The results have showed that hyper pure ClO2 solution is more effective than other currently used disinfectants in case of aerobic bacteria and Candida yeast. In case of anaerobes its efficiency is similar to CHX solution. The biofilm dissolving effect of hyper pure ClO2 is significantly stronger compared to CHX and Listerine® after 5 min treatment. In conclusion, hyper pure ClO2 has a potent disinfectant efficacy on oral pathogenic microorganisms and a powerful biofilm dissolving effect compared to the current antiseptics, therefore high purity ClO2 may be a new promising preventive and therapeutic adjuvant in home oral care and in dental or oral surgery practice.