Green nail: Etiology and treatment of chloronychia.

"Green nails" or chloronychia results from an infection mostly caused by Pseudomonas sp. but also from other bacterial or fungal contamination. Its presents as a typical triad: green discoloration of the nail plate with proximal chronic paronychia and disto-lateral onycholysis. In a moist environment, Pseudomonas colonizes onycholysis of any origin (traumatic, inflammatory or tumoral). Nail color varies from pale green to dark green, almost black. Treatment consists in cutting of the detached nail plate, brushing the nail bed with a 2% sodium hypochlorite solution twice daily accompanied by moisture eviction by wearing latex gloves over cotton ones for all daily household tasks.

Comparation of the effectiveness of conventional needle irrigation and photon-induced photoacoustic streaming with sodium hypochorite in the treatment of teeth with apical periodontitis: a randomized clinical trial.

Photon-initiated photoacoustic streaming (PIPS) with an Er: YAG laser has been introduced in root canal treatment to improve irrigation and facilitate the removal of bacteria in the root canal system. This study aimed to compare the antibacterial effectiveness of two different root canal irrigation techniques, conventional needle irrigation (CNI) and PIPS, using 1% sodium hypochlorite (NaOCl), in the treatment of teeth with apical periodontitis. Sixty patients with a total of sixty teeth affected by apical periodontitis were included in this study. The teeth underwent root canal therapy, and after mechanical instrumentation, they were randomly assigned to two groups (n = 30) based on the final irrigation protocol: CNI or PIPS with 1% NaOCl. Bacterial suspensions in the root canals were evaluated using Adenosine 5'-triphosphate (ATP) assay kit after mechanical instrumentation and after final irrigation. Then, a follow-up was conducted after 7 days. The results revealed that final irrigation significantly reduced ATP values in both the CNI and PIPS groups (P < 0.001). The ATP values after final irrigation was greater in the CNI group compared to the PIPS group (P < 0.001). After a 7-day follow-up, percussion tenderness and fistula were significantly resolved in both groups (P < 0.05). A multivariate linear regression model was used to identify the factors that influence post irrigation ATP values. The analysis demonstrated that pre-operative percussion tenderness (P = 0.006), the presence of a fistula (P < 0.001) and the method used in the final irrigation (P < 0.001) had a significant impact on the ATP value after final irrigation. These results indicate that employing PIPS with 1% NaOCl as the final irrigation protocol exhibited superior antibacterial effectiveness and has the potential to enhance clinical outcomes in the treatment of teeth afflicted with apical periodontitis.

Clinical efficacy of endodontic protocols on reducing cultivable bacteria and endotoxin in infected root canal in patients submitted to head and neck radiotherapy: a randomised clinical trial.

OBJECTIVES: Assess the efficacy of biomechanical preparation using a reciprocating system followed by final irrigation protocols, then intracanal medication, on reducing endotoxins and cultivable bacteria of infected teeth in irradiated patients. MATERIALS AND METHODS: Twenty-two infected single-rooted canals in patients submitted to head and neck radiotherapy were prepared by reciprocating motion and 2.5% NaOCl. Patients were randomly divided into two groups of 11 patients before the final irrigation protocol: apical positive pressure (APP) or passive ultrasonic activation (PUA). Both groups were treated in two sessions, using Ca(OH)2 as intracanal medication for 14 days. Root canal content sampling was performed after canal access (S1), after biomechanical preparation plus the irrigation protocol (S2), and after intracanal medication (S3). Chromogenic limulus amoebocyte lysate assay measured endotoxin levels (EU/mL), and bacterial load was determined by culture techniques (CFU/mL). RESULTS: Treatment protocols reduced bacterial counts after S2 in both groups (p = 0.01). S3 differed from S1 (p = 0.01), but not from S2 (p = 0.4). Endotoxin levels were reduced in both groups after S2 (P = 0.03) and were lower in S3 than in S2, with significant differences in the APP group (p = 0.03). CONCLUSIONS: Biomechanical preparation using a reciprocating system and 2.5% NaOCl in irradiated teeth, followed by the irrigation protocol (APP or PUA), demonstrated efficacy in reducing endodontic contaminants. Ca(OH)2 as intracanal medication should be performed in irradiated patients with infected root canals. CLINICAL RELEVANCE: This clinical study demonstrated that endodontic treatment in irradiated patients is efficacious at reducing bacterial load and endotoxin levels.

Bioburden assessment of necrotic teeth disinfected with sodium hypochlorite, diode laser, and photodynamic therapy using flow cytometry-a randomized double-blinded clinical trial.

This study aimed to comparatively evaluate the disinfecting potential of sodium hypochlorite, diode laser, and photodynamic therapy in non-vital teeth with or without periapical rarefaction. Forty-five patients with the diagnosis of pulp necrosis with apical rarefaction were randomly assigned to three groups (n = 15) based on the disinfection protocol. Access cavities were prepared and pre-instrumentation microbial samples were taken using a paper point. Working length determination followed by cleaning and shaping with rotary files was performed. The canals were lubricated with ethylenediaminetetraacetic acid (EDTA) during instrumentation and finally rinsed with copious amounts of saline. Canals in group 1 were irrigated with 5 mL of 5.25% NaOCl, those in group 2 received irradiation with 808-nm diode laser (30 s, 7W), and those in group 3 were soaked with methylene blue photosensitizer (5 min) before irradiation with 660-nm diode laser (3 min). Post-disinfection microbial samples were collected using a paper point. Pre- and post-disinfection live bacterial counts were analyzed using a flow cytometer. The data were statistically analyzed using one-way ANOVA and Student's t-test. Comparison of pre-instrumentation mean live bacterial count showed no significant difference between the groups (p > 0.05). The mean live bacterial count post-disinfection was 41.07%, 46.99%, and 34.45% in groups 1-3 respectively. A significant reduction in the bacterial count was seen following disinfection in all the groups (p < 0.05). It can be concluded that both diode laser and photodynamic therapy were equally effective as 5.25% NaOCl in reducing the bioburden in root canals. TRIAL REGISTRATION: CTRI/2018/03/012667.

Clinical Evaluation of a Novel Combination of Sodium Hypochlorite/Amino Acid and Cross-linked Hyaluronic Acid Adjunctive to Non-surgical Periodontal Treatment: A Case Series.

PURPOSE: The adjunctive subgingival application of sodium hypochlorite/amino acid and a mixture of natural and cross-linked hyaluronic acid gels (high molecular weight) has been recently proposed as a novel modality to enhance the outcomes of non-surgical periodontal therapy. The aim of this prospective case series was to evaluate the clinical outcomes obtained following the subgingival application of a combination of sodium hypochlorite/amino acid and a mixture of natural and cross-linked hyaluronic acid (high molecular) gels in conjunction with non-surgical periodontal therapy. MATERIAL AND METHODS: Twenty-one systemically healthy, non-smoking patients diagnosed with stage II-III, grade A/B periodontitis underwent full-mouth subgingival debridement (SD) performed with ultrasonic and hand instruments. All sites with probing depths (PD) ≥ 4 mm were treated with additional repeated (i.e., 2-3 times) instillation of sodium hypochlorite/amino acid gel in the periodontal pockets prior to and during SRP. Following mechanical debridement, a mixture of natural and cross-linked hyaluronic acid (high molecular) gel was applied in the pockets. The primary outcome variable was PD reduction; changes in clinical attachment level (CAL) and bleeding on probing (BOP) were the secondary outcomes. The clinical parameters were assessed at baseline, 3 and 6 months after therapy. RESULTS: Compared to baseline, a statistically significant mean reduction of PD values was obtained after 3 and 6 months, amounting to 2.6 ± 0.4 mm, and 2.9 ± 0.4 mm, respectively (p < 0.001). Mean CAL gain measured 2.3 ± 0.5 mm at 3 months and 2.6 ± 0.5 mm at 6 months in comparison to baseline (p < 0.001). Mean reduction of BOP values was 54.9 ± 16.9 % at 3 months and 65.6 ± 16.4 % at 6 months (p < 0.001). The number of moderate pockets (4-5 mm) decreased from 1808 at baseline to 274 at the 6-month evaluation, and the number of deep (≥ 6 mm) pockets dropped from 319 to 3, respectively. CONCLUSION: The combination of sodium hypochlorite/amino acid and a mixture of natural and cross-linked hyaluronic acid (high molecular) adjunctive to subgingival debridement may represent a valuable approach to improve the outcomes of non-surgical periodontal treatment.

Clinical Study of Antimicrobial Efficacy of Laser Ablation Therapy with Indocyanine Green in Root Canal Treatment.

INTRODUCTION: Laser ablation (LA) therapy is used as an adjunct to endodontic treatment to improve microbial reduction. However, studies evaluating the impact of LA with indocyanine green (ICG) are scarce. This study aimed to evaluate the antimicrobial efficacy of LA therapy with ICG in root canal treatment. METHODS: Sixty patients with periapical lesions in teeth with a single canal and absence of pain, edema, and previous treatment were selected. Patients were randomly allocated into 3 groups according to the apical sizes used (n = 20); 25/04, 30/04, and 35/04 were the final sizes used. In half the patients of each group, 2.5% sodium hypochlorite was used as an irrigating solution, and in the other half, saline solution was used. After instrumentation, all patients received LA therapy with ICG. Root canal sampling was performed before (S1) and after (S2) root canal instrumentation and immediately after LA therapy with ICG (S3). Colony-forming units were counted, and statistical tests were applied (P < .05). RESULTS: There was a significant reduction in colony-forming units from S1 to S2 in all treatment protocols (P < .05); 2.5% sodium hypochlorite as an irrigating solution showed a greater microbial reduction compared with saline solution (P < .05). LA therapy with ICG further reduced the microbial counts significantly (S2 to S3 and S1 to S3) whether sodium hypochlorite or saline was used (P < .05). CONCLUSIONS: LA therapy with ICG significantly increased microbial reduction in root canals regardless of instrumentation sizes or the irrigation solution used.

Irrigation protocols effects on radicular dentin: Cleaning, disinfection and remaining ultrastructure / Efecto del protocolo de irrigación en la dentina radicular: limpieza, desinfección y ultraestructura remanente

A successful endodontic treatment requires a combination of satisfactory mechanical instrumentation, adequate irrigation protocols, and three-dimensional obturation of the canal system. Irrigation is considered the most critical procedure to ensure cleaning and disinfection. To date, a large variety of irrigants has been proposed. However, sodium hypochlorite (NaOCl) remains the gold standard. In order to achieve complete cleaning and disinfection, final irrigation with EDTA and ultrasonic devices has been used as an ideal protocol. Most endodontic research focuses on the cleaning and antibacterial properties of the irrigant solutions. Recent evidence demonstrated that the irrigation protocols cause erosion, affecting the radicular dentin ultrastructure. This article aims to describe the clinical features of the present knowledge concerning the effect of irrigation protocols on radicular dentin.

Un tratamiento de endodoncia exitoso requiere de una satisfactoria instrumentación mecánica, protocolos de irrigación adecuados y obturación tridimensional del sistema de conductos radiculares. La irrigación se considera el procedimiento más crítico para garantizar la limpieza y desinfección. Hasta la fecha, se ha propuesto una gran variedad de irrigantes. Sin embargo, el hipoclorito de sodio (NaOCl) sigue siendo el estándar de oro. Para lograr una limpieza y desinfección completa, se ha utilizado como protocolo ideal la irrigación final con EDTA y dispositivos ultrasónicos. La mayor parte de la investigación en endodoncia se enfoca en las propiedades antibacterianas y de limpieza de las soluciones de irrigación. Reciente evidencia demostró que los protocolos de irrigación provocan erosión, afectando la ultraestructura de la dentina radicular. Este artículo tiene como objetivo describir algunas consideraciones clínicas del conocimiento actual sobre el efecto de los protocolos de irrigación en la dentina radicular.

Concise evaluation and therapeutic guidelines for severe periodontitis: A public health perspective.

The main goal of periodontology is to prevent and arrest gingivitis and periodontitis to avoid tooth loss and focal infection of periodontal origin. Periodontal scaling or flap surgery of moderate-to-severe periodontitis have shortcomings, most likely because removal of herpesviruses and bacterial pathogens in deep periodontal lesions and the adjacent inflamed gingiva requires systemic antimicrobial treatment (or gingivectomy). Valacyclovir (1000 mg twice daily on day 1, and 500 mg twice daily on day 2 and on day 3) is a potent anti-herpesvirus agent. Antibiotic combinations against bacterial pathogens include amoxicillin-metronidazole (250 mg of each, thrice daily for 4 days; for systemically healthy adults) and ciprofloxacin-metronidazole (500 mg of each, twice daily for 4 days; for immunosuppressed individuals and patients exposed to contaminated water and poor sanitation). Supportive antiseptic treatment may consist of 0.1%-0.2% sodium hypochlorite (regular household bleach) as cooling spray in ultrasonic scalers, flosser fluid in oral irrigators, and mouthrinse in patient self-care. The anti-infective treatment described here helps control cases of severe periodontitis and constitutes an exceedingly inexpensive alternative to conventional (mechanical) periodontal therapy.

Effects of dentinary contamination by endodontic irrigants on bonding strength of adhesive systems

This study aimed to evaluate if 2.5% sodium hypochlorite compromises the adhesion of bonding materials. The factors in the study were the irrigation solutions in two levels: 2.5% sodium hypochlorite and saline solution; and the adhesive systems used in three levels: three-step adhesive, universal adhesive, and two-step self-etch adhesive systems. The answer variable used was the microshear bond strength obtained through a universal testing machine and fracture mode. Six groups were obtained (n=10) : Etch-and-rinse/Saline (saline solution + 3-step adhesive system - Scotchbond Multipurpose, 3M ESPE); Universal/saline (saline solution + universal adhesive system ­ Prime&Bond,); Self-etch/saline (saline solution + 2-step self-etch adhesive systems - Clearfil SE Bond); Etch-and-rinse/Hypo (sodium hypochlorite 2,5% + 3-step adhesive system - Scotchbond Multiuso); Universal/Hypo (sodium hypochlorite 2,5% + universal adhesive system ­ Prime&Bond); Self-etch/Hypo (sodium hypochlorite 2,5% + 2-step self-etch adhesive system - Clearfil Se Bond). The specimens were obtained from 60 healthy bovine incisors. The crowns were separated from the roots, and the regularization of the buccal surface was performed. The groups received saline solution and 2.5% sodium hypochlorite for 30 minutes, respectively. A matrix of 1mm and 3mm oh height was stabilized by Scotch tape to obtain the resin sticks. Afterward, the bond strength test was performed in a universal testing machine at 1mm/min speed. The data were analyzed with normality Shapiro-Wilk, two-way ANOVA, and Tukey's tests (p<0.001). Etch-and-rinse and Self-etch adhesives presented the highest bond strength values after irrigation with saline solution and 2.5% sodium hypochlorite, respectively (P < 0.01). The irrigation with 2.5% sodium hypochlorite decreased the bond strength values of Etch-and-rinse and Universal (P < 0.01). On the other hand, 2.5% sodium hypochlorite improved the bond strength values of Self-etch (P < 0.01). In conclusion, 2.5% sodium hypochlorite negatively impacted the bond strength of Etch-and-rinse and Universal but improved the adhesion of Self-etch.

Evaluation of the dentinal tubule penetration of an endodontic bioceramic sealer after three final irrigation protocols

Introduction: This study aimed to evaluate the dentinal tubule penetration of an endodontic bioceramic sealer, Sealer Plus BC, after three final irrigation protocols. Methods: Thirty distobuccal roots of maxillary molars were selected. Root canal preparation was performed up to an #40.06 instrument (X1 Blue) under 2.5% sodium hypochlorite irrigation. Specimens were randomly divided into three groups (n=10), according to the final irrigation protocol: G-NaOCl (2.5% sodium hypochlorite + PUI), G-SS (0.9% saline solution + PUI) and G-H20 (Deionized water + PUI). After final irrigation protocols, all specimens were irrigated with phosphate buffer solution. Root canal obturation was performed using the single cone technique and Sealer Plus BC, stained with a specific fluorophore. Specimens were transversely sectioned and each root third was evaluated in a confocal scanning laser microscopy. Images obtained were analyzed for sealer penetration in the dentinal tubules. Results: Dentinal tubule penetration of Sealer Plus BC was not observed in any root third, regardless of the final irrigation protocol investigated. Conclusions: Sealer Plus BC dentinal tubule penetration was not observed after none of the protocols tested. Dentinal tubule penetrability of Sealer Plus BC may be related to other factors rather than the final irrigation protocol.

Bioseguridad en el laboratorio dental / Biosafety in the dental laboratory

Una enfermedad infecciosa es aquella producida por un agente infeccioso (bacterias, hongos, virus, etc.) que ingresa y se desarrolla en el organismo de un hospedero. Posteriormente, puede trasmitirse de un individuo a otro directamente por contacto entre ambos, o bien, indirectamente, por medio de un vec-tor biológico (de naturaleza animal o vegetal), o de un fómite (objeto inanimado). Las vías por las que un agente infeccioso puede ingresar a un hospedero son: inhalación (respiración de aerosoles), ingestión (salpicaduras de gotas), penetración de mucosas (na-sal, ocular y bucal) o lesiones en la piel o mucosas. Las fuentes de infección pueden ser los pacientes, el personal del consultorio o laboratorio, las superficies e instrumental contaminados y las prótesis o com-ponentes de éstas. Para evitar la propagación de los agentes microbianos se debe interrumpir el proceso de transmisión de los mismos. Todo profesional debe fortalecer y readecuar normas y protocolos de biose-guridad en la tarea diaria, para minimizar el riesgo de transmisión directa y cruzada entre el profesional, su equipo auxiliar, el laboratorista y los pacientes (AU)

An infectious disease is one caused by an infectious agent (bacteria, fungi, virus, etc.) that enters and develops in a host. Then it can be transmitted from one individual to another directly by contact between the two or, indirectly through a biological vector (an animal or plant nature), or a fomite (an inanimate object). The routes by which an infectious agent can enter a host are: inhalation (breathing of aerosols), ingestion (splash of droplets), penetration of mucous membranes (nasal, ocular and oral) and skin or mucous lesions. Sources of infection can be patients, office or laboratory personnel, contaminated surfaces and instruments and the prosthesis or component thereof. To prevent the spread of microbial agents, the process of their transmission must be interrupted. Every professional must strengthen and readjust biosafety standards and protocols in daily work to minimize the risk of direct and cross-transmission between the professional, his auxiliary team, the laboratory technician and the patients (AU)

The antibacterial efficacy of photon-initiated photoacoustic streaming in root canals with different diameters or tapers.

BACKGROUND: In recent years, the concept of minimally invasive endodontics has been proposed, which could be described as preventing or treating diseases by preserving more dental tissue and creating minimal damage. In the process of root canal preparation, it was recommended to use instruments with a smaller taper to preserve more tooth tissue and improve the preservation rate of the affected teeth. Photon-induced photoacoustic streaming (PIPS) was a new type of laser-activated irrigation technology, which was now widely used in endodontic treatment. The purpose of this article was to evaluate the bactericidal effect of PIPS with NaOCl in root canals with different widths or tapers. METHODS: Twenty-three maxillary first molars with three independent root canals were included in this study. The mesiobuccal (MB), distobuccal (DB), and palatal (P) root canals were prepared at sizes of #10/.02, #25/.02, and #25/.06, respectively. After being incubated with a bacterial suspension for 4 weeks, the specimen were irrigated with 2% NaOCl activated by conventional needle irrigation (CNI) (n = 10) or PIPS (n = 10). Three specimen were not treated (control group). Before and after irrigation, the presence of bacteria was assessed with an adenosine 5'-triphosphate (ATP) assay kit and biofilms were assessed using confocal laser scanning microscopy and scanning electron microscopy. RESULTS: In specimen prepared using PIPS irrigation, the ATP was reduced by more than 98%. When the root canal taper was 0.02, the size #25 root canals had a higher percentage of dead bacteria than the size #10 root canals in all regions (P < 0.05) in the PIPS group. When the root canal width was #25, the 0.02 taper group had a higher percentage of dead bacteria than the 0.06 taper group in the apical region (P < 0.05), except coronal and middle regions (P > 0.05). PIPS irrigation results in a greater percentage of dead bacteria and reduction of ATP in size #10/.02 root canals than CNI in size #25/.06 root canals in three regions (P < 0.05). CONCLUSION: Increasing the width from #10 to #25 improves the bactericidal effect of PIPS in the root canal. Increasing the taper of the root canal from 0.02 to 0.06 at size #25 did not affect the bactericidal effects of PIPS. PIPS resulted in more dead bacteria in specimen with smaller tapers and root canal widths than CNI. PIPS can be used to clean the smear layer in the coronal region and open the dentin tubules. CLINICAL SIGNIFICANCE: Activation of irrigants with PIPS brought about significant bacterial reduction smaller tapers and width root canals compared to CNI, which was beneficial to prevent excessive loss of tooth tissue and conserve the structural integrity of teeth.

Effect of a 980-nm diode laser on post-operative pain after endodontic treatment in teeth with apical periodontitis: a randomized clinical trial.

BACKGROUND: This study aimed to assess the effect of a 980-nm diode laser following chemomechanical root canal preparation on the severity of post-operative pain (PP) after root canal treatment (RCT). METHODS: This study included asymptomatic, single-rooted teeth with a periapical index (PAI) score of 3 or 4. All the patients received RCT, including dressing with calcium hydroxide (Ca(OH)2), during two visits. The patients were randomly divided into two groups (n:30): a control group, in which the final irrigation was performed using 5 ml of 2.5% sodium hypochlorite (NaOCI), followed by 5 ml of 17% and ethylenediaminetetraacetic acid (EDTA) and 5 ml of distilled water, and a laser group, in which the root canals were irradiated using a 980-nm diode laser after the final irrigation at both visits. The pain levels after both visits were evaluated using a visual analogue scale (VAS) after 8 h, 24 h, 48 h and 7 d. In addition, the time intervals to medication intake were recorded. The collected data were statistically analysed using the chi-square and Mann-Whitney U test (p < 0.05). RESULTS: The average pain level in the control group 24 h after the first visit was significantly higher than that in the laser group (p < 0.05). The average pain level 24 h and 48 h after the second visit was significantly higher in the control group (p < 0.05). The levels of PP 24 h after the first visit were higher than those after the second visit only in the control group (p < 0.05). After the first visit, analgesic use in the control group was significantly higher after 8 h (40%) and 24 h (23%) as compared with that in the laser group (p < 0.05). CONCLUSIONS: Root canal irradiation with a diode laser may reduce PP after RCT in single-rooted teeth with a PAI score of 3 or 4. TRIAL REGISTRATION: Effect of the Diode Laser on Post-operative Pain After Endodontic Treatment in Teeth with Apical Periodontitis: NCT04486196. Registered 24 July 2020-Retrospectively registered, http://clinicaltrials.gov/ct2/show/NCT04486196.

Comparación de la efectividad antimicrobiana entre hipoclorito de sodio 2, 5% y ácido hipocloroso 5% frente a Enterococcus faecalis: prueba in vitro / Comparison of antimicrobial effectiveness between sodium hypochlorite 2.5% and hypochlorous acid 5% against Enterococcus faecalis: an in vitro test

La terapia endodóntica tiene como uno de sus objetivos lograr la completa desinfección del sistema de conductos radiculares. Por esto, se deben seleccionar sustancias irrigantes que tengan la capacidad de eliminar todo el contenido de dicho sistema. La acción antimicrobiana es una de las características más importantes a tener en cuenta en la elección. El hipoclorito de sodio (NaOCl) tiene capacidad bactericida sobre muchos de los microorganismos de la flora endodóntica. El Enterococcus faecalis es una bacteria altamente resistente a antibacterianos que sobrevive en condiciones extremas. El ácido hipocloroso (HOCl) es una molécula derivada del NaOCl que ha demostrado tener alto poder bactericida sobre cepas patogénicas bucales. El objetivo de este trabajo fue evaluar y comparar la efectividad antimicrobiana in vitro del NaOCl 2.5% y el HOCl al 5% frente a Enterococcus faecalis. Una suspensión de Enterococcus faecalis (ATCC29212), de turbidez 0.5 en escala de McFarland, fue inoculada en varios tubos de ensayo, los cuales contenían cada antimicrobiano. Se dejaron actuar durante 1, 5 y 10 minutos para luego neutralizarlos e inclubarlos a 37º C en condiciones de capnofilia durante 48 hs. Todo el procedimiento se realizó por quintuplicado. Los resultados se midieron mediante recuento de UFC/ml. No se evidenció presencia de Enterococcus faecalis en las placas que contenían la solución de NaOCl al 2.5% como tampoco en aquellas que contenían HOCl al 5%. In vitro, el HOCl y el NaOCl en las concentraciones probadas, eliminaron completamente las cepas de Enterococcus faecalis (AU)

Determination of sodium hypochlorite concentrations in the activation of the irrigant by passive technique with ultrasonic, during the ex vivo endodontic protocol

ABSTRACT: Introduction: Sodium hypochlorite and ultrasonic activation have a synergistic and improving effect on canal disinfection. Some authors found irrigant decrease after activation with ultrasonic, while others described an increased concentration in later stages. The aim of this study was to determine if activation of sodium hypochlorite by passive ultrasonic irrigation reduces its concentration compared to a technique without activation. Materials and methods: A ex-vivo descriptive study was conducted with teeth, randomized into two groups: 10 controls and 20 experimental. The hypochlorite of groups undergoing endodontic treatment was collected, and the post-irrigation residual with saline was gathered. The activation by ultrasonic was performed in stage 4.5 with Ultrasonic Scaler NSK®, three cycles of 20 seconds each per tooth. Irrigant concentration was measured by spectrophotometry. Results. In the first 4 stages, there were no concentration differences between groups. Stage 4.5 demonstrated a significant difference between the treated and control group. At saline irrigation stages, there was only a significant difference in stage E5. When activation was performed, the sodium hypochlorite curve maintained concentration values close to 5% in more stages in comparison to the control group. Conclusions: Passive ultrasonic activation demonstrated higher significant concentration of sodium hypochlorite, compared to a technique without activation.

Sellado marginal aplicando hipoclorito de sodio versus ácido fosfórico como acondicionador dental / Marginal sealing applying sodium hypochlorite versus phosphoric acid as dental conditioner

RESUMEN Introducción: La microfiltración es uno de los problemas principales de todas las obturaciones a base de resina. Muchos estudios buscan optimizar un buen sellado marginal utilizando diversos acondicionadores, como el hipoclorito de sodio, que permite que el adhesivo penetre bien, al generar desproteinización, y el ácido fosfórico que permite remover el barro dentinario, y así de esta manera formar una capa híbrida al colocar el adhesivo. Objetivo: Evaluar el grado de sellado marginal de la resina Bulk Fill aplicando gel de hipoclorito de sodio 10 por ciento comparado con el gel de ácido fosfórico al 37 por ciento en el acondicionamiento dental in vitro. Métodos: El universo fue de 72 dientes con cavidades clase I; se separaron en 4 grupos por muestra de 18 dientes cada uno; después de obturar se realizó el termociclaje a 500 ciclos entre 5 °C a 55 °C; luego se sumergieron en azul de metileno 2 por ciento, durante 12 h y 24 h a temperatura de 37 °C. Finalmente se evaluó el sellado marginal en el estereomicroscopio, según el ISO / TS 11405: 2015, con los criterios siguientes: grado 0 (sin microfiltración), grado 1 (microfiltración hasta esmalte), grado 2 (microfiltración hasta dentina) y grado 3 (microfiltración hasta piso pulpar). Resultados: El acondicionamiento con ácido fosfórico 37 por ciento a las 12 h presentó grado 0 (55,6 por ciento) y grado 1 (33,3 por ciento), y a las 24 h, grado 1 (55,6 por ciento). Con respecto al hipoclorito de sodio 10 por ciento a las 12 h, grado 0 (44.4 por ciento) y a las 24 h predominó grado 1 (55,6 por ciento). Para la contrastación de hipótesis en muestras relacionadas se obtuvo en ácido fosfórico 37 por ciento e hipoclorito de sodio al 10 por ciento a las 12 h y 24 h un p= 0,052 y p= 0,584, respectivamente. Para comparaciones entre muestras independientes a las 12 h y 24 h se obtuvo p= 0,462 y p= 0,406, respectivamente. Conclusiones: El gel de hipoclorito de sodio al 10 por ciento presenta similar eficacia en el sellado marginal respecto al gel de ácido fosfórico al 37 por ciento, al utilizarlo como acondicionador dental(AU)

ABSTRACT Introduction: Microfiltration is one of the main problems of all resin sealings. Many studies aim to optimize marginal sealing using a variety of conditioners, such as sodium hypochlorite, which allows good penetration of the adhesive by generating deproteinization, and phosphoric acid, which allows removal of the dental smear layer, thus creating a hybrid layer when the adhesive is placed. Objective: Evaluate the marginal sealing degree of Bulk Fill resin applying 10 percent sodium hypochlorite gel versus 37 percent phosphoric acid gel in in vitro dental conditioning. Methods: The study universe was 72 teeth with class I cavities, divided into four groups of 18 teeth. Upon sealing, thermal cycling was performed at 500 cycles from 5 ºC to 55 ºC. Next the teeth were submerged in 2 percent methylene blue for 12 h and 24 h at a temperature of 37 ºC. Finally marginal sealing was evaluated in the stereo microscope according to ISO / TS 11405: 2015, using the following scale: grade 0 (no microfiltration), grade 1 (microfiltration as far as the enamel), grade 2 (microfiltration as far as the dentin), and grade 3 (microfiltration as far as the pulp floor). Results: Conditioning with 37 percent phosphoric acid was grade 0 (55.6 percent) and grade 1 (33.3 percent) at 12 h, and grade 1 (55.6 percent) at 24 h, whereas conditioning with 10 percent sodium hypochlorite was grade 0 (44.4%) at 12 h, and predominantly grade 1 (55.6 percent) at 24 h. Hypothesis contrast in related samples yielded 37 percent phosphoric acid and 10 percent sodium hypochlorite at 12 h and 24 h, p= 0.052 and p= 0.584, respectively. Comparison between independent samples at 12 h and 24 h yielded p= 0.462 and p= 0.406, respectively. Conclusions: The 10 percent sodium hypochlorite gel has similar marginal sealing effectiveness as the 37 percent phosphoric acid gel when used as dental conditioners(AU)

Anti-infective therapy of peri-implant mucositis with adjunctive delivery of a sodium hypochlorite gel: a 6-month randomized triple-blind controlled clinical trial.

OBJECTIVE: To evaluate the effects of adjunctive delivery of a sodium hypochlorite gel in the treatment of peri-implant mucositis (PM). MATERIALS AND METHODS: Forty-six subjects with 68 implants diagnosed with PM were randomly assigned to two treatment groups. Prior to mechanical debridement, a sodium hypochlorite gel was delivered to the implants of the test group while implants of the control group received a placebo gel. Application of both test and placebo gels was repeated 5 times at baseline. The primary outcome variable was the change in pocket probing depth (PPD) between baseline and 6 months. RESULTS: After 6 months, the mean PPD decreased statistically significantly from 3.93 ± 1.09 mm to 3.04 ± 0.46 mm in the test (p = 0.0001) and from 3.68 ± 0.85 mm to 3.07 ± 0.58 mm in the control (p = 0.0001) group, respectively. No statistically significant difference (p = 0.53) was observed with respect to PPD changes from baseline to 6 months between test (0.88 ± 1.04 mm) and control group (0.61 ± 0.75 mm), respectively. The number of implants with bleeding on probing (BoP) decreased statistically significantly from 33 to 18 in the test group (p = 0.0001) and from 34 to 23 in the control group (p = 0.0001) after 6 months. CONCLUSIONS: In conclusion and within the limits of the present study, changes in PPD from baseline to 6 months were not statistically significantly different between groups. Complete resolution of mucosal inflammation was not achieved with either of the therapies. CLINICAL RELEVANCE: The present outcomes have showed that a complete resolution of peri-implant mucositis is not possible to obtain by means mechanical debridement with or without a sodium hypochlorite gel application.

Effect of passive ultrasonic activation on microorganisms in primary root canal infection: a randomized clinical trial

Abstract Objective: This clinical study sought to evaluate the effectiveness of passive ultrasonic activation (PUA) in eliminating microorganisms in primary endodontic infection (PEI) after instrumentation of root canals using microbiological culture and checkerboard DNA-DNA hybridization. Methodology: Twenty root canals with PEI and apical periodontitis were selected. The root canals were instrumented and then randomly divided into 2 groups, according to the irrigation method: PUA and conventional needle irrigation (CNI). Microbiological samples were collected before instrumentation (S1), after instrumentation (S2) and after irrigation with 17% EDTA (S3). The samples were subjected to anaerobic culture technique and checkerboard DNA-DNA hybridization analysis. Results: A statistically significant difference was found between CNI (23.56%) and PUA (98.37%) regarding the median percentage values for culturable bacteria reduction (p<0.05). In the initial samples, the most frequently detected species was S. constellatus (50%), and after root canal treatment was E. faecalis (50%). Conclusion: Both treatments significantly decreased the number of bacterial species compared with the initial sample. However, no statistical difference in the total microbial load between PUA and CNI groups was detected. The number of cultivable anaerobic bacteria reduced significantly using PUA, and the bacterial composition and number of bacterial species after using either CNI or PUA was similar.

Endodontical treatment of periapical tooth injury with photodynamic therapy: Case report.

This article describes the use of Photodynamic Therapy (PDT) during the endodontic treatment of teeth with periapical lesion. Patients presented tooth 35 with diagnostic hypotheses of Periapical Cyst or Granuloma. The Crown-Down preparation was performed with the HyFlex CM system. In case I it was not possible to reach the working length, in case II the foraminal debridement was performed at the actual tooth length. In the final irrigation, the E1 - Irrisonic ultrasonic insert was used, promoting sequentially agitation of NaOCl 2.5%, EDTA 17% and NaOCl 2.5%. Then, PDT was applied with 0.005% methylene blue dye. Calcium Hydroxide with Parammonochlorophenol was used and after 15 days, the final irrigation protocol and PDT were performed again. After 90 days of case I and 1 year of case II, the total lesion regression was observed in both cases. It is concluded that the proposed treatment improved the microbial disinfection favoring the regression of the periapical alterations providing satisfactory clinical and radiographic results.

Effectiveness of XP-Endo Finisher in the reduction of bacterial load in oval-shaped root canals

Abstract: This study investigated the effectiveness of XP-Endo Finisher (XPF) associated with XP-Endo Shaper (XPS) or Reciproc Blue (RB) files in reducing bacterial load in oval-shaped root canals (RC) during chemomechanical preparation (CMP) using 0.9% saline solution (NaCl) or 2.5% sodium hypochlorite (NaOCl). Eighty mandibular incisors with single oval-shaped RC were contaminated with Enterococcus faecalis. The teeth were randomly assigned to eight experimental groups (n = 10) according to the CMP, as follows: G1: XPS, G2: XPS + XPF, G3: RB, and G4: RB + XPF. CMP was performed with NaCl or NaOCl. The reduction of bacterial load was assessed by colony-forming unit count before (S1) and after (S2) CMP. Data normality was verified by using Shapiro-Wilk test. ANOVA, Tukey's test, and Bonferroni post-hoc test were used at a 5% significance level. Culturable bacteria were present in all S1 samples (p>0.05). All instrumentation techniques were effective in reducing bacterial load, irrespective of the irrigating solution (p < 0.05). With the use of NaCl, RB was more effective than XPS (p = 0.035). With the use of NaOCl, XPS and RB presented similar effectiveness (p = 0.779). XPF enhanced the bacterial reduction of both systems tested (p < 0.05). The use of NaOCl improved the CMP, irrespective of the instrumentation technique used (p < 0.05). In conclusion, XPS and RB files are effective in reducing bacterial levels in oval-shaped RC. The use of XPF as a method of agitation of the irrigating solution improved the cleaning efficiency of both file systems tested. Mechanical preparation performed with saline solution decreased culturable bacteria from the root canal, but antimicrobial substances such as NaOCl should be used to achieve a significantly better disinfection.