Does the ultrasonic activation of sealer hinder the root canal retreatment?

OBJECTIVES: To evaluate if the ultrasonic activation of sealer hinders the root canal retreatment. MATERIALS AND METHODS: Thirty mandibular premolars were prepared using the ProTaper Universal system (Dentsply) until the instrument F3 (0.30/0.09). The canals were distributed into 2 groups (n = 15), according to the filling technique: NUact group - sealer without ultrasonic activation + gutta-percha cones and Uact group - sealer with ultrasonic activation + gutta-percha cones. The canals were re-instrumented with Largo burs, followed by the instrument R50 (0.50/0.05) of the Reciproc system. The time required to perform re-instrumentation was recorded (s). The roots were longitudinally cleaved, and the total area of root canal and remaining filling material were quantified (%). The ANOVA test was applied to the data and complemented by Student's t test (P < 0.05). RESULTS: Uact group had higher percentage of remaining filling material than NUact group (P < 0.05). When the root thirds were considered, there was statistically significant difference only for Uact group at the apical third (P < 0.05). There was no difference between groups regarding the time required to perform re-instrumentation (P > 0.05). CONCLUSIONS: Ultrasonic activation of sealer leads to a higher percentage of remaining filling material attached to the root canal walls. However, it did not affect the retreatment time. CLINICAL SIGNIFICANCE: Ultrasonic activation increases sealer penetration into dentinal tubules, improving its resistance to dislodgement. However, there is no scientific evidence to prove if ultrasonic activation of sealer hinders its removal when root canal retreatment is necessary.

Can Heated Distilled Water Effectively Prevent Precipitate Formation between NaOCl and CHX?

Introduction: The present study aimed to investigate the capacity of different irrigation protocols using heated distilled water at 65°C (HDW), in preventing the formation of the brown-orange precipitate observed after the interaction between sodium hypochlorite (NaOCl) and chlorhexidine (CHX). Methods: Forty human canines were selected, prepared, and cleaved in two halves. Images of delimited areas in each root canal thirds were obtained through a stereomicroscope (16x and 40x). After reassembly, the teeth were distributed into four groups (n = 10) according to the final irrigation protocol: G1 (no HDW): EDTA + NaOCl + CHX with conventional irrigation (CI); G2 (HDW + CI): EDTA with passive ultrasonic irrigation (PUI) + NaOCl (PUI) + HDW (CI) + CHX (PUI); G3 (HDW + PUI): EDTA + NaOCl + HDW + CHX with PUI; G4 (HDW + CUI): EDTA (PUI) + NaOCl (PUI) + HDW with continuous ultrasonic irrigation (CUI) + CHX (PUI). After irrigation, the teeth were re-separated and images of the same delimited areas were obtained again. Scores were assigned according to the amount of precipitate observed, comparing the initial and final images. The data were submitted to Kruskal-Wallis, Dunn and Friedman statistical tests (α = 5%). Results: G1(no HDW) showed the highest scores in the analysis between groups (p < 0.001), with a greater amount of precipitate in the cervical and medium thirds (p < 0.001). The thirds of the other experimental groups did not differ from each other (p > 0.05). Conclusion: The intermediate irrigation with heated distilled water at 65°C prevented the formation of brown-orange precipitate, regardless of the use of ultrasonic activation (PUI or CUI).

Influence of a Metal Artifact Reduction Filter on the Diagnostic Accuracy of Complete and Incomplete Vertical Root Fractures.

INTRODUCTION: This study aimed to assess the influence of the e-vol DX BAR filter on the diagnostic accuracy of complete and incomplete vertical root fractures (VRFs). METHODS: Twenty single-rooted teeth were selected. The tooth crowns were removed, and the root canals were prepared up to a 40/.06 instrument (ProTaper Next). Each specimen was scanned in a Prexion 3D cone-beam computed tomography (CBCT) device, in a dry human skull, in 4 different situations: no root canal filling, gutta-percha, fiberglass post, and metal post. The specimens were fractured in a universal testing machine by using a customized wedge. Each specimen was reinspected to confirm the presence of incomplete VRFs. Another set of CBCT scans was performed. Then, the fractures were completed in the universal testing machine, the teeth were reinspected, and the CBCT images were acquired again. Images were assessed by using the e-Vol DX software system, with the BAR filter and with the original images, for the diagnosis of VRFs. Statistical analysis was performed by using the DeLong and McNemar tests for the comparison of the area under the receiver operating characteristic curves (AUC), accuracy, sensitivity, and specificity values. RESULTS: The use of the BAR filter did not improve the diagnostic values of AUC, accuracy, sensitivity, and specificity in both fracture patterns (P > .05). Incomplete VRFs presented significantly lower AUC, accuracy, and sensitivity compared with complete VRFs (P < .0001). CONCLUSIONS: The BAR filter did not improve the diagnostic accuracy of VRFs. The intracanal materials also did not influence the diagnosis. Incomplete VRFs were highly associated with a decrease in sensitivity.

The use of a setting accelerator and its effect on pH and calcium ion release of mineral trioxide aggregate and white Portland cement.

The aim of this study was to evaluate the influence of adding 10% calcium chloride (CaCl2) indicated as setting accelerator on pH and release of calcium ions of commercially available materials: ProRoot MTA (tooth-colored formula), MTA Branco, and White Portland cement. The products were mixed for 30 seconds in previously established ratios. To estimate the values of pH and release of calcium ion, polyethylene tubes were filled with the materials and immersed in containers with 10 ml of deionized water. The analyses were performed baseline, 30 minutes, 60 minutes, and 24 hours after the mixing process. A pHmeter (MicroNal B 371, Sao Paulo, SP, Brazil) and an atomic absorption spectrophotometer (Model GBC 904; CG Corp, Melbourne, Australia) equipped with a hollow cathode lamp were used to determine the data. According to the Student's t-test, the comparison between the pure and the CaCl2-added products indicated that the presence of this substance increased immediately the pH, although the results were very similar when they were analyzed in the other intervals. In addition, products with CaCl2 released more calcium ions than pure materials in the 24-hour period (p<0.05). The results revealed that the addition of CaCl2 to MTA enhanced the physicochemical properties of this product. Thus, materials mixed with CaCl2 became easier to handle and needed lower amounts of water in the mixing process.