Micro-CT evaluation of different final irrigation protocols on the removal of hard-tissue debris from isthmus-containing mesial root of mandibular molars.

OBJECTIVES: This study aimed to compare four final irrigation protocols (passive ultrasonic irrigation [PUI], EndoVac, Self-Adjusting File [SAF] and EasyClean) on the removal of accumulated hard-tissue debris (AHTD) from mesial canals of mandibular molars through microcomputed tomographic (micro-CT) analysis. MATERIALS AND METHODS: Forty mesial roots of mandibular molars presenting isthmuses type I or III were scanned in a micro-CT device and instrumented up to Reciproc R40 instrument. After the completion of canal preparations, root canals of each group were submitted to a final rinse using 20 mL of solution (16 mL of 5.25% NaOCl and 4 mL of 17% EDTA) in a total time of 5 min according to one of the four final irrigation protocols (n = 10): PUI, EndoVac, SAF and EasyClean operated at reciprocating motion. The sample was scanned again after canal preparation and after the use of the final irrigation protocols, and the registered data sets were examined to evaluate the percentage of AHTD. Data were statistically compared using the Tukey test with a significance level set at 5%. RESULTS: All groups presented a decrease on the accumulation of hard-tissue debris after the use of the final irrigation protocols (P < 0.05). No significant differences in the removal of AHTD were observed among the final irrigation protocols (P > 0.05). CONCLUSIONS: All final irrigation protocols showed the same effectiveness in the removal of AHTD. None of them was able to render mesial canals of mandibular molars completely free from packed debris. CLINICAL RELEVANCE: This study highlighted that all final irrigation protocols (PUI, EndoVac, SAF, and EasyClean) promoted a similar removal of AHTD. However, none of the final irrigation protocols was able to render mesial canals of mandibular molars completely free from packed debris.

Impact of Calcium-Hydroxide, Sodium Ascorbate, and Sodium Thiosulphate on Bond Strength of Composite Restorations to Bleached Dentin.

This study evaluated the impact of using calcium-hydroxide or the antioxidant agents on the bond strength of adhesive restorations to bleached dentin. Forty teeth were prepared and allocated into 8 groups according to the surface treatment after bleaching (application or not of calcium hydroxide, 10% sodium ascorbate and 5% sodium thiosulphate for 10min), and the time of final restoration (immediate or after 7-days). Sodium perborate with 20% hydrogen peroxide was applied for 3 weeks using a developed artificial pulp chamber, with replacement every week. Composite resin restoration was performed and microtensile test was performed. Then, specimens were analyzed using a stereomicroscope and SEM. Data was submitted to Kruskal-Wallis and Dunn tests (p<0.05). The bond strength of non-bleached teeth was similar to the groups restored after 7 days of bleaching (p<0.05). The lowest values of bond strength were showed by groups restored immediately after bleaching (p<0.05). In all groups, there was a considerable predominance of adhesive fractures. Delaying the final restoration of teeth submitted to nonvital bleaching for 7 days permits an increase in bond strength. The immediate restoration of bleached teeth after the use of 10% sodium ascorbate or 5% sodium thiosulfate for 10 minutes showed unsatisfactory results. Clinical relevance Irrespective of the dentin protocol applied before adhesion, a satisfactory and an unsatisfactory result of bond strength values will be obtained delaying the final restoration or immediately performing the final restoration, respectively. Therefore, after nonvital tooth bleaching, clinicians should always delay the final restoration for a minimum period of 7 days.

Cytotoxicity, and antimicrobial and physicochemical properties of sealers incorporated with Uncaria tomentosa.

This study evaluated the cytotoxicity, the antimicrobial and physicochemical properties of root canal sealers incorporated with phytotherapic Uncaria tomentosa (UT). Unmodified AH Plus (Dentsply, DeTrey, Germany) and MTA Fillapex (Angelus, Londrina, Brazil) were used as controls. UT was incorporated into AH Plus and MTA Fillapex, at concentrations of 2% and 5% of the total weight of these sealers (w/w). Flowability, setting time, and solubility were evaluated following ISO requirements. The pH values were measured at periods of 12, 24, 48 hours, and 7 days. The antimicrobial activity of the sealers against Enterococcus faecalis was analyzed by both direct contact tests in freshly prepared sealers, and after 7 days. The cytotoxicity of the samples was evaluated by the MTT assay, to check Balb/c 3T3 cell viability. The statistical analysis was performed by one-way ANOVA and Tukey's test (p < 0.05). The incorporation of UT was associated with a decrease in flow, for both sealers, an increase in AH Plus setting time, increase in MTA Fillapex pH values, and solubility (after 14 days), for both sealers (p < 0.05). Regarding the antibacterial evaluation, bacterial reduction was reported after incorporation of UT into both AH Plus and MTA Fillapex, up to 7 days after handling of the material (P<0.05). UT incorporation decreased the cytotoxic effects of both AH Plus and MTA Fillapex sealers in a way directly proportional to their respective concentrations (p < 0.05). In conclusion, UT can be added to both sealers to reduce their cytotoxicity, and improve their antibacterial effects, without compromising their original physicochemical properties.

Do intracanal medications used in regenerative endodontics affect the bond strength of powder-to-liquid and ready-to-use cervical sealing materials?

Aim: This study evaluated the effect of four intracanal medications commonly used in regenerative endodontic procedures on the bond strength of four calcium silicate-based materials, in which two are powder-to-liquid products (MTA and MTA-HP) and the other are ready-to-use materials (EndoSequence Root Repair Material Fast Set Putty [ERRM] and Bioceramic Repair [BIO-C Repair]). Methods: Ten bovine central incisors were selected and 4 slices (1.0 ± 0.1 mm) were prepared from each root. Next, four 0.8-mm wide holes were drilled in each slice and specimens were filled with one of the following intracanal medications: triple antibiotic paste, double antibiotic paste, calcium hydroxide with distilled water, and calcium hydroxide with 2% chlorhexidine gel. After 21 days, holes were filled with one of the materials: MTA, MTA-HP, ERRM, or BIO-C Repair. After storage, push-out test and failure analysis were performed. Data were submitted to analysis of variance in a 4 × 4 factorial scheme. Tukey's test was used for multiple comparisons. Results: The use of different interappointment dressings did not influence the results (P > 0.05). ERRM and BIO-C Repair presented significantly higher values than MTA and MTA-HP (P < 0.0001). Specimens showed a 100% occurrence of adhesive failures. Conclusion: The use of different intracanal medications presented similar impact on bond strength of calcium silicate-based materials. Ready-to-use ERRM and BIO-C Repair materials presented the best push-out values to dentine, whereas powder-to-liquid MTA and MTA-HP cements showed the lowest results.

Cleaning Ability of Irrigants and Orange Oil Solvent Combination in the Removal of Root Canal Filling Materials.

OBJECTIVE: This study investigated the influence of different irrigants and the use of orange oil solvent in the removal of filling materials during root canal retreatment. METHODS: Forty maxillary premolars were shaped using the ProTaper System up to file F3 (size 30, 0.09 taper) and filled by Tagger's hybrid technique using the AH Plus. Samples were randomly assigned to four groups (n=10) according to the irrigating protocol during endodontic retreatment with the ProTaper Universal Re-treatment System: G1, 2% chlorhexidine (CHX) gel; G2, 2% CHX gel with an orange oil solvent; G3, 5% sodium hypochlorite (NaOCl); and G4, 5% NaOCl with an orange oil solvent. Afterwards, the samples were longitu-dinally split into two halves, and the root wall images were prepared by scanning electron microscopy. Two pre-calibrated evaluators analyzed the images using a filling materials remnants score system. Data were statistically analyzed using the Kruskal-Wallis and Dunn's tests (p<0.05). RESULTS: All samples had residual filling materials in the root canal walls after instrumentation. According to the presence of the filling material remnants in the total area of samples, the groups were ranked in the follow-ing order: G2=G4>G1=G3. No statistical differences were found when the CHX and NaOCl were used (p>0.05). Groups in which a solvent was used showed a less effective cleaning ability (p<0.05). The use of NaOCl with solvent presented the highest amounts of filling materials remnants in the critical apical area (p<0.05). CONCLUSION: The use of orange oil with NaOCl or CHX does not improve the removal of residual root canal filling materials.

Bond Strength of Experimental Root Canal Sealers Based on MTA and Butyl Ethylene Glycol Disalicylate.

This study investigated the bond strength of two experimental root canal sealers based on MTA and butyl ethylene glycol disalicylate: MTAe and MTAe-HA. The reference materials used for comparison were AH Plus and MTA Fillapex. Twenty human upper incisors were selected and one 1 mm slice was obtained from the cervical third of each root. On the coronal surface of each slice, four 0.9 mm wide holes were drilled through the dentine. Standardized irrigation was performed and holes were filled with one of the four tested sealers: AH Plus, MTA Fillapex, MTAe, and MTAe-HA. The filled slices were stored in a PBS solution (pH 7.2) for 7 days at 37 °C. A push-out assessment was performed with a 0.7 mm plunger tip. Load was applied at a crosshead speed of 0.5 mm/min until sealer displacement. The results were expressed in MPa. The Kruskal-Wallis test was applied to assess the effect of each sealer on the push-out bond strength. Mann-Whitney with Bonferroni correction was used to isolate the differences. The alpha-type error was set at 0.05. Significant differences among medians values obtained by materials were observed (p<0.001). AH Plus displayed the highest value of bond strength (p<0.001). In contrast, MTA Fillapex presented the lowest bond strength among all tested sealers (p<0.001). Experimental sealers showed intermediary bond strength values, with no statistical differences between them (p>0.05). In conclusion, experimental root canal sealers presented suitable bond strength outcomes when compared to MTA Fillapex.

The use of auxiliary devices during irrigation to increase the cleaning ability of a chelating agent.

OBJECTIVES: This study investigated the cleaning ability of ultrasonically activated irrigation (UAI) and a novel activation system with reciprocating motion (EC, EasyClean, Easy Equipamentos Odontológicos) when used with a relatively new chelating agent (QMix, Dentsply). In addition, the effect of QMix solution when used for a shorter (1 minute) and a longer application time (3 minutes) was investigated. MATERIALS AND METHODS: Fifty permanent human teeth were prepared with K3 rotary system and 6% sodium hypochlorite. Samples were randomly assigned to five groups (n = 10) according to the final irrigation protocol: G1, negative control (distilled water); G2, positive control (QMix 1 minute); G3, QMix 1 minute/UAI; G4, QMix 1 minute/EC; G5, QMix 3 minutes. Subsequently the teeth were prepared and three photomicrographs were obtained in each root third of root walls, by scanning electron microscopy. Two blinded and pre-calibrated examiners evaluated the images using a four-category scoring system. Data were statistically analyzed using Kruskal-Wallis and Dunn tests (p < 0.05). RESULTS: There were differences among groups (p < 0.05). UAI showed better cleaning ability than EC (p < 0.05). There were improvements when QMix was used with auxiliary devices in comparison with conventional irrigation (p < 0.05). Conventional irrigation for 3 minutes presented significantly better results than its use for 1 minute (p < 0.05). CONCLUSIONS: QMix should be used for 1 minute when it is used with UAI, since this final irrigation protocol showed the best performance and also allowed clinical optimization of this procedure.

Cytotoxicity, and antimicrobial and physicochemical properties of sealers incorporated with Uncaria tomentosa

Abstract This study evaluated the cytotoxicity, the antimicrobial and physicochemical properties of root canal sealers incorporated with phytotherapic Uncaria tomentosa (UT). Unmodified AH Plus (Dentsply, DeTrey, Germany) and MTA Fillapex (Angelus, Londrina, Brazil) were used as controls. UT was incorporated into AH Plus and MTA Fillapex, at concentrations of 2% and 5% of the total weight of these sealers (w/w). Flowability, setting time, and solubility were evaluated following ISO requirements. The pH values were measured at periods of 12, 24, 48 hours, and 7 days. The antimicrobial activity of the sealers against Enterococcus faecalis was analyzed by both direct contact tests in freshly prepared sealers, and after 7 days. The cytotoxicity of the samples was evaluated by the MTT assay, to check Balb/c 3T3 cell viability. The statistical analysis was performed by one-way ANOVA and Tukey's test (p < 0.05). The incorporation of UT was associated with a decrease in flow, for both sealers, an increase in AH Plus setting time, increase in MTA Fillapex pH values, and solubility (after 14 days), for both sealers (p < 0.05). Regarding the antibacterial evaluation, bacterial reduction was reported after incorporation of UT into both AH Plus and MTA Fillapex, up to 7 days after handling of the material (P<0.05). UT incorporation decreased the cytotoxic effects of both AH Plus and MTA Fillapex sealers in a way directly proportional to their respective concentrations (p < 0.05). In conclusion, UT can be added to both sealers to reduce their cytotoxicity, and improve their antibacterial effects, without compromising their original physicochemical properties.

Resistência de união à dentina de um material fotopolimerizável à base de silicato de cálcio e modificado por resina / Dentin bond strength of resin-modified light-curable calcium-silicate-based material

Objetivo: este estudo teve como objetivo comparar a resistência de união à dentina de um material à base de silicato de cálcio fotopolimerizável modificado por resina (TheraCal LC®; Bisco, Schaumburg, IL, EUA) com MTA branco (WMTA®; Angelus, Londrina, PR, Brasil). Materiais e Métodos: dezesseis incisivos superiores e caninos humanos foram selecionados e três discos de 1 mm foram obtidos a partir do terço médio de cada raiz. Na superfície coronal de cada disco, dois furos de 1,2 mm de largura foram perfurados na dentina. Em seguida, os buracos artificiais foram preenchidos com um dos materiais testados: WMTA® e TheraCal LC®. As fatias dentárias preenchidas foram armazenadas em uma solução salina tamponada com fosfato (PBS) (pH 7,2) por 7 dias a 37°C. Depois disso, a avaliação do push-out foi realizada com uma ponta do êmbolo de 1,0 mm. A carga foi aplicada a uma velocidade de 0,5 mm / min até o deslocamento do selador. Os resultados foram expressos em MPa. O teste U de Mann-Whitney foi aplicado para classificar os materiais quanto à resistência adesiva à dentina. O nível de significância foi estabelecido em = 5%. Resultados: todas as amostras apresentaram resultados de resistência de união à dentina mensuráveis e não ocorreram falhas prematuras. O TheraCal LC® demonstrou valores superiores de resistência de união à dentina quando comparado ao WMTA® (P<0,0001). Conclusões: existe uma vantagem do TheraCal LC® sobre o WMTA® no que diz respeito à resistência da união ao empurrar e, portanto, pode ser considerado um material reparador promissor e inovador

Objective: this study aimed to compare the dentin bond strength of a resin-modified light-curable calcium-silicate-based material (TheraCal LC®; Bisco, Schaumburg, IL, USA) with White MTA (WMTA®; Angelus, Londrina, PR, Brazil). Materials and Methods: sixteen human maxillary incisors and canines were selected and three 1-mm-discs were obtained from the middle third of each root. On the coronal surface of each disc, two 1.2-mm-wide-holes were drilled through the dentin. Then, artificial holes were filled with one of the tested materials: WMTA® and TheraCal LC®. The filled dental slices were stored in a phosphate-buffered saline (PBS) solution (pH 7.2) for 7 days at 37°C. After that, push-out assessment was performed with a 1.0-mm-plunger-tip. Load was applied at a crosshead speed of 0.5 mm/min until sealer displacement. The results were expressed in MPa. Mann-Whitney U test was applied to rank materials regarding dentin push-out bond strength. Significance level was set at a = 5%. Results: All specimens showed measurable results and no premature failure occurred. TheraCal LC® demonstrated superior push-out bond strength values to dentin when compared to WMTA® (P<0.0001). Conclusions: there is advantage of TheraCal LC® over WMTA® as regards to the push-out bond strength and, therefore it may be taken as a promising and innovative reparative material

Improved sealing ability promoted by calcium silicate-based root canal sealers

Aim: This study investigated the sealing ability produced by AH Plus (Dentsply DeTrey, Konstaz, Germany), EndoSequence BC sealer (Brasseler USA, Savannah, GA, USA), GuttaFlow (Coltène/Whaledent, Altstätten, France) and MTA Fillapex (Angelus, Londrina, Brazil). Methdos: A total of forty-six single-root human canines were prepared and randomly divided into four experimental groups (n=10): MTA Fillapex, EndoSequence BC Sealer, AH Plus or GuttaFlow. Teeth with intact crowns served as negative controls (n=3) and teeth filled with only gutta-percha served as positive controls (n=3). Teeth were mounted in a two-chamber apparatus and exposed to Enterococcus faecalis. The number of days over a 60-days period was recorded for the appearance of turbidity in the lower chamber. Kaplan-Meier method was used to estimate the survival curves. The nonparametric log-rank test was used to compare the survival curves using a significance level of 0.05. Results: The results at the end of the observation time were further analyzed by chi-square testing. All positive controls leaked within 24 h, whereas none of the negative controls leaked after 60 days. EndoSequence BC Sealer and MTA Fillapex had significant less bacterial leakage (P<0.05) than the other tested sealers. No significant difference between AH Plus and GuttaFlow was observed (P>0.05). Conclusion: In conclusion, calcium-silicate based root canal sealers promoted improved sealing ability when compared to other endodontic sealers

Bond strength of experimental root canal sealers based on mta and butyl ethylene glycol disalicylate

Abstract This study investigated the bond strength of two experimental root canal sealers based on MTA and butyl ethylene glycol disalicylate: MTAe and MTAe-HA. The reference materials used for comparison were AH Plus and MTA Fillapex. Twenty human upper incisors were selected and one 1 mm slice was obtained from the cervical third of each root. On the coronal surface of each slice, four 0.9 mm wide holes were drilled through the dentine. Standardized irrigation was performed and holes were filled with one of the four tested sealers: AH Plus, MTA Fillapex, MTAe, and MTAe-HA. The filled slices were stored in a PBS solution (pH 7.2) for 7 days at 37 °C. A push-out assessment was performed with a 0.7 mm plunger tip. Load was applied at a crosshead speed of 0.5 mm/min until sealer displacement. The results were expressed in MPa. The Kruskal-Wallis test was applied to assess the effect of each sealer on the push-out bond strength. Mann-Whitney with Bonferroni correction was used to isolate the differences. The alpha-type error was set at 0.05. Significant differences among medians values obtained by materials were observed (p<0.001). AH Plus displayed the highest value of bond strength (p<0.001). In contrast, MTA Fillapex presented the lowest bond strength among all tested sealers (p<0.001). Experimental sealers showed intermediary bond strength values, with no statistical differences between them (p>0.05). In conclusion, experimental root canal sealers presented suitable bond strength outcomes when compared to MTA Fillapex.

Resumo Esse estudo investigou a resistência de união de dois cimentos endodônticos experimentais à base de MTA e butiletilenoglicol dissalicilato: MTAe e MTAe. Os materiais de referência utilizados para comparação foram os cimentos endodônticos MTA Fillapex e AH Plus. Vinte incisivos superiores humanos foram selecionados e um slice dentinário de 1 mm de espessura foi obtido do terço cervical de cada raiz. Na superfície coronária de cada slice, quatro orifícios com 0,9 mm de diâmetro foram confeccionados através da dentina. Uma irrigação padronizada foi realizada e os orifícios foram preenchidos com um dos quatro cimentos endodônticos avaliados: AH Plus, MTA Fillapex, MTAe, e MTAe-HA. Os slices preenchidos foram armazenados em solução PBS (pH 7,2) durante 7 dias a 37°C. O ensaio de push-out foi realizado por meio de um dispositivo com 0,7 mm de diâmetro. A carga foi aplicada com a velocidade de 0,5 mm/min até a obtenção de deslocamento do material obturador. Os resultados foram expressos em MPa. O teste de Kruskal-Wallis foi aplicado para avaliar o efeito da resistência de união de cada cimento endodôntico. O teste de Mann-Whitney com correção de Bonferroni foi utilizado para isolamento das diferenças. O erro do tipo-alfa foi fixado em 0,05. Diferenças significantes entre os valores de medianas obtidos pelos materiais foram observados (p<0,001). O AH Plus demonstrou os maiores valores de resistência de união (p<0,001). Em contraste, o MTA Fillapex apresentou a menor resistência de união entre todos os cimentos testados (p<0,001). Os cimentos experimentais demonstraram valores intermediários, com ausência de diferenças estatísticas entre si (p>0,05). Em conclusão, os cimentos endodônticos experimentais à base de MTA e butiletilenoglicol dissalicilato apresentaram resultados adequados de resistência de união quando comparados ao MTA Fillapex.

Avaliação da resistência de união de cimentos endodônticos experimentais à base de MTA e butiletilenoglicol dissalicilato / Evaluation of push-out bond strength of experimental root canal sealers based on MTA and butyl ethylene glycol disalicylate

O objetivo deste estudo foi avaliar a resistência de união de dois cimentos endodônticos experimentais à base de MTA e butiletilenoglicol dissalicilato: MTAe e MTAe-HA. Os cimentos endodônticos comerciais MTA Fillapex e AH Plus foram utilizados como materiais de referência para comparação. Vinte incisivos centrais superiores permanentes humanos foram selecionados e um slice dentinário (1 ± 0,1 mm de espessura) foi obtido à partir da junção amelocementária de cada raiz. Quatro orifícios com 0,9 mm de diâmetro foram confeccionados na superfície axial de cada slice dentinário. As amostras receberam uma irrigação padronizada e foram secas com papel absorvente. Em seguida, cada um dos orifícios foi preenchido com um dos quatro cimentos endodônticos avaliados. Os slices dentinários preenchidos foram armazenados em ambiente umidificado em solução tampão fosfato-salino (pH 7,2) durante 7 dias a 37°C. Após o armazenamento, realizou-se ensaio de push-out. A carga foi aplicada com a velocidade de 0,5 mm/min até a obtenção do deslocamento do material obturador, sendo o resultado expresso em MPa. O teste de Kruskal-Wallis foi aplicado para avaliar o efeito da resistência de união de cada cimento endodôntico. O teste Mann-Whitney com correção de Bonferroni foi utilizado para isolamento das diferenças. O erro do tipo  foi fixado em 0,05. Houve diferenças estatísticas significativas entre os materiais avaliados (P = 0,000). O AH Plus demonstrou os maiores valores de resistência de união (P = 0,000). O MTA Fillapex apresentou a menor resistência de união entre todos os grupos experimentais (P = 0,000). Nenhuma diferença foi encontrada entre os dois cimentos endodônticos experimentais (P < 0,05). Pode-se concluir que os cimentos experimentais à base de MTA e butiletilenoglicol dissalicilato apresentaram resultados adequados de resistência de união à dentina quando comparados ao MTA Fillapex.

The present study was designed to investigate push-out bond strength of two experimental root canal sealers based on MTA and butyl ethylene glycol disalicylate: MTAe and MTAe-HA. Commercial sealers MTA Fillapex and AH Plus were used as reference materials for comparison. Twenty human permanent maxillary central incisors were selected and one dentin slice (1 ± 0.1 mm thick) was obtained from the cementoenamel junction of each root. On the axial surface of each dentine disc, four 0.9-mm-wide holes were drilled. Standardized irrigation was performed and samples were dried with absorbent paper. Then, each role were filled with one of the four tested root canal sealers. The filled dental slices were stored in phosphate buffered saline solution (pH 7.2) for 7 days at 37°C. After storage, a push-out assessment were performed. Loading was applied at a crosshead speed of 0.5 mm/min until sealer displacement and the results were expressed in MPa. Kruskal-Wallis test was applied to assess the effect of each endodontic sealer on the push-out bond strength. Mann-Whitney with Bonferroni correction was used to isolate the differences. The alpha-type error was set at 0.05. There were significant differences among materials (P = 0.000). AH Plus filled specimens had the highest push-out bond strength values (P = 0.000). MTA Fillapex had the lowest push-out bond strength among all experimental groups (P = 0.000). No difference has been found between the two experimental root canal sealers (P < 0.05). It has been concluded that experimental MTA and butyl ethylene glycol disalicylate based sealers presented suitable dentine bond strength outcomes when compared to MTA Fillapex.