Oral pregabalin for postoperative pain relief after third molar extraction: a randomized controlled clinical trial.

OBJECTIVES: The aim of this randomized controlled clinical trial was to evaluate the efficacy and safety of pregabalin administered pre- and postoperatively in patients with pain and swelling due to the surgical removal of impacted lower third molars. MATERIALS AND METHODS: The final study sample comprised 60 volunteers (23 males and 37 females). Group 1 (n = 30) received 75 mg oral pregabalin 1 h before surgery and 1 h after surgery. Group 2 (n = 30) served as a control group and received no pregabalin. Both groups were administered with 650 mg paracetamol every 8 h for 2 days. Postoperative pain intensity and swelling were measured using a visual analog scale (VAS); pain relief experienced was reported using a four-point verbal rating scale (VRS); the rescue medication requirement, adverse effects, and global impression of the medication were also recorded. RESULTS: No significant difference in pain intensity (VAS) was observed between the groups. However, fewer rescue medication tablets were needed by pregabalin-treated patients than by controls (p = 0.021). The frequency and intensity of adverse effects were significantly higher in pregabalin-treated patients (p < 0.001), although no serious adverse events occurred. No significant difference in the degree of swelling was observed in any measurement except that from mandibular angle to lip junction, which showed lesser inflammation in the pregabalin group at 24 h post-surgery (p = 0.011). The global opinion on the medication received was more positive in the pregabalin group (p = 0.042). CONCLUSIONS: The administration of pregabalin reduces the requirement for rescue medication after third molar surgery and results in a more constant pain level, with fewer peaks of pain intensity. CLINICAL RELEVANCE: These findings suggest that pregabalin may be useful to control acute postoperative pain. Adverse effects are known to be reduced at the low pregabalin dose used in our study.

Analysis of the Prognostic Factors That Influence the Outcome of Periapical Surgery, including Biomimetic Membranes for Tissue Regeneration: A Review.

The objective of this study was to analyze the prognostic factors that influence the outcome of periapical surgery. A systematic search of the literature was carried out using PubMed and Scopus databases between January 2000 and December 2023 with no language limitations. The PICO question of the present systematic review was: What prognostic factors may influence the outcome of periapical surgery? The most relevant randomized controlled clinical trials (RCTs), prospective clinical trials, retrospective studies, and meta-analyses (n = 44) were selected from 134 articles. The reviewed literature evidenced that bone-lesion healing could significantly be improved by the absence of deep periodontal pockets (>4 mm), localization in anterior teeth, the absence of pain and/or preoperative symptoms, a size of bone lesion < 5 mm, the use of ultrasound, the correct placement of retrograde filling material, and the use of different biomimetic membranes for guided tissue regeneration (GTR). Some preoperative and intraoperative factors could significantly improve the prognosis of periapical surgery. However, these results were not conclusive, and further high-quality research is required.

Decalcifying effects of antimicrobial irrigating solutions on root canal dentin.

OBJECTIVE: The aim of this study was to determine the decalcifying efficacy of 7% maleic acid (MA), 2% chlorhexidine (CHX), and combinations of 7% MA + 0.2% cetrimide (CTR) and 2% CHX + 0.2% CTR, in four time periods. STUDY DESIGN: Four specimens per tooth were obtained from a 2-mm thick slice of the cervical third of the root of ten human incisors. At 1, 2, 3 and 5 minutes of immersion, the concentrations of Ca2+ were measured by atomic absorption spectrophotometry. The results were analyzed using the Mann-Whitney U-test. RESULTS: Statistically significant differences were seen for the extracted calcium in all time periods. The amount of calcium extracted by 7% MA was the highest at all four immersion times, followed by 7% MA + 0.2% CTR. Two percent CHX and its combination with 0.2% CTR extracted virtually no calcium. CONCLUSIONS: The decalcifying capacity of 7% MA and 2% CHX diminished when combined with 0.2% CTR.

Antimicrobial activity and enterococcus faecalis biofilm formation on chlorhexidine varnishes.

OBJECTIVE: To evaluate, in vitro, the antimicrobial activity and biofilm formation of three chlorhexidine varnishes in four E. faecalis strains: E. faecalis ATCC 29212, E. faecalis EF-D1 (from failed endodontic treatment), E. faecalis 072 (cheese) and E. faecalis U-1765 (nosocomial infection), and one E. durans strain (failed endodontic treatment). STUDY DESIGN: The direct contact test was used to study the antimicrobial activity. Bacterial suspensions were exposed for one hour to EC40, Cervitec (CE) and Cervitec Plus (CEP) varnishes. "Eradication " was defined as 100% bacterial kill. The formation of enterococci biofilms was tested on the surface of the varnishes after 24 hours of incubation and expressed as percentage of biofilm reduction. RESULTS: EC40 eradicated all strains except E. faecalis ATCC 29212, where 98.78% kill was achieved. CE and CEP showed antimicrobial activity against all the strains, but most clearly against E. durans and E. faecalis 072. EC40 completely inhibited the formation of biofilm of E. faecalis ATCC 29212, E. faecalis 072 and E. durans. CE and CEP led to over 92% of biofilm reduction, except in the case of E. faecalis U-1765 on CEP (76.42%). CONCLUSION: The three varnishes studied were seen to be effective in killing the tested strains of enterococci and in inhibiting the formation of biofilm, the best results being observed with EC40.

In vitro Enterococcus faecalis biofilm formation on five adhesive systems.

OBJECTIVE: To determine the E. faecalis biofilm formation on the surface of five adhesive systems (AS) and its relationship with roughness. STUDY DESIGN: The formation of E. faecalis biofilms was tested on the surface of four dual-cure AS: AdheSE DC, Clearfil DC Bond, Futurabond DC and Excite DSC and one light-cure antimicrobial AS, Clearfil Protect Bond, after 24 hours of incubation, using the MBEC high-throughput device. RESULTS: E. faecalis biofilms grew on all the adhesives. The least growth of biofilm was on Excite DSC, Clearfil Protect Bond, and the control. Futurabond DC resulted in the greatest roughness and biofilm amount. There was a close relationship between the quantity of biofilm and roughness, except for Clearfil Protect Bond, which showed little biofilm but high roughness. CONCLUSION: None of the tested AS prevented E. faecalis biofilm formation, although the least quantity was found on the surface of Clearfil Protect Bond.

Eradication of enterococci biofilms by lactic acid alone and combined with chlorhexidine and cetrimide.

OBJECTIVE: The antimicrobial activity of lactic acid (LA) alone or in combination with chlorhexidine (CHX) and cetrimide (CTR) against three Enterococcus faecalis strains, E. faecalis ATCC 29212, E. faecalis EF-D1 and E. faecalis U-1765, one Enterococcus durans strain and one dual-species biofilm was investigated. STUDY DESIGN: The irrigating solutions tested were 20%, 15%, 10%, 5% and 2.5% LA, alone and in combination with 2% CHX and with 0.2% CTR. The biofilms were grown in the MBECTM high-throughput device for 24 hours and exposed to the solutions for 30 seconds and 1 minute. "Eradication" was defined as 100% bacterial kill. RESULTS: Twenty percent LA eradicated all enterococci biofilms after 30 seconds contact time. The association of LA+0.2% CTR achieved better results than LA alone, in contrast with the results obtained using LA+2% CHX. E. durans was eradicated by all the tested solutions at 1 minute. The dual-species biofilm, E. faecalis ATCC 29212+E. durans, gave intermediate values of the pure cultures. CONCLUSIONS: LA is capable of eradicating enterococci biofilm at a concentration of 20%. The combination of lower concentrations with 0.2% CTR achieved eradication after 1 minute.

An in vitro evaluation of two dentine adhesive systems to seal the pulp chamber using a glucose penetration model.

OBJECTIVES: To evaluate the sealing capability of Cavit™ G with or without Clearfil™ S3 Bond and Prime & Bond NT placed in the pulp chamber. STUDY DESIGN: Forty single rooted premolars, extracted for orthodontic and periodontal reasons, with intact coronal surface and mature apices, were standardized to a length of 15 mm. The teeth were instrumented, filled with a gutta-percha master cone and divided into three groups to obturate the pulp chambers: Cavit™ G; Clearfil™ S3 Bond plus Cavit™ G and Prime & Bond® NT plus Cavit™ G. A glucose leakage model was used for evaluating the coronal microleakage. The Mann-Whitney test was used to evaluate the differences in the means of the glucose leakage. RESULTS: An increase in glucose penetration was observed during the first week in groups Cavit™ G and Cavit™ G+PBNT. The glucose penetration values of all groups were similar at 30 and 45 days, and there were no significant differences among them in both time periods (p=0.736 and p=0.581, respectively). CONCLUSIONS: The adhesive systems did not improve the capability of Cavit™ G to seal the pulp chamber over time.

Intraorifice sealing ability of different materials in endodontically treated teeth.

OBJECTIVES: To evaluate Cavit TM G, ProRoot TM MTA and Tetric® EvoFlow as intraorifice barriers to prevent coronal microleakage in root canal treatment. STUDY DESIGN: Forty-two human single rooted teeth were divided randomly in three experimental groups of 10 specimens each and two control groups. The experimental groups were prepared with hand instrumentation and cold lateral condensed technique of the gutta-percha. Four millimetres of coronal gutta-percha were removed and replaced by one of the following filling materials: Cavit TM G, Tetric® EvoFlow or ProRoot TM MTA. In the experimental groups, leakage was measured by the concentration of leaked glucose in the apical reservoir at 1, 7, 30, and 45 days, using the enzymatic glucose oxidase method. Data were analyzed by means of Mann-Whitney U and Kruskal-Wallis tests at α=0.05. RESULTS: The glucose penetration results of three experimental groups increased gradually over time. No significant differences were found among groups at 24 hours and 1 week. At thirty and forty-five days, Cavit TM and Tetric® EvoFlow values were significantly different (p=0.007 and p=0.023, respectively). CONCLUSIONS: The sealing ability of the Cavit TM G, ProRoot TM MTA and Tetric® EvoFlow used as intraorifice materials tends to be similar over time.

Long-term sealing ability of GuttaFlow versus Ah Plus using different obturation techniques.

OBJECTIVE: To compare the long-term sealing ability of GuttaFlow® using different obturation techniques. STUDY DESIGN: Three hundred teeth, prepared with a crown-down technique, were divided into thirty experimental groups (n=10) to evaluate the apical and coronal leakage, at 3, 30 and 120 days, of lateral compaction gutta-percha+AH Plus TM, lateral compaction gutta-percha+GuttaFlow®, single cone+AH Plus TM, single cone+GuttaFlow®, and GuttaFlow® only. RESULTS: Both coronal and apical leakage, at the three times of measurement, no significant differences were found among GuttaFlow®+lateral compaction gutta-percha and GuttaFlow®+single cone groups, whereas the only GuttaFlow® reached the highest leakage values at 30 and 120 days. AH Plus TM, using both techniques, showed high levels of leakage after 120 days to the coronal leakage and after 30 days to the apical leakage when compared silicon based sealer. CONCLUSION: GuttaFlow®, using with lateral compaction and single cone techniques, shows a greater apical and coronal sealing ability than AH Plus TM over time. GuttaFlow® when used as only creates a poorer sealing when used with lateral compaction gutta-percha or single cone techniques.

Cytotoxic effects of two acid solutions and 2.5% sodium hypochlorite used in endodontic therapy.

AIM: To evaluate the cytotoxicity of 15% citric acid, 5% phosphoric acid and 2.5% NaOCl on cultured fibroblasts using MTT colorimetric assay. METHODOLOGY: Irrigating solutions of 5% phosphoric acid, 15% citric acid, and 2.5% NaOCl, diluted at 0.1% and 0.5%, were applied to cell cultures of 3T3L1 fibroblasts. The cell viability was determined by means of MTT colorimetric assay after a period of 1, 6 and 24 hours. Percentages of cell viability were analyzed using the Kruskal-Wallis test for global comparisons and the Mann-Whitney U-test for pairwise comparisons. RESULTS: The percentage of cell viability diminished progressively over a 24 hour period in all solutions at both dilutions. At 0.1% dilution, 2.5% NaOCl (63.39%) and 15% citric acid (53.91%) showed the highest percentage of cell viability (p=0.083). At 0.5% dilution, 2.5% NaOCl again showed the highest cell viability value (48.51%). CONCLUSIONS: The irrigating solution with the highest percentage of cell viability was 2.5% NaOCl at both 0.1% and 0.5% dilutions. A very low percentage of cell viability was obtained with 15% citric acid and 5% phosphoric acid at 0.5% dilution.

Measurement of dental implant stability by resonance frequency analysis: a review of the literature.

Dental implant treatment is an excellent option for prosthetic restoration that is associated with high success rates. Implant stability is essential for a good outcome. The clinical assessment of osseointegration is based on mechanical stability rather than histological criteria, considering primary stability (absence of mobility in bone bed after implant insertion) and secondary stability (bone formation and remodelling at implant-bone interface). The aim of this study was to review the literature on Resonance Frequency Analysis (RFA) as a method for measuring dental implant stability. An online search of various databases was conducted on experimental and clinical research published between 1996 and 2008. The studies reviewed demonstrate the usefulness of RFA as a non-invasive method to assess implant stability. Further research is required to determine whether this system is also capable of measuring the degree of dental implant osseointegration.

Retention of three fissure sealants and a dentin bonding system used as fissure sealant in caries prevention: 12-month follow-up results.

BACKGROUND: Bonding agents could be used as fissure sealants. This study compares the retention three fissure sealants (Delton, Delton Plus and Concise) and a filled dentin bonding system (Optibond Solo). METHODS. Fifty-six children aged 7-8 years received fissure sealants either in the four permanent first molars, in the four deciduous second molars, or in all eight of these teeth. Every child received a different sealing material in each quadrant on a random basis. Clinical evaluation at 12 months was performed by a single blind examiner, and the retention was classified as either a success (total retention) or a failure (partial retention or not present). RESULTS: There were no statistically significant differences among the four materials in permanent maxillary molars or deciduous molars. In permanent mandibular molars, Optibond Solo showed a lower percentage of retention (40.9%), significantly different (p=0.002) to that of Delton (89.5%), Delton Plus (87.5%) and Concise (76.5%). CONCLUSION: One bottle dentin bonding system used as a sealant does not improve the retention of conventional fissure sealants. CLINICAL IMPLICATION: Because of the scarcity of studies on the use of dental adhesives as sealants, further studies are warranted for the final support of that conclusion.

Effect of post space preparation on apical seal: influence of time interval and sealer.

OBJECTIVE: To assess the efficacy of two sealants to preserve the apical seal after root canal preparation and cementation of posts at 24 h or 72 h after endodontic treatment. STUDY DESIGN: Sixty human single-root teeth were instrumented and obturated using lateral compaction technique with EndoFill [30] or AH-Plus) [30] and were prepared in one of three ways, leaving a 3 mm gutta percha remnant in all cases: without cast post preparation, with preparation after 24 h or after 72 h. After cementing the posts, the specimens were thermal cycled at 5 and 55 degrees C in water baths, submerged in 2% methylene blue dye for 72 h, embedded in acrylic resin and cut transversally into three 1-mm apical sections. Dye leakage was quantitatively assessed as the percentage leaked area. RESULTS AND CONCLUSION: Comparison of the apical sections showed significant differences in leakage with both sealers among the three preparation groups (p<0.001). No significant differences between sealers were found in any preparation group or in the same sections.

Apical seal comparison of low-temperature thermoplasticized gutta-percha technique and lateral condensation with two different master cones.

AIM: To compare the apical sealing in mesio-buccal canals of extracted molars obturated with low-temperature thermoplasticized gutta-percha or cold lateral condensation techniques using a .06 or a .02 mm/mm tapered gutta-percha master cone. The secondary aim was to evaluate the depth of spreader penetration in root canals using a .06 or a .02 mm/mm tapered gutta-percha master cone. METHODOLOGY: Forty-four mesio-buccal curved canals (25-40 degree) were instrumented with .06 nickel-titanium rotary instruments and randomly distributed into two control groups (n=4) and three experimental groups (n=12) for obturation by the Ultrafil 3D system or by cold lateral condensation with .06 or .02 tapered master cone. Canal sealer AH-Plus was used. The depth of spreader penetration was recorded in millimetres. Roots were covered with two layers of nail polish, immersed in India ink for 7 days, transversally sectioned and examined with a stereomicroscope. Student s t test was used to determine whether there was a difference in spreader penetration between groups. Kruskal-Wallis test was used to determine whether there was a difference in leakage. RESULTS: There were no differences among the three groups (p=0.396), which showed a very similar mean microleakage (0.42, 0.75 and 0.42). The difference in spreader penetration between the groups filled by cold lateral condensation was significant (p=0.001) CONCLUSION: The Ultrafil 3D system and cold lateral condensation techniques with .06 or .02 tapered master cones were equally effective in the apical sealing of curved canals. The spreader penetrated deeper using a .02 mm/mm tapered gutta-percha master cone.

Impact of public preventive programmes on oral quality of life of 11 to 12-yr-old school students.

OBJECTIVES: The objective was to analyze the impact of preventive programmes on oral quality of life in school students aged 11-12 yrs. STUDY DESIGN: In the school year 1996/97, a quasi-experimental study was initiated in Granada province with four groups of students aged 6-7 yrs: Sealant + Fluoride (sealants on first permanent molars applied in the health centre for a 3-yr active programme, and fluoride varnish applied every four months for 3 yrs, n=65), Sealant (only sealants, n=80), Fluoride (only fluoride varnish, n=107) and Control group (n=59). All students were examined every 6 months at school during the 3-yr active programme and received an oral health report after each examination. At 5.5 yrs (school year 2002/03), after 2.5 yrs with no programme, students were again examined and completed a questionnaire on oral quality of life scored from -6 (minimum) to +6 (maximum). RESULTS: Oral quality of life values (+/- standard deviation) were: 3.31+/-0.30 (Sealant + Fluoride), 3.11+/-0.27 (Sealant), 3.18+/-0.23 (Fluoride) and 2.95+/-0.32 (Control), with no statistically significant differences among them. CONCLUSIONS: Fissure sealant and fluoride varnish programmes had no significant influence on oral quality of life after a 5.5- yr follow-up (3 yrs of active programme plus 2.5 yrs of discontinuation).

The effectiveness of different acid irrigating solutions in root canal cleaning after hand and rotary instrumentation.

The goal of this study was to evaluate the cleaning ability of three acid irrigating solutions after hand and rotary instrumentation. Eighty human teeth were randomly divided in eight groups. Four groups were prepared with hand instrumentation and other four with ProTaper. The irrigating solutions were 15% citric acid plus 2.5% NaOCl; 15% EDTA plus 2.5% NaOCl; 5% orthophosphoric acid plus 2.5% NaOCl; and 2.5% NaOCl alone as control. Canal walls were observed with scanning electron microscopy, and photomicrographs were taken in apical, middle, and coronal thirds. A scoring system for debris and smear layer was used. Acid solutions with 2.5% NaOCl were effective in the elimination of smear layer or debris, and no significant differences were showed in smear layer removal between techniques. However, 2.5% NaOCl did not remove smear layer or debris, and no significant differences in debris were observed between manual and rotary techniques.

Influence of cavity type and size of composite restorations on cuspal flexure.

OBJECTIVES: The present study examines the influence of cavity type, and size of composite restorations on cuspal flexure due to polymerization shrinkage. METHODS: Thirty healthy premolars were selected and divided into two experimental groups. Group 1: Mesial, mesio-distal, and MOD cavities were successively prepared in each tooth by means of the SONICSYS approx system (KaVo) using a n 2 (small) diamond tip. Group 2: The same cavity preparation sequence was followed but a n 3 (medium) tip was used. Cavity preparations were performed and afterwards restored using the same adhesive system and resin composite. Cuspal displacement was measured 15 min after completion of each type of restoration. RESULTS: Under the experimental conditions used, polymerization shrinkage of composite restorations resulted in an inward deflection of the cusps in all the situations evaluated. The Friedman global test found significant differences according to the cavity type and size (p<0.05). The Wilcoxon test revealed that deflection was significantly affected by the amount of dental tissue lost, since practically no movement was observed in the case of mesial cavities but extensive displacements were recorded for MOD restorations (p<0.05). However, no influence of bucco-lingual width on cuspal flexure was detected by the Student s t test (p>0.05). CONCLUSIONS: The present study demonstrates that significantly higher cuspal deflection is observed in MOD restorations, showing that the degree of dental removal influences the cuspal flexure from polymerization shrinkage of composite restorations.

Ex vivo microbial leakage after using different final irrigation regimens with chlorhexidine.

OBJECTIVE: To assess the influence of final irrigation protocols with chlorhexidine in the coronal leakage of Enterococcus faecalis in filled root canals. MATERIAL AND METHODS: Seventy single-root canals from extracted teeth were prepared using ProTaper instruments. The irrigation protocol accomplished an alternating irrigation with 5 mL of 2.5% sodium hypochlorite (NaOCI) and 17% EDTA between each file. The teeth were randomly divided into four experimental groups (n=15) according to the final irrigation regimen: group 1, without final irrigation; group 2, irrigation with 10 mL 2.0% chlorhexidine (CHX); group 3, with a final application of EC40™; and group 4, irrigation with the combination (1:1) of 0.2% CHX + 0.1% cetrimide (CTR). All the teeth were mounted in a two-chamber apparatus and the coronal access was exposed to E. faecalis. The presence of turbidity in the BHI broth over a period of 180 days was observed. The Friedman test was used for statistical analysis. RESULTS: EC40™ varnish showed the least leakage at 180 days, and was statistically similar to 2% CHX. No significant differences were observed between the group without final irrigation and the 2% CHX group or 0.2% CHX + 0.1% CTR. CONCLUSIONS: In this ex vivo study, EC40™ showed the longest delayed coronal leakage of E. faecalis, although without significant differences from 2% CHX.

Antimicrobial activity of essential oils and chloroform alone and combinated with cetrimide against Enterococcus faecalis biofilm.

The Enterococcus faecalis bacteria have been identified as the most commonly recovered species from teeth with persistent endodontic infections. The antimicrobial activity of essential oils and chloroform (CHL), alone and in association with various concentrations of cetrimide (CTR), against biofilm of Enterococcus faecalis was investigated. Solutions of CHL, eucalyptus oil (EO) and orange oil (OO) associated with CTR at 0.3%, 0.2%, 0.1%, and 0.05% were used to determine antimicrobial activity by exposing treated bovine dentine blocks to E. faecalis. Biofilms grown in the dentine blocks for 7 days were exposed to solutions for 2 and 5 min. Biofilm reduction between OO and EO at 2 min did not show any significant differences; however, OO had a higher kill percentage of biofilms than did the eucalyptus oil at 5 min (p < 0.01). Combinations with CTR at all concentrations achieved a 100% kill rate at 2 and 5 min. The association of CTR with solvent agents achieved the maximum antimicrobial activity against E. faecalis biofilms in dentine.

Residual effectiveness of final irrigation regimens on Enteroccus faecalis-infected root canals.

INTRODUCTION: The application of a final irrigating solution that remains active over a fairly long period of time stands as one strategy for preventing bacterial recolonization or eliminating the bacteria that persist after root canal treatment. The aim of this study was to evaluate the residual antimicrobial activity of four final irrigation regimens in root canals contaminated with Enterococcus faecalis. METHODS: Biofilms of E. faecalis were grown in uniradicular roots for 4 weeks. After preparing the roots chemomechanically, four final irrigation regimens were applied: (1) group EDTA-NaOCl, 17% EDTA followed by 5.25% sodium hypochlorite (NaOCl); (2) group MA-NaOCl, 7% maleic acid (MA) followed by 5.25% NaOCl; (3) group EDTA-CHX + CTR, 17% EDTA followed by 2% chlorhexidine (CHX) + 0.2% cetrimide (CTR); and (4) group MA-CHX + CTR, 7% MA followed by 2% CHX + 0.2% CTR. Samples were collected for 60 days to denote the presence of bacterial growth. The Fisher exact test was used to compare the percentages of specimens without E. faecalis regrowth. RESULTS: All root canals in which the final irrigant was 5.25% NaOCl yielded positive cultures on the fifth day. Groups EDTA-CHX + CTR and MA-CHX + CTR with a final irrigation of 2% CHX + 0.2% CTR showed respective percentages of samples without regrowth of 72.1% and 66.8% at 60 days. There were no statistically significant differences between these groups. CONCLUSIONS: The combination of 2% CHX + 0.2% CTR would be an effective alternative final irrigation regimen given its antimicrobial action over time.