Randomized Clinical Study of the Use of MTA and Biodentine™ for Pulpotomy in Primary Teeth

ABSTRACT Objective: To verify, through clinical and radiographic evaluations, the in vivo response of the dentin-pulpal complex of human primary teeth after pulpotomy with MTA and Biodentine™ in a follow-up period of 3, 6, and 12 months. Material and Methods: Thirty teeth were divided into MTA pulpotomy (n = 15) and Biodentine™ pulpotomy (n = 15) from children between 5 and 9 years of age, a randomized clinical trial with simple random sampling. The materials were inserted into the cavity after opening and removing the coronary pulp tissue. The cavity base consisted of glass ionomer cement and light-cured composite resin restoration. Clinical and radiographic analyses were performed after 3, 6, and 12 months. Statistical analysis by Fisher's exact test for dichotomous data at a 5% significance level was utilized. Results: Both materials caused color change after 12 months. However, MTA showed a higher percentage than Biodentine™ (p<0.0001). Pain was detected only with Biodentine™ at six months and mobility at 12 months (p=0.0013). Radiographically, after 12 months, periapical lesions, interradicular lesions, and internal resorption were evidenced in 13% of the cases for Biodentine™-treated teeth (p<0.0013). MTA induced pulp calcification in 13% of cases, unlike Biodentine™ (p<0.0013). Conclusion: BiodentineTM and MTA are suitable for clinical use in pulpotomy treatment, yet both materials lead to tooth discoloration.

Cytotoxicity and inflammatory mediators release by macrophages exposed to real seal xt and sealapex xpress

Abstract This study evaluated the cytotoxicity of Sealapex Xpress and Real Seal XT and their effect on macrophage activation. J774.1 macrophages were incubated with Sealapex Xpress and Seal Real XT (0.1, 1.0, and 10 mg/mL) for 24 and 48 h. Cell viability was assessed by the MTT assay and macrophage activation was measured by pro- and anti-inflammatory cytokine production using ELISA. Data were analyzed using one-way ANOVA and Tukey's post-test (a=0.05). Cell viability was not affected with 0.1 or 1.0 mg/mL of extracts of Sealapex Xpress and Real Seal XT at 24 and 48 h (p>0.05), but was significantly lower when cells were exposed to 10 mg/mL of both sealers (p<0.05). Sealapex Xpress inhibited the production of TNF-a, whereas Real Seal XT induced TNF-a secretion at 24 h (p<0.05). IL-6 production was induced by Real Seal XT, but not by Sealapex Xpress (p<0.05). Real Seal XT and Sealapex Xpress induced the secretion of anti-inflammatory IL-10. IL-4 was not detected in any group. In conclusion, both sealers had low toxicity but differentially activated macrophages. Macrophage activation by Sealapex Xpress was characterized by inhibition of TNF-a and induction of IL-10, whereas Real Seal XT induced IL-6 solely.

Resumo O objetivo deste estudo foi avaliar in vitro a citotoxicidade dos cimentos endodônticos Sealapex Xpress e Real Seal XT pelo ensaio de MTT e a ativação de macrófagos J774.1. Os cimentos endodônticos Sealapex Xpress e Real Seal XT foram pesados e os extratos foram obtidos a partir da diluição em meio de cultura DMEM por 48 horas (10mg/mL, 1mg/m, e 0,1 mg/mL). A viabilidade celular foi avaliada pelo ensaio MTT e a produção de citocinas (TNF-a, IL-6 e IL-10) foi investigada pelo ensaio imunoenzimático (ELISA) em células de linhagem (macrofagos J774.1). Os dados obtidos foram analisados utilizando-se análise de variância de uma via e pós-teste de Tukey (a=0,05). A viabilidade celular após 24 ou 48 horas não foi afetada nas concentrações de 0,1 ou 1 mg/mL dos dois cimentos estudados (p>0,05). Por outro lado, na concentração 10 mg/mL, a viabilidade celular foi significativamente mais baixa (p <0,05). Observou-se que o Sealapex Xpress inibiu a produção de TNF-a, enquanto o Real Seal XT induziu a secreção de TNF-a às 24 h (p<0,05). A produção de IL-6 foi induzida pelo Real Seal XT, mas não pelo Sealapex Xpress (p<0,05). A secreção da citocina anti-inflamatória IL-10 foi induzida tanto pelo Real Seal XT quanto pelo Sealapex Xpress. IL-4 não foi detectada em nenhum grupo. Em conclusão, os dois cimentos obturadores apresentaram baixa toxicidade, mas ativaram os macrófagos de modo distinto. A ativação pelo Sealapex Xpress foi caracterizada pela inibição do TNF-a e indução da IL-10, enquanto o Real Seal XT induziu somente IL-6.

Mechanical Preparation Showed Superior Shaping Ability than Manual Technique in Primary Molars - A Micro-Computed Tomography Study

Abstract The aim of the study was to evaluate canal preparation in primary molars with hand files, ProTaper Next and Self-Adjusting File (SAF) by 2D and 3D micro-computed tomography (micro-CT) analysis. Canals of 24 primary molars were prepared with hand files (HF), ProTaper Next (PTN) and SAF (n=8/group). The teeth were scanned before and after root canal preparation and the pre- and postoperative micro-CT images were reconstructed. Changes in 2D (area, perimeter, roundness, minor and major diameter) and 3D [volume, surface area, structure model index (SMI)] morphological parameters, as well as canal transportation and lateral perforations were evaluated (Kruskal-Wallis and ANOVA; a=0.05). SAF presented smaller changes in minor diameter, volume and surface area compared with HF and PTN (p<0.05). PTN presented more circular canals after preparation. 3D analysis revealed greater transportation in HF. PTN and SAF presented more centered canal preparation, especially in curved areas. SAF and HF presented, respectively, the lowest (0.05±0.02 and 0.07±0.04) and highest (0.14±0.11 and 0.29±0.17) apical transportation. There were fewer lateral perforations in SAF (4.2%) and PTN (7.7%) than in HF (47.8%) (p<0.05). In primary molars, mechanical preparation showed better shaping ability than hand files, promoting more centered preparations and lower occurrence of lateral perforations and canal transportation. Clinical Relevance: Manual instrumentation is still reported as the main choice in the primary teeth preparation; however, studies have shown limitations in its use. The morphological characteristics of primary teeth and the limited knowledge of shaping procedures in these teeth using mechanical preparation become a challenge for clinical practice and might impair the predictability of endodontic treatment.

Resumo Este estudo avaliou o preparo do canal radicular em molares decíduos com sistema manual e mecanizado [ProTaper Next e Self-Adjusting File (SAF)], por meio de parâmetros morfológicos bi (2D) e tridimensionais (3D) em microtomografia computadorizada (micro-CT). Canais radiculares de 24 molares decíduos foram preparados com limas manuais (M), ProTaper Next (PTN) e SAF (n=8/grupo). Os dentes foram escaneados antes e após o preparo do canal radicular e as imagens de micro-CT pré e pós-operatória foram reconstruídas. As mudanças nos parâmetros morfológicos 2D (área, perímetro, circularidade, menor e maior diâmetro) e 3D [volume, área de superfície, índice de estrutura do modelo (SMI)], bem como o transporte do canal radicular e a presença de perfurações laterais foram avaliadas (Kruskal-Wallis and ANOVA; a=0.05). SAF apresentou menores mudanças no diâmetro menor, volume e área de superfície quando comparado com M e PTN (p<0.05). PTN mostrou canais mais circulares após o preparo. A análise 3D revelou maior transporte para o grupo M. PTN e SAF mostraram maior centralização do preparo do canal radicular, especialmente em áreas de curvatura. SAF e M apresentaram, respectivamente, o menor (0,05±0,02 e 0,07±0,04) e o maior (0,14±0,11 e 0,29±0,17) transporte apical. Foi possível observar menor porcentagem de perfurações laterais para os grupos SAF (4,2%) e PTN (7,7%) comparados ao grupo M (47,8%) (p<0.05). Conclui-se que o preparo mecanizado dos canais radiculares em molares decíduos, apresentou melhor capacidade de modelagem do que as limas manuais, promovendo preparos mais centralizados e menor ocorrência de perfurações laterais e transporte do canal.

Gerenciamento de resíduos odontológicos no serviço público / Dental waste management in the public service

OBJETIVO: Verificar o processo de gerenciamento dos resíduos odontológicos do serviço público de saúde em 11 municípios brasileiros. MATERIAL E MÉTODO: Uma única pesquisadora realizou as visitas e as observações foram anotadas em um roteiro previamente elaborado e testado. RESULTADO: Foram visitadas 50 unidades de saúde, sendo que nenhuma apresentou cópia do plano de gerenciamento de resíduos. Do total de estabelecimentos, 62% realizavam a correta segregação dos resíduos no momento da sua geração. A presença de recipientes adequados a cada tipo de resíduo gerado no consultório odontológico foi observada em 74% dos estabelecimentos e, destes, 94% apresentavam capacidade adequada ao tipo de resíduo gerado. A identificação do tipo de resíduo nas embalagens plásticas bem como anotações identificando o estabelecimento gerador dos resíduos foram encontradas em 8% e 6%, respectivamente. Somente 21% dos estabelecimentos apresentavam locais apropriados, de acordo com as normas vigentes, para o armazenamento dos resíduos até que fosse feita a coleta externa. CONCLUSÃO: Constatou-se na presente pesquisa que a rotina adotada pela rede pública de saúde bucal, no que tange ao gerenciamento de resíduos de saúde, apresentou falhas.

OBJECTIVE: was to investigate the process of waste management of dental public health service in eleven counties. MATERIAL AND METHOD: one researcher conducted the visits, and observations were recorded on a previously elaborated and tested. RESULT: We visited 50 health units, and none presented a copy of the waste management plan. Of the total 62% of businesses held the correct segregation of waste at the time of his generation. The presence of containers suitable for each type of waste generated at the dental office was observed in 74% and of those, 94% had adequate capacity for the type of waste generated. The identification of the type of waste in plastic containers and annotations identifying the establishment from which the waste was found in 8% and 6% respectively. Only 21% of establishments had appropriate locations, according to the current regulations for the storage of waste until collection was done outside. CONCLUSION: It was found in this study that the routine adopted by public oral health, regarding the management of healthcare waste had flaws.

Conhecimento sobre saúde bucal por concluintes de pedagogia / Knowledge regarding oral health among graduates in Education

Este estudo teve por objetivo investigar as opiniões e o conhecimento de concluintes do curso de Pedagogia da cidade de Araçatuba, São Paulo, Brasil, em 2009, sobre saúde bucal. Para tanto, foi utilizado um questionário semiestruturado, abordando as opiniões dos estudantes sobre educação em saúde bucal e seu conhecimento sobre aspectos relativos à cárie dentária, à odontologia preventiva e à odontologia na primeira infância. De um universo de 120 estudantes, 92 (76,6%) consentiram participar do estudo. Destes, 86,8% acadêmicos acham que o professor deve atuar como educador em saúde bucal e 92,4% consideram importante a sua integração com profissionais de saúde. Responderam corretamente sobre o conceito de placa bacteriana e cárie dentária, respectivamente, 9% e 34,8%. Sobre o surgimento da cárie e sobre a possibilidade de se ter dentes saudáveis a vida inteira, responderam corretamente 67% e 83,7%, respectivamente. Assim, os concluintes de Pedagogia têm opiniões positivas em relação à educação em saúde bucal; entretanto, o seu conhecimento sobre a temática abordada é insatisfatório, uma vez que eles serão futuros professores e formadores de opinião.

This study aimed to investigate the opinions and knowledge on oral health among 2009 graduates in Education at the city of Araçatuba (state of São Paulo). To this end, a semi-structured interview was carried out to address the views of the students about education in oral health and their know-ledge concerning aspects related to tooth decay, to Preventive Dentistry, and Dentistry in early childhood. Of a universe of 120 students, 92 (76.6%) agreed to participate in the study. Of these, 86.8% of the students believe that the teacher should act as an educator in oral health, and 92.4% consider it important to integrate with healthcare professionals. Nine percent and 34.8%, respectively, provided correct answers about the concepts of dental plaque and cavities. On the appearance of cavities and about the possibility of having healthy teeth for life, 67% and 83.7%, responded correctly, respectively. Graduates in Education have positive opinions regarding Education in Oral Health; however, they have insufficient know-ledge on the subject, particularly considering they will be future teachers and opinion leaders.

Conductas de estudiantes del área de la salud frente a la exposición ocupacional a material biológico / Health students behavior when espoused to biological material

El objetivo de este estudio fue verificar la percepción de estudiantes de odontología relacionada a las actitudes frente a la incidencia de accidente ocupacional con material biológico. La población estudiada estaba formada por alumnos del último año del curso de Odontología. Se aplicó un cuestionario semi-estructurado, con la intención de verificar exposición ocupacional a material biológico. Participaron de la investigación 117 alumnos, siendo que 47 (40,2 por ciento) informaron haber sufrido algún tipo de accidente con material biológico y 100 (85,5 por ciento) afirmaron no haber tenido o tuvieron poca orientación sobre la forma de proceder. 59 (50,4 por ciento) dijeron no saber después de cuánto tiempo debería ser iniciada la quimioprofilaxis al VIH, 82 (70,1 por ciento) cuál es la duración y 86 (73,5 por ciento) sobre su eficacia. Se concluye que existe deficiencia de conocimiento sobre el tema y actitudes a ser tomadas en el caso de infortunio profesional.

The aim of this study was to verify the perception of ending students of Dentistry Course in relation to attitudes front occurrence of occupation accident with biological material. Studied population was constituted by students of last year of Dentistry Course. It was applied a semi-structured questioner with the aim to verify the occupational exposition at biological material. Just 117 students participated of this research being 47 (40,2 percent) cited suffer themselves some kind of accident with biological material and 100 (85,5 percent) affirmed didn’t had suffered or had little orientation about how to conduct. Just 59 (50,4 percent) said they didn’t know after how much time it was adequate to start the chemical prophylaxy at HIV, 82 (70,1 percent)what was it duration and 86 (73,5 percent) what was the efficacy. It was possible to conclude that there is absence of know about this theme and attitudes to realize on professional misfortune cases.

Epidemiologia do câncer de boca em laboratório público do Estado de Mato Grosso, Brasil / Oral cancer epidemiology in a public laboratory in Mato Grosso State, Brazil

O objetivo deste trabalho foi analisar a epidemiologia do câncer de boca, dos casos diagnosticados pelo laboratório público do Estado de Mato Grosso, Brasil, após a instituição da política de atenção às doenças da boca e da face do estado. Trata-se de um estudo epidemiológico transversal. O objeto estudado foi o laudo histopatológico, pesquisando-se um total de 1.324 laudos emitidos entre janeiro de 2005 e dezembro 2006. Verificaram-se os casos de câncer de boca, o seu percentual em relação ao universo das lesões bucais e as seguintes variáveis: tipo histológico, sexo, idade e procedência dos pacientes (capital ou do interior). Após a análise dos dados verificaram-se 44 lesões de câncer de boca, representando 3 por cento dos diagnósticos. O tipo histológico mais incidente foi o carcinoma epidermóide. A maioria dos diagnósticos foi referente aos homens na 5ª e 6ª décadas de vida residentes no interior do estado. Conclui-se com este estudo que em dois anos de funcionamento o serviço público de patologia bucal registrou um considerável número de casos de câncer de boca.

This study analyzed oral cancer epidemiology based on histopathology reports from a public laboratory in Mato Grosso, Brazil, after a specific policy was implemented for treating oral and facial diseases in the State. This was a cross-sectional epidemiological study, based on 1,324 histopathology reports issued from January 2005 to December 2006. The study identified 44 cases of oral cancer, or 3 percent of all oral lesions, and analyzed them in relation to the following variables: histological type, gender, age, and patient's place of residence (capital versus rest of State). The most common histological type was squamous cell carcinoma. Most of the diagnoses occurred in men in their 50s and 60s living in the interior of the State. During two years in operation, this public oral pathology service had recorded a considerable number of oral cancer cases.

El certificado odontológico, para justificar al trabajador, ¿es un derecho asegurado? / Is dental sick leave a guaranteed right?

Se tuvo como objetivo verificar en este trabajo la validación (aceptación) de los certificados odontológicos por las industrias asociadas al CIESP (Centro de las Industrias del Estado de São Paulo) de la región noroeste del Estado de São Paulo, Brasil. Se utilizó como instrumento de recolección de datos un cuestionario semi-estructurado, auto-aplicable, compuesto por preguntas abiertas y cerradas, referentes a la actividad y tamaño de la industria, realización de exámenes obligatorios, aceptación y validación de los certificados odontológicos y tipo de asistencia odontológica proporcionada por la industria. La mayor parte, 58 de ellas (92%), de las industrias aceptaba certificado odontológico; sin embargo, 24 (41,4%) aceptaban solamente en el caso de cirugías y extracciones dentarias y 4 (6,8%) después de la homologación del médico del trabajo. Además, para que el certificado odontológico tuviera validez era exigida la presencia de la Clasificación Internacional de Enfermedades (CIE) por la mayor parte, 46 (79,3%), de las industrias. La aceptación del certificado odontológico por las industrias investigadas es alta, a pesar de existir la dependencia del tipo de procedimiento y presencia de la CIE.

The aim of the this work was to verify the validation (acceptance) of odontological clean bill of health by industries associated to CIESP (Centre of Industries of São Paulo state) of the Northeast region of São Paulo state, Brazil. A questionnaire was used as an instrument of data collecting, which was semi- structured, self applying, composed by open and closed questions, referring to activity and size of the industry, carrying out the obliged exams, acceptance and validation of the odontological clean bill of health and type of odontological assistance offered by the industry. The majority 58 (92%) of the industries accepted odontological clean bill of health, however, 24 (41,4%) took them only in cases of surgeries and exodonty and 4 (6,8%) after homologation of the job´s doctor. Moreover, for the validity of the odontological clean bill of health, was asked the presence of the International Classification of Diseases by great part of the industries – 46 (79,3%) . The acceptance of the odontological clean bill of health by the researched industries is high, although, there is the dependence of the type of procedure and presence of the International Classification of Diseases.