Endodontic treatment as a Reduction in the Risk of infective Endocarditis in a Male Patient with Eisenmenger Syndrome

This case report aimed to describe the importance of endodontic treatment in reducing infectious foci in patients with Eisenmenger syndrome (ES) and describe the characteristics of ES, so that the endodontist can safely treat these patients. A 57-year-old male with ES sought dental care complaining of dental pain. Irreversible pulpitis was diagnosed in tooth 37 and pulp necrosis in teeth 36, 34 and 31. Tests of prothrombin time (PT), activated partial thromboblastin time (APTT) and international normalized ratio (INR) were prescribed to evaluate the profile of coagulation using Marevan and antibiotic prophylaxis with amoxicillin. The endodontic treatments were performed. At the end, the patient reported no pain or discomfort in the teeth and improved masticatory function. The removal of oral infectious foci in patients with ES is important to reduce the risk of IE, which could seriously compromise the health and overall prognosis of the patient.

Este reporte de caso tuvo como objetivo describir la importancia del tratamiento endodóntico en la reducción de focos infecciosos en pacientes con síndrome de Eisenmenger (SE) y describir las características del SE, para que el endodoncista pueda tratar con seguridad a estos pacientes. Un hombre de 57 años con ES buscó atención dental quejándose de dolor dental. Se diagnosticó pulpitis irreversible en el diente 37 y necrosis pulpar en los dientes 36, 34 y 31. Se solicitaron pruebas de tiempo de protrombina (PT), tiempo de tromboblastina parcial activada (TTPA) y índice internacional normalizado (INR) para evaluar el perfil de coagulación utilizando Marevan y profilaxis antibiótica con amoxicilina. Se realizaron los tratamientos de endodoncia. Al final, el paciente no refirió dolor ni molestias en los dientes y mejoró la función masticatoria. La eliminación de focos infecciosos orales en pacientes con ES es importante para reducir el riesgo de EI, que podría comprometer gravemente la salud y el pronóstico general del paciente.

CYCLIC AND TORSIONAL FATIGUE RESISTANCE OF THERMALLY TREATED ROTARY NiTiINSTRUMENTS WITH DIFFERENT DESIGNS

Aims: The aim was to evaluate the cyclic and torsional fatigue resistance among thermally treated NiTi rotary instruments with different design features.Materials and methods: Sixty instruments of three systems were used (n=20): TruNatomy 26.04 (TN 26.04), BassiLogic 25.05 (BL 25.05), and Flat File 25.04 (FF 25.04). The cyclic fatigue test (n=10) was performed to evaluate the time to fracture (s) and the number of cycles until failure (NCF). The torsion test was performed to evaluate the torque (N.cm) and maximum angular deflection until fracture (n=10). The fracture surface of each fragment was examined under a scanning electron microscope. The data were analyzed by Tukey's test (p<0.05).Results: BL 25.05 and FF 25.04 instruments had a higher number of cycles and time to fracture compared with TN 26.04 (p<0.05). TN 26.04 instruments showed lower torque to fracture.Conclusions: Based on the proposed objectives and the methodology used, TruNatomy 26.04 instruments present lower resistance to cyclic fatigue and torsional fatigue when compared to BassiLogic 25.05 and Flat File 25.04 instruments.

Influence of temperature on the torsional properties of two thermally treated NiTi rotary instruments

Abstract This study aimed to evaluate the influence of temperature on torsional strength and angular deflection of two experimental NiTi rotary instruments manufactured from Blue and Gold thermal treatments and with identical cross-sections. A total of 40 experimental NiTi instruments 25.06 and with a triangular cross-section and manufactured from Blue and Gold thermal treatments were used (n=20). The torsional test was performed in the 3 mm from the tip of the instrument according to ISO 3630-1. The torsional test evaluated the torsional strength and angular deflection to failure at room temperature (21°C ± 1° C) and body temperature (36°C ±1°C). The fractured surface of each fragment was observed by using scanning electron microscopy (SEM). Data were analyzed using an unpaired t test for inter and intra-group comparison and the level of significance was set at 5%. The results showed that the body temperature did not affect the torsional strength and angular deflection of the instruments when compared with room temperature (P>0.05). However, at body temperature, the Blue NiTi instruments presented significantly lower angular deflection in comparison with Gold NiTi instruments (P<0.05). There was no significant difference regarding the torsional strength of the instruments at body temperature (P>0.05). The temperature did not affect the torsional strength of the instruments manufactured from Blue and Gold technology. However, the Blue NiTi instruments presented significantly lower angular deflection than Gold instruments at 36°C temperature.

Resumo O objetivo deste estudo foi avaliar a influência da temperatura nas propriedades de torção (resistência à torção e deflexão angular) de dois instrumentos rotatórios experimentais de NiTi fabricados com secção triangu.ar e tratamentos térmicos Blue e Gold. Quarenta instrumentos experimentais de NiTi 25.06 com tratamento térmico Blue e Gold foram usados (n= 20). Foi avaliada a resistência torcional e a deflexão angular até a fratura na temperatura ambiente (21°C ± 1°C) e corporal (36°C ± 1°C). O teste torcional foi realizado nos 3 mm da ponta dos instrumentos de acordo com a ISO 3630-1. A superfície fraturada de cada instrumento foi observada pelo microscópio eletrônico de varredura (MEV). Os dados foram analisados por meio do teste t não pareado para a comparação inter e intragrupos e o nível de significância à 5%. Os resultados demonstraram que a temperatura corporal não afetou a resistência a torção e deflexão angular quando comparada com a temperatura ambiente (P>0.05). No entanto, na temperatura de 36°C o instrumento com tratamento térmico Blue apresentou menor deflexão angular quando comparado com o Gold (P<0.05). Não houve diferença significante entre os dois instrumentos em relação a resistência à torção. A temperatura corporal não modificou a resistência torcional dos instrumentos fabricados com tecnologia Blue e Gold. No entanto, os instrumentos com NiTi Blue apresentaram menor deflexão angular do que o Gold a 36°C.

Divergence between confidence and knowledge of endodontists regarding non-odontogenic pain

Abstract This study aimed to assess the self-reported levels of confidence and knowledge related to non-odontogenic pain among a group of Brazilian endodontists. Methodology A total of one hundred and forty-six endodontists affiliated with the Brazilian Society of Endodontics participated in the survey. The questionnaire, distributed via email or WhatsApp, contained inquiries designed to gauge self-perceived confidence and knowledge concerning non-odontogenic pain. The practitioners were categorized into four groups based on their self-reported familiarity with various orofacial pain types, classified as either sufficient or insufficient, and on their engagement in ongoing educational programs related to orofacial pain. Data were analyzed by Chi-Square Test and Fischer's exact test (p<0.05). Results Overall, self-reported confidence about non-odontogenic pain was high, especially for endodontists who considered their knowledge about orofacial pain sufficient, regardless of whether they had (71.1% - 97.8%) or not (35.7% - 96.4%) been continuously involved in education courses on orofacial pain. In general, self-reported knowledge about non-odontogenic pain was insufficient (0% - 42%), except in the question about how they would act in cases of pain that persists beyond the normal healing time after an endodontic procedure (70.6% - 81.9%). In general, endodontists are confident in their diagnosis and treatment of non-odontogenic pain. Nonetheless, this confidence did not correlate with a commensurate knowledge depth of. Thus, specialization courses in endodontics should highly consider training and qualifying these professionals in the diagnosis of non-odontogenic pain.

CYCLIC AND TORSIONAL FATIGUE RESISTANCE OF THREE DIFFERENT THERMALLY TREATED NICKEL-TITANIUM ROTARY INSTRUMENTS

Background: The aim of this study was to evaluate the cyclic fatigue and torsional fatigue resistance of three thermally treated rotary instruments, such as: Logic 2 25.05 (LOG 25.05), Edge Taper Platinum 25.06 (EDT 25.06) and ProTaper Gold 25.08 (PTG 25.08).Methods: A total of 60 rotary instruments of LOG 25.05, EDT 25.06 and PTG 25.08 were used (n=20). Cyclic fatigue tests were performed at 36°C using an artificial stainless steel canal with a 60ºangle and a 5-mm radius of curvature. The time (in seconds) and number of cycles to fracture (NCF) was recorded. The torsional test evaluated the torque and angle of rotation to failure at 3 mm from the tip according to ISO 3630-1. The fractured surface of each fragment was observed by using scanning electron microscopy (SEM). Data were analyzed using one-way ANOVA and Holm-Sidak's tests for multiple comparison, the level of significance was set at 5%.Results: EDT 25.06 had highest cyclic fatigue resistance (time and NFC), followed by LOG 25.05 and PTG 25.08 (P<0.05). There were no significantly difference between LOG 25.05 and ETP 25.06 regarding the NCF (P>0.05). In relation the torsional test, the LOG 25.05 and ETP 25.06 presented similar torque (P>0.05). The PTG presented greater torque than the other groups (P<0.05). The PTG 25.08 presented the lowest angular rotation to fracture than the other groups (P<0.05). The SEM images demonstrated typical features of cyclic and torsional fracture.Conclusion: In conclusion, the LOG 25.05 and ETP 25.06 presented similar cyclic and torsional properties. The PTG 25.08 showed greater torsional strength.

Evaluation of in vitro experimental model for analysis of bioceramic sealers

Abstract This study aimed to evaluate physicochemical properties of three ready-to-use calcium silicate-based endodontic sealers: Endosequence BC Sealer, Bio C Sealer, and Sealer Plus BC. Radiopacity was evaluated using specimens of 10 mm in diameter and 1 mm in height, along with an aluminum step wedge. For the flow test, 0.5 mL of each sealer was deposited between glass plates and the mean of the measurement of two diameters was considered the cement flow value. For pH and calcium release, root canals of 30 prototypes of upper incisor acrylic resin teeth were filled with sealer and gutta percha point and then immersed in containers with 13 mL of ultrapure water. Both pH and release of calcium ions (atomic absorption spectrophotometer) were measured at 3, 24, 72, and 168 h. Acrylic resin teeth were scanned by Micro-CT 1174 at the time of pH and calcium ion readings for volumetric change analysis. The data were analyzed by ANOVA, Tukey's, Kruskal-Wallis, and Dunn's tests. Endosequence BC Sealer presented the lowest, and Bio C Sealer the highest volumetric change after 72 h and 168 h (p < 0.05). Endosequence BC Sealer presented higher radiopacity (p < 0.05). All materials showed alkalinization capacity. All of them presented calcium ion release, with a higher value for Sealer Plus BC. All materials presented alkalinization, calcium release capacity, radiopacity, and flow above the minimum values required by the ISO standard. The highest volumetric loss was experienced by Bio C Sealer and the lowest one by Endosequence BC Sealer.

Laboratory study of tissue repair of resin-based endodontic sealers in critical surgical defects

Abstract Filling materials should be restricted to the root canal space. However, sometimes it is impossible to control the apical extrusion, in this case, the fate of the filling material and the result of the treatment will depend on its physicochemical properties and biocompatibility. Objective To evaluate the tissue response and bone repair capacity of endodontic sealers that were implanted in the calvaria of Wistar rats, forming the groups (n=16): AH Plus and Sealer Plus, compared to the clot group. Methodology On days 30 and 60, the animals were euthanized, the calvaria was removed and processed for hematoxylin-eosin, immunohistochemistry for collagen type I, Picrosirus red and microtomographic analysis. Data were subjected to ANOVA and Tuckey tests (p<0.05). Results At 30 days, all groups showed an intense inflammatory reaction (p>0.05). At 60 days, the AH Plus and Sealer Plus maintained an intense inflammatory infiltrate compared to the clot group (p<0.05). We observed immunopositive areas for type I collagen in all groups at 30 days and 60 days (p>0.05). We observed more red collagen fibers for the Sealer Plus compared to the clot group at 30 days (p<0.05). Considering the total fibers, the clot group at 30 days compared to 60 days after surgery showed an increase in the amount of matrix (p<0.05). There were no statistical differences between groups for green and yellow fibers (p>0.05). Regarding morphometric parameters, at 30 days, the newly formed bone volume and number of bone trabeculae were higher in the groups with sealers compared to the clot group (p<0.05). At 60 days, AH Plus and Sealer Plus showed greater bone neoformation compared to the clot group (p<0.05). Conclusions Despite AH Plus and Sealer Plus induced an intense inflammatory reaction, they can be considered biocompatible materials, since they allowed bone repair.

Root canal length changes during mechanical preparation due to different cervical enlargement patterns

Abstract This study aimed to evaluate the root canal real length (RL) changes due to the mechanical instrumentation use with different flaring magnitudes. After access cavity, 60 mesial root canals of mandibular molars were randomly separated in three groups: Hyflex EDM (HF; #25/.12, #10/.05 e #25/~), Reciproc Blue (RB; R25), and MTwo (M2; #10/.04, #15/.05, #20/.06 e #25/.06). The RL was defined as the apical limit, and 2.5% sodium hypochlorite irrigating solution was chosen. After the access cavity (RL 1), cervical flaring (RL 2), and complete chemical-mechanical preparation (RL 3), the RL was evaluated. The RL was evaluated by a blind examiner with the aid of a microscope (16x) placing the endodontic file stop at the coronary reference. When comparing length measurements, the RL was shorter before instrumentation than that after instrumentation. A reduction of 0.65 mm (HF), 0.61 mm (RB), and 0.48 mm (M2) was observed. However, among groups, no statistical differences were found (p > 0.05). Under the conditions tested, it can be inferred that all mechanical systems provoked RL variations, which emphasizes the need for constant verification of the odontometry, mainly before root canal obturation.

Effect of nickel-titanium alloys on root canal preparation and on mechanical properties of rotary instruments

Abstract The aim of this study was to evaluate the quality of curved root canal preparation, torsional fatigue, and cyclic fatigue of rotary systems manufactured with different NiTi alloys. Ninety single-rooted canals with curvatures of 15° to 30o were scanned and divided into three groups according to the rotary system used: BT-Race (BTR) - 10.06, 35.00, 35.04; SequenceRotaryFile (SRF) - 15.04, 25.06, 35.04; and ProDesignLogic (PDL) - 25.01, 25.06, 35.05. Each system was used on three specimens. The teeth were prepared, scanned, and analyzed to assess increase in volume, transportation, and centering ability of the root canal. Torsional fatigue of glide path instruments (BTR 10.06, SRF 15.04 and PDL 25.01) and cyclic fatigue of the finishing instrument (BTR 35.04, SRF 35.04 and PDL 35.05) were obtained by analyzing completely new instruments (n = 10) and instruments after they had been used three times (n = 10). After the torsional and cyclic fatigue tests, the fractured surface of the new and used instruments were examined by scanning electron microscopy. Increase in volume, canal transportation, and centering ability showed no significant differences among the groups (p > 0.05). The torsional test showed that SRF 15.04 produced the highest torque values for both new and used instruments, followed by PDL 25.01 and BTR 10.06 (p < 0.05). PDL 25.01, both new and used, exhibited higher values of angular deflection followed by SRF 15.04 and BTR 10.06 (p < 0.05). As regards cyclic fatigue, use of PDL 35.05, both new and used, required a longer time and larger number of cycles than did SRF 35.04 and BTR 35.04 (p < 0.05). Clinical use affected the torsional fatigue of BTR; however, cyclic fatigue was not significantly affected (p < 0.05). All rotary systems were able to prepare the curved canals satisfactorily and were used safely on the three specimens. Relative to torsional fatigue, SRF 15.04 exhibited a higher torque, and PDL 25.01, higher angular deflection. BTR 10.06 was the most affected by clinical use. PDL 35.05 showed greater resistance to cyclic fatigue.

Successful revascularization procedure in an immature permanent necrotic second lower molar: a case report with 4. 5- years follow- up

Background: Infection control is mandatory for revascularization procedures, enabling to eliminate patient's clinical symptoms and signs. Despite presenting a complex morphology when compared to anterior teeth, if a strict disinfection protocol is adopted and the revascularization procedure's biological principles are followed, the therapy can be successful in molar teeth. Methods: This case report aims to present a clinical case of successful revascularization in an immature permanent necrotic second lower molar. Clinical decisions and explanations regarding possible mechanisms related to the treatment's success in a tooth with complex morphology are discussed. Results: Revascularization procedures were performed on a 12-year-old male patient diagnosed with symptomatic periapical periodontitis in a tooth 37. The case highlights the need for infection control and biological principles that surrounds the success of this therapy. Follow-up times presented in this case were six months, 1, 2, 4 and 4.5-years, respectively. Continued root development was observed, and the tooth remains intact and without symptoms. Conclusion: The association of infection control and the biological principles of revascularization procedures allow the maintenance and continuation of tooth development, even when these present complex morphologies.

Physicochemical properties and antimicrobial activity of calcium hydroxide pastes in association with other compounds

Aim: This study aimed to evaluate the pH, Ca2+ release, solubility, and antimicrobial activity of calcium hydroxide (Ca(OH)2) pastes in association with different substances. Methods: Sixty acrylic teeth (n=10) were filled with pastes that associated Ca(OH)2 with the following substances: benzalkonium chloride 5% (G1) and 50% (G2) both in propylene glycol, arnica glycolic extract (G3), green tea glycolic extract (G4), Calen/PMCC™ (G5), and Calen™ (G6). In the group G1 to G4 were used 1g of Ca(OH)2 powder with 0,8g of vehicle. pH and Ca2+ release was measured after 7, 15, and 30 days. For solubility, micro-CT was used immediately and at the periods of 7, 15, and 30 days. For the antimicrobial analysis, a biofilm of E. faecalis was induced in vitro on bovine dentin discs. Live/dead viability dye and confocal scanning microscopy were used. Results: The highest pH values occurred on the first 7 days, and the G6, G1, G3, and G5 presented the highest pH values at this period (P <0.05). Ca2+ release was higher in all groups at 7 days, with the highest values observed in G1, G5, and G6. The volume of all pastes showed no significant difference in the intragroup analysis at 7 and 15 days (P <0.05). G1 and G2 showed the highest antimicrobial action (P <0.05). For the biovolume, there was difference between the G6 and the other groups (P >0.05) with G1 presenting the lowest values. Conclusion: Benzalkonium chloride 5% increases the antimicrobial action of the Ca(OH2), without impairs physicochemical properties

Influence of EDTA and its Association with Benzalkonium Chloride on Enterococcus faecalis Adhesion to Dentin / Influencia del EDTA y su Asociación con Cloruro de Benzalconio en la Adhesión de Enterococcus faecalis a la Dentina

ABSTRACT: The aim of this in vitro study was to investigate the influence of ethylenediaminetetraacetic acid (EDTA) associated with the benzalkonium chloride (BAK) on the adhesion and formation of Enterococcus faecalis biofilms attached to coated dentin. Discs standard bovine dentin blocks were treated with the coating materials evaluated: Saline solution (control), 17 % EDTA, 17 % EDTA associated with 1 % BAK for 5 minutes and subsequently washed with saline solution. Afterwards, biofilms of E. faecalis (ATCC 29212) were grown on the surface of coated dentin blocks for time intervals of 1 hour and 7 days (n = 20) and were subsequently washed with phosphate-buffered saline (PBS). Bacterial viability and total biovolume were analyzed by confocal laser scanning microscopy (CLSM) using the Live/Dead technique. Nonparametric Kruskal-Wallis followed by Dunn tests were used to determine statistical differences (a = 5 %). The 17 % EDTA + 1 % BAK group showed significantly lower biovolume and bacterial viability values at the end of 1 hour (p < 0.05). After 7 days of contamination, the 17 % EDTA and 17 % EDTA + 1 % BAK groups showed similar results that differed statistically from those of the control group (p < 0.05). The saline solution group showed higher values. The use of BAK associated with EDTA on dentin blocks surfaces before exposure to contamination was able to interfere in the adhesion of E. faecalis to dentin. Also, dentin treatment by BAK associated with a chelating agent influences the secondary biofilm formation, which could have important effects on the long-term success of root canal treatment.

RESUMEN: El objetivo del estudio consistió en investigar in vitro, la influencia del ácido etilendiamino-tetraacético (EDTA) con cloruro de benzalconio (BAK) en la adhesión y formación de biopelículas de Enterococcus faecalis a la dentina. Discos de dentina bovina fueron tratadas con solución salina (control), 17 % de EDTA, 17% de EDTA asociado con 1 % de BAK durante 5 minutos y lavadas con solución salina. Las biopelículas de E. faecalis (ATCC 29212) se cultivaron sobre los discos de dentina durante intervalos de tiempo de 1 hora y 7 días (n = 20), lavados con solución salina tamponada con fosfato (PBS). La viabilidad bacteriana y el biovolumen total se analizaron mediante microscopía de barrido por láser (CLSM) utilizando la técnica Live / Dead. Se realizó prueba no paramétrica de Kruskal-Wallis, seguida por Dunn con una diferencia estadística (a = 5 %). El grupo de 17 % EDTA + 1 % BAK mostró valores significativamente menores de biovolumen y viabilidad bacteriana al final de 1 hora (p < 0,05). Después de 7 días de contaminación, los grupos de 17 % EDTA y 17 % EDTA + 1 % BAK mostraron resultados similares que diferían estadísticamente del grupo control (p < 0,05). La solución salina mostró valores más altos. La asociación de BAK con EDTA antes de la contaminación interfirió en la adhesión de E. faecalis. Además, el tratamiento de la dentina por BAK asociado con EDTA influye en la formación de biopelículas secundarias, lo que podría tener efectos importantes sobre el éxito a largo plazo del tratamiento del conducto radicular.

Uso da tecnologia e cimento de silicato de cálcio na resolução de complicações no retratamento endodôntico: relato de caso / Use of technology and calcium silicate cement in the resolution of endodontic retreatment complications: Case report

Introdução: Acidentes e complicações podem acontecer em qualquer fase do tratamento endodôntico. Podem ocorrer devido a diversos fatores, como falhas dos instrumentos, dificuldades anatômicas e limitações do profissional, o que, muitas vezes, pode alterar o prognóstico de um caso. Objetivo: O presente relato de caso aborda uma situação em que uma paciente se apresentava com dois instrumentos fraturados e uma perfuração radicular em um dente molar inferior com periodontite apical. Relato do caso: Os fragmentos foram removidos por meio de técnica mecanizada e ultrassônica padronizada, e a perfuração foi tratada e selada com material à base de silicato de cálcio. Conclusão: O emprego de recursos tecnológicos atuais favoreceu a resolução do caso, melhorando seu prognóstico. O restabelecimento da condição de normalidade do dente e tecidos adjacentes foi confirmado por exames radiográficos e tomográficos (AU).

Introduction: Accidents and complications may happen at any endodontic treatment stage. These are likely to change the prognosis of treatment and can be due to factors related to instrumental failure, anatomic difficulties and the professional's limitations. Objective: This case report addresses a case where a patient presenting two separated instruments and a root perforation in a lower molar with apical periodontitis. Case report: The separated instruments have been removed by mechanical and ultrasonic standardized method and the perforation was treated and sealed by silicate cement-based material. Conclusion: The use of technological resources favored the resolution of the case, increasing its predictability. The reestablishment of the normal condition of the tooth and surrounding tissues was confirmed by radiograph and computed tomography exams (AU).

Knowledge about Coronavirus disease 19 (COVID-19) and its professional repercussions among Brazilian endodontists

Abstract The aim of this study was to assess Brazilian endodontists' level of knowledge about the coronavirus disease (COVID-19) and examine its professional repercussions. The link to the online survey that was created for this study was shared with Brazilian endodontists through social networking applications. The questionnaire contained questions that pertained to COVID-19 and its impact on dental practice. The collected data were analyzed using t-test, chi-square analysis, and analysis of variance, and the level of significance was set at 0.05. A total of 2,135 participants responded to the questionnaire, and all five Brazilian regions were represented in the sample. A total of 98.50% of endodontists reported that dental procedures can transmit COVID-19. Complete social distancing was practiced by 96.68% of the participants, and approximately 25% knew someone who had COVID-19. Moreover, in their daily practice, 72.13% of them implemented biosecurity measures that are ineffective in preventing COVID-19. Furthermore, 91.7% of them reportedly suspended elective dental procedures. Only 55.69% of them reported that they performed only emergency procedures in their workplaces. Those who believed that COVID-19 cannot be transmitted during dental procedures were less knowledgeable about the symptoms of COVID-19 (p = 0.0095). Endodontists who believed that personal protective equipment cannot prevent contamination were more knowledgeable about the symptoms of COVID-19 than their counterparts (p = 0.0003). The participating Brazilian endodontists demonstrated adequate knowledge about the risk of contamination during dental procedures and the main symptoms of COVID-19. Only some professionals reported providing emergency dental care during the pandemic.

Tratamento não cirúrgico para remoção de instrumento fraturado e guta-percha extravasada, com o uso do Masserann EndoKit / Non-surgical treatment for removing fractured instrument and extravasated gutta-percha, by using the Masserann EndoKit

Objetivo: o objetivo deste artigo é relatar um caso clínico em que um instrumento fraturado e a guta-percha extravasada foram removidos via canal. Relato de caso: paciente do sexo masculino, com 38 anos de idade, foi encaminhado para avaliação do incisivo lateral superior direito (dente #12). O paciente apresentava dor à palpação na região apical e ausência de sintomatologia espontânea. O exame radiográfico revelou a presença de cone de guta-percha extravasado, uma espiral de Lentulo fraturada, além de lesão periapical no dente #12. O retratamento endodôntico foi o procedimento de escolha, na tentativa de remover os dois materiais. A espiral de Lentulo foi removida com Masserann Endokit; e o cone de guta-percha, utilizando limas Hedstroen. Após realizar a instrumentação e o preenchimento do conduto com pasta de hidróxido de cálcio com iodofórmio, constatou- se a presença de reabsorção no terço apical. Depois de dois meses, observou-se redução da lesão; utilizou-se, então, MTA na região da reabsorção, e o conduto foi obturado com cone de guta-percha e cimento endodôntico Sealer 26. Conclusão: controles clínicos e radiográficos foram realizados após dois, quatro e oito anos, demonstrando reparo na região apical e ausência de sintomatologia (AU).

The objective of this article was to report a clinical case of finding a fractured instrument and over-extended guttapercha of a tooth, which were removed via the canal. The patient, a 38-year-old man, was referred for treatment of the right maxillary lateral incisor (tooth 7). The patient presented pain on palpation at the apical level and absence of spontaneous symptomatology. Radiographic examination revealed the presence of a over-extended gutta-percha cone, a fractured Lentulo spiral and periapical lesion in tooth 7. Endodontic retreatment was the chosen procedure in an attempt to remove both materials. The Lentulo spiral was removed by means of the Masserann Endokit, and the gutta-percha cone by using Hedstroen files. While performing instrumentation, and filling the canal with calcium hydroxide with iodoform, the presence of resorption in the apical third was verified. After 2 months, reduction of the lesion was observed, thus MTA was placed in the area of resorption and the remainder of the canal was filled with a gutta-percha cone and Sealer 26 cement. Clinical and radiographic controls performed after 2, 5 and 7 years showed repair of the area and absence of symptomatology (AU).

Torsional fatigue strength of reciprocating and rotary pathfinding instruments manufactured from different NiTi alloys

Abstract To evaluate the torsional properties of engine-driven pathfinding instruments manufactured from different NiTi alloys - R-Pilot (tip size 12.5;.04 taper; M-Wire) and One G (tip size 14;.03 taper; Conventional NiTi). A total of 40 NiTi instruments from engine-driven pathfinding instruments (n = 20) were used. The torsion tests followed ISO 3630-1 (1992). Three millimeters of each instrument tip was fastened to a small load cell by a lever arm linked to the axis of torsion. During the test, the torsion testing machine software measured the maximum torsional strength and angle of rotation (0) before instrument failure. The fractured surface of each instrument was assessed by scanning electron microscopy (SEM). In addition, a supplementary examination was performed to measure the cross-sectional area and the metal mass volume of each instrument 3 mm from the tip. Data were analyzed using a t-test, with significance level set at 5%. R-pilot had significantly higher torsional strength than did One G (p < 0.05). Regarding the angle of rotation to fracture, One G had higher angles than did R-Pilot (p < 0.05). The supplementary examination showed that R-Pilot had the highest cross-sectional area and volume of metal mass at 3 mm from the tip (p < 0.05). R-pilot (M-Wire NiTi alloy) had a significantly higher torsional strength and One-G (superelastic NiTi alloy) had the highest angle of rotation to fracture.

Evaluation of physicochemical properties of new calcium silicate-based sealer

Abstract This study aimed to evaluate the physicochemical properties of a calcium silicate-based sealer (Sealer Plus BC; MK Life, Porto Alegre, Brazil) compared with an epoxy-resin sealer (AH Plus; Dentsply DeTrey GmbH, Konstanz, Germany). Initial and final setting time was assessed based on ISO 6876:2012 and ASTM C266:03. Calcium ion release and pH were evaluated by filling polyethylene tubes with sealers and then immersing them in 10 mL of deionized water. Following experimental periods of 1, 24, 72 and 168 hours, the samples were measured regarding pH and calcium ion release with a pH meter and a colorimetric spectrophotometer, respectively. The flow was examined based on ISO 6876:2012. Rings of 10 mm in diameter with 1 mm thickness were prepared to analyze the radiopacity (ISO 6876:2012 and ADA n.57) and solubility (ISO 6876:2012). The data were analyzed by variance analysis, Student-T and Tukey tests (p<0.05). The calcium ion release and pH values were significantly higher for the Sealer Plus BC compared with the AH Plus (p<0.05). Lower setting time, flow and radiopacity were observed for the bioceramic sealer than for AH Plus (p<0.05). Sealer Plus BC exhibited higher solubility compared with AH Plus (p<0.05). Sealer Plus BC showed physicochemical properties as setting time, pH, calcium release, flow, and radiopacity following the required standards, but higher solubility than the minimum values required by ISO 6876:2012.

Resumo Este estudo teve por objetivo avaliar as propriedades físico-químicas de um cimento à base de silicato de cálcio (Sealer Plus BC MK Life, Porto Alegre, Brasil) e compará-las a um cimento à base de resina epóxica (AH Plus, Dentsply DeTrey GmbH, Konstanz, Alemanha). Tempo de presa inicial e final foram avaliados com base na ISO 6876:2012 e ASTM C266:03. Liberação de íons cálcio e pH foram avaliados após o preenchimento de tubos de polietileno com os cimentos e imersão em 10 mL de água deionizada. Após os tempos experimentais de 1,24,72 e 168 horas, os valores de pH e liberação de íons cálcio foram mensurados utilizando um medidor de pH e um espectofotômetro colorimétrico, respectivamente. Escoamento foi avaliado com base na ISO 6876:2012. Moldes de 10 mm de diâmetro e 1 mm de espessura foram preparados para análise de radiopacidade (ISO 6876:2012 e ADA n.57), solubilidade (ISO 6876:2012). Os dados foram analisados por análise de variância, teste T de Student e teste de Tukey (p<0,05). A liberação de íons cálcio e os valores de pH foram significativamente maiores para o Sealer Plus BC em comparação com o AH Plus (p<0,05). Menores valores de tempo de presa, escoamento e radiopacidade foram observados para o cimento biocerâmico quando comparados com o AH Plus (p<0,05). Sealer Plus BC apresentou propriedades físico-químicas de tempo de presa, pH, liberação de íons cálcio, escoamento, radiopacidade de acordo com as normas exigidas, porém maior solubilidade que aquelas previstas pela ISO 6876:2012.

Análise do EDTA tetrassódico associado ao hipoclorito de sódio no preparo biomecânico dos canais radiculares e em protocolos de irrigação final / Analysis of tetrasodium EDTA associated with sodium hypochlorite in the preparation biomechanical parameters of root canals and in final irrigation protocols

Introdução: O objetivo deste estudo foi avaliar a associação do hipoclorito de sódio e EDTANa4 como irrigante comparado ao EDTANa3 quanto a capacidade de limpeza, preparo biomecânico e na irrigação final, associados ou não com a agitação ultrassônica. Materiais e Método: Foram utilizados 40 pré-molares inferiores, instrumentados e analisados em MEV para comprovar a formação de smear-layer. Realizou-se então os protocolos de irrigação utilizando diferentes associações, associadas ou não a agitação ultrassônica. Resultados: O EDTA trissódico agitado ou não com ultrassom, favoreceu limpeza significante (P<0.05) apenas nos terços médio e cervical, enquanto que para o EDTA tetrassódico sem agitação a limpeza foi significante (P<0.05) apenas no terço médio. Comparando os irrigantes, independente do método de irrigação, houve diferença estatisticamente significante (P<0.05) apenas no terço médio na comparação entre o EDTA trissódico pela irrigação convencional e EDTA tetrassódico pela irrigação convencional. Conclusão: O EDTA trissódico favoreceu uma melhor limpeza em relação ao EDTA tetrassódico, principalmente no terço médio. Além disso, a agitação ultrassônica não favoreceu melhor limpeza de parede em relação à irrigação convencional.

AIM: The aim of this study was to evaluate the efficacy of Sodium Hypochlorite associated or not with Tetrasodium EDTA in smear layer removal during root canal preparation. Additionally, to compare the cleaness of dentin walls after a final irrigation of Trisodium EDTA and Sodium Hypochlorite associated with Tetrasodium EDTA, activated or not by utrasonic. Methods: 40 mandibular premolars were used, which were divided in 2 groups (n=20). G1 the root canals were instrumented using Sodium hypochlorite and G2 using Sodium hypochlorite associated with Tetrasodium EDTA. Then, the dentin walls were analyzed by Scanning Electron Microscopy (SEM) to assess presence or not of smear-layer. After this step, it was performed a final irrigation of Trisodium EDTA and Sodium Hypochlorite associated with Tetrasodium EDTA, activated or not by utrasonic. Results: The was no significantly difference between the Sodium Hypochlorite and Sodium Hypochlorite associated with Tetrasodium EDTA during root canal preparation (P>0.05). Regarding the final irrigation, the Trisodium EDTA presented significantly difference when activated ultrasonic in the coronal and middle thirds (P<0.05). The association of Sodium Hypochlorite and Tetrasodium EDTA presented significantly difference only in the middle third without ultrasonic activation (P<0.05). In general, the Trisodium EDTA favoured better smear layer removal than Tetrasodium EDTA. Conclusion: The Trisodium EDTA favored a better smear layer ramoval than Tetrasodium EDTA, mainly in the middle third. In addition, ultrasonic activation improved the smear layer removal in comparison with conventional irrigation.

Effect of the irrigation protocols on the elimination of dentin debris from simulated lateral canals / Efeito do método de irrigação na eliminação de debris dentinários em canais late-rais simulados

Objective: Computed microtomography was used to evaluate the capacity of debris removal from simulated lateral canals, in conventional irrigation, passive ultrasonic irrigation (PUI), continuous passive irrigation (CUI), Endoactivator and EasyClean, for both types of motion (continuous and reciprocating). Material and Methods: Sixty acrylic incisors with 3 simulated lateral canals per tooth (cervical, middle and apical third) were instrumented with Reciproc 40/06 and then filled with dentin debris. The teeth were scanned and divided into 6 groups (n = 10) according to the irrigation protocol: G1 - conventional, G2 - PUI, G3 - CUI, G4 - Endoactivator, G5 - EasyClean continuous rotation and G6 - EasyClean reciprocating. After the irrigation protocols, the samples were scanned again. The initial and final volume images were analyzed and the percentage of debris removal were found for each group in all levels. Results: There were significant differences between the initial and final volume of debris after the protocols, with the exception of conventional irrigation group in the apical and cervical thirds, EasyClean reciprocating in the middle and cervical thirds, and CUI in the middle third. In the analysis between the groups: in the apical third, Endoactivator and PUI removed more debris than CUI (p < 0.05); in the middle and cervical thirds, PUI was more efficient than conventional irrigation, EasyClean reciprocating and CUI (p < 0.05). Conclusion: No method completely removed the debris. PUI was the method that showed greater effectiveness in cleaning the lateral canals. (AU)

Objetivo: O objetivo desse estudo foi avaliar a capacidade de remoção de debris de canais laterais simulados através da microtografia computadorizada (microCT), na irrigação convencional, ultrassônica passiva (IUP), ultrassônica contínua (IUC), Endoactivator e EasyClean, para os dois tipos de movimento (contínuo ou alternado). Material e Métodos: Sessenta incisivos de acrílico com três canais late-rais simulados por dente (terço cervical, médio e apical) foram instrumentados com Reciproc 40/06 e preenchidos com debris de dentina bovina. Os dentes fo-ram escaneados e divididos em 6 grupos (n = 10): G1 - convencional, G2 - IUP, G3 - IUC, G4 - Endoactivator, G5 - EasyClean rotação continua e G6 - EasyClean reciprocante. Depois do protocolo de irrigação, as amostras foram novamente escaneadas. O volume inicial e final das imagens foram analisados e o percentual de debris removidos foram encontrados para cada grupo nos três terços. Resultados: Todos os grupos obtiveram diferenças significantes após o proto-colo de irrigação, com exceção do grupo da irrigação convencional nos terços apical e cervical, EasyClean reciprocante (médio e cervical) e IUC no terço médio. Na análise intragrupo para o terço apical, EndoActivator e IUP removeram mais debris que IUC (p<0,05); no médio e cervical, IUP foi mais eficiente que a irrigação convencional, EasyClean reciprocante e IUC (p<0,05). Conclusão: Nenhum método foi capaz de remover completamente os debris. A irrigação ultrassônica passiva foi a que demonstrou melhor efetividade na limpeza dos canais laterais. (AU)

Do different strains of E. faecalis have the same behavior towards intracanal medications in in vitro research?

Abstract: The aim of this study was to evaluate the antimicrobial action of different endodontic pastes against Enterococcus faecalis ATCC 29212, isolated from the urinary tract, and compare the action with E. faecalis ATCC 4083, isolated from the root canal. For this purpose, dentin blocks were infected for 21 days with both bacteria at different time-intervals to ensure there would be no cross contamination. After this period, blocks were immersed in the test medications for 7 days, according to the following groups: CH/S, CH/P, CH/CMCP, CH/CHX, CH/DAP and TAP. Images of the samples were captured with a confocal microscope and the percentage of live cells was computed by means of the Bioimage program. The ATCC 29212 strain was shown to be more resistant to CH/SS, Calen, CH/DAP, and TAP than the ATCC 4083 strain. The antimicrobial action of the medications against each strain were divergent concerning the order of susceptibility. The authors concluded that the strains behaved in a different manner: in general, those extracted from the urinary tract were more resistant to the tested medications. Therefore, when E. faecalis must be used for in vitro research in endodontics, we suggest the use of ATCC 4083 strain to obtain results that are closer to the clinical reality.