Effect of passive ultrasonic activation on microorganisms in primary root canal infection: a randomized clinical trial

Abstract Objective: This clinical study sought to evaluate the effectiveness of passive ultrasonic activation (PUA) in eliminating microorganisms in primary endodontic infection (PEI) after instrumentation of root canals using microbiological culture and checkerboard DNA-DNA hybridization. Methodology: Twenty root canals with PEI and apical periodontitis were selected. The root canals were instrumented and then randomly divided into 2 groups, according to the irrigation method: PUA and conventional needle irrigation (CNI). Microbiological samples were collected before instrumentation (S1), after instrumentation (S2) and after irrigation with 17% EDTA (S3). The samples were subjected to anaerobic culture technique and checkerboard DNA-DNA hybridization analysis. Results: A statistically significant difference was found between CNI (23.56%) and PUA (98.37%) regarding the median percentage values for culturable bacteria reduction (p<0.05). In the initial samples, the most frequently detected species was S. constellatus (50%), and after root canal treatment was E. faecalis (50%). Conclusion: Both treatments significantly decreased the number of bacterial species compared with the initial sample. However, no statistical difference in the total microbial load between PUA and CNI groups was detected. The number of cultivable anaerobic bacteria reduced significantly using PUA, and the bacterial composition and number of bacterial species after using either CNI or PUA was similar.

Comparison of the effects of low-level laser and pulsed and continuous ultrasound on pain and physical disability in chronic nonspecific low back pain: a randomized controlled clinical trial

Abstract Objective: To compare the short-term effects of pulsed laser and pulsed and continuous ultrasound on pain and functional disability in women with chronic non-specific low back pain. Methods: The sample was composed of 100 volunteers randomly allocated into four groups: The Pulsed Laser Group (n = 26) was treated with 3 J/cm2; the Pulsed Ultrasound Group (n = 24; 3 MHz) was treated with 1 W/cm2; the Continuous Ultrasound Group (n = 26; 1 MHz) was treated with 1 W/cm2; and a Control Group (n = 24), where the patients were still waiting for treatment. Before and after 10 sessions of treatment, the intensity of pain was assessed using the visual analogue scale (VAS), the quality of pain was evaluated using the McGill pain questionnaire and functional disability was investigated using the Roland-Morris questionnaire. Results: The three treated groups exhibited a decrease in pain (p < 0.001); the Pulsed Laser Group showed the greater relative gain (91.2%), Meanwhile, the Control Group exhibited a worsening of - 5.8%. The three treated groups demonstrated improvement in the quality of pain (McGill) in the total, sensory and affective dimensions (p < 0.005; p < 0.002; p < 0.013, respectively). All treated groups showed a decrease in functional disability (p < 0.001), but the Pulsed Ultrasound Group showed the highest relative gain (83.3%). Conclusions: The three modalities have significant effects to decreasing low back pain and improving functional disability in women with non-specific chronic low back pain, but the pulsed low-level laser had the best results on pain while the pulsed ultrasound had the best results on improve the functional disability. Trial registration:ClinicalTrials.gov: NCT02150096.

Ultrasonic tips as an auxiliary method for the instrumentation of oval-shaped root canals

Abstract To evaluate the influence of novel ultrasonic tips as an auxiliary method for the rotary preparation of flattened/oval-shaped canals. Forty-five mandibular incisors were selected and divided into one of three experimental groups (n = 15): Group PFCP - ProDesign Logic 25/.05 + Flatsonic + Clearsonic + Prodesign Logic 40/.01; Group FCP - Flatsonic + Clearsonic + ProDesign Logic 40/.01; and Group PP - Prodesign Logic 25/.05 + Prodesign Logic 40/.05. The teeth were scanned preoperatively and postoperatively using microcomputed tomography. The percentage values for increase in volume, non-instrumented surface area, dentin removal, degree of canal transportation, and centering ratio between the experimental groups were examined. Data were analyzed using the non-parametric Kruskal-Wallis and Dunn's tests (p < 0.05). Group PFCP showed the greatest volume increase in the total portion of the root canal and the lowest percentage of non-instrumented surface area. Regarding the degree of transportation in the buccolingual direction, statistically significant differences between groups PFCP and PP were observed at the coronal third of the canal. In the mesiodistal direction, no statistically significant differences were observed at the coronal, middle, and apical thirds. As for the centering ratio, statistically significant differences were found in the buccolingual direction. In the mesiodistal direction, no statistically significant differences were observed at the coronal, middle, and apical thirds. The use of novel ultrasonic tips combined with rotary instruments in group PFCP provided a significant increase in volume and reduced the percentage of non-instrumented areas during the preparation of flattened/oval-shaped canals.

Efficacy of sonic and ultrasonic irrigation devices in the removal of debris from canal irregularities in artificial root canals

Abstract Objective To evaluate the efficacy of different sonic and ultrasonic devices in the elimination of debris from canal irregularities in artificial root canals. Materials and Methods A resin model of a transparent radicular canal filled with dentin debris was used. Five groups were tested, namely: Group 1 - ultrasonic insert 15.02; Group 2 - ultrasonic insert 25/25 IRRI K; Group 3 - ultrasonic insert 25/25 IRRI S; Group 4 - sonic insert 20/28 Eddy on a vibrating sonic air-scaler handpiece; Group 5 - 20.02 K-file inserted on a Safety M4 handpiece. Two different irrigants (5% sodium hypochlorite and 17% EDTA) and 3 different times of activation (20, 40, and 60 seconds) were tested. Means and standard deviations were calculated and statistically analyzed with the Kruskal-Wallis and Wilcoxon tests (p<0.05). Results No statistically significant differences were found between the two irrigants used. Group 4 removed more debris than the other groups (p<0.05). Groups 1, 2, and 3 removed more debris than group 5 (p<0.05). A statistically significant difference (p<0.05) was found for the time of activation in all groups and at all canal levels, except between 40 and 60 seconds in group 4 at coronal and middle third level (p>0.05). Conclusions No significant differences were found between 5% sodium hypochlorite and 17% EDTA. When the time of activation rises, the dentin debris removal increases in all groups. Both sonic and ultrasonic activation demonstrate high capacity for dentin debris removal.

Função neuromuscular do bíceps braquial em contração isométrica após termoterapia / Neuromuscular function of braquial biceps in isometric contraction after termotherapy

A alteração na temperatura de um tecido pode promover efeitos fisiológicos que levam a alterações circulatórias e nervosas, tais como vasodilatação e aumento na flexibilidade. Objetivo: Avaliar, através de uma avaliação neuromuscular não invasiva, como a termoterapia influencia na força muscular e nos sinais mioelétricos do bíceps braquial em contração isométrica. Métodos: Dezessete voluntários foram orientados a fazer contração isométrica do músculo bíceps braquial concomitantemente com a eletromiografia de superfície. A avaliação eletromiográfica e de força foram realizadas antes e após a intervenção com recursos termoterapêuticos: gelo (15 minutos) e ultrassom continuo (1MHz, 0.8W/cm2, 7 minutos). Resultados: Mostraram que as mulheres possuem menos força e ativam menos unidades motoras. No entanto, a frequência de disparos elétricos nas vias efetoras é maior, o que indica maior propensão à fadiga. Após a aplicação do calor, não foram observadas diferenças na resposta neuromuscular do bíceps braquial em contração. Já a crioterapia, promoveu redução significativa na força e no número de unidades motoras ativadas durante a contração. O resfriamento do tecido muscular promove a diminuição da ação das fibras musculares, uma vez que há redução da velocidade da condução do impulso nervoso e do reflexo do arco miotático. Além disso, a crioterapia também diminui a sensibilidade dos órgãos tendinosos de Golgi, aumenta a viscosidade sanguínea, provoca a vasoconstrição. Todos estes fatores, somam-se para culminar na diminuição da ativação neuromuscular e, consequentemente, na redução da força do músculo

The change in temperature of a biological tissue can promote physiological effects that lead to circulatory and nerve changes, such as vasodilation and increased flexibility. Objective: The objective of this study was to evaluate, through a noninvasive neuromuscular assessment, how thermotherapy influences the muscular strength and the myoelectric signals of the biceps brachial in isometric contraction. Methods: Seventeen volunteers were instructed to perform isometric contraction of the brachial biceps muscle concomitantly with surface electromyography. Electromyographic and force evaluation were performed before and after the intervention with thermotherapeutic resources that consisted of ice therapy for 15 minutes and continuous ultrasound (1MHz, 0.8W/cm2) for 7 minutes. Results: Women have less strength and fewer motor units. However, the frequency of electric inputs of the effector pathways is higher, which indicates a greater propensity to fatigue. After the application of heat, no differences were observed in the neuromuscular response of the contracting brachial biceps. The cryotherapy, however, promoted a significant reduction in the strength and number of motor units activated during the contraction. Conclusion: The cooling of muscle tissue promotes a decrease of muscle fibers activities, since there is a reduction in the velocity of nerve impulse conduction and the reflex of the myotatic arch. In addition, cryotherapy also decreases the sensitivity of the Golgi tendon organs, increases blood viscosity, and causes vasoconstriction. All these factors are combined to culminate in the decrease of neuromuscular activation and, consequently, in the reduction of muscle strength

Effect of ultrasound streaming on the disinfection of flattened root canals prepared by rotary and reciprocating systems

Abstract New technical and scientific developments have been advocated to promote the success of the endodontic treatment. In addition to rotary and reciprocating systems, irrigating solution agitation has been suggested and passive ultrasonic irrigation (PUI) is the most used. Objective: To evaluate, in vitro, the effect of ultrasound streaming (US) in the disinfection of flattened root canal systems prepared by the ProTaper, BioRaCe and Reciproc systems, utilizing the microbiological culture. Methodology: Extracted human mandibular incisors (n=84) were used. Suspensions of Enterococcus faecalis (ATCC 29212) were standardized and inserted along with the teeth immersed in brain-heart infusion (BHI) broth. The contamination was made following a protocol during 5 days. The teeth were randomly divided into six groups: G1, ProTaper Universal; G2, ProTaper Universal with US; G3, BioRaCe; G4, BioRaCe with US; G5, Reciproc; and G6, Reciproc with US. Irrigation was performed with saline solution. After biomechanical preparation, microbiological samples were performed with sterilized paper points, which were diluted and spread on BHI agar; after 48 h, the colony forming units (CFU/mL) were counted for each sample. Results: Groups using ultrasonic agitation presented a greater antibacterial effect than the other ones, even using saline solution as irrigant. The ProTaper Universal system showed the best antibacterial activity of the tested systems (median of 0 CFU/mL with and without surfactant or ultrasonic activation [PUI]). Even with PUI, Reciproc (median of 2.5 CFU/mL with PUI and 5 without it) could not reduce as many colonies as ProTaper Universal without US. The BioRaCe system had greater bacterial reduction when using US (median of 0 CFU/mL with PUI and 30 without it). Conclusions: US promoted greater reduction in the number of bacteria in the flattened root canals prepared with nickel-titanium mechanized systems. Regarding the instruments used, the ProTaper Universal system was the most effective in reducing the bacterial number.

Penetración Dentinaria in vitro del Hipoclorito de Sodio a Diferentes Concentraciones con las Técnicas de Irrigación Convencional y Ultrasónica Pasiva / In vitro Dentinary Penetration of Sodium Hypochlorite at Different Concentrations with the Conventional and Ultrasonic Passive Irrigation Techniques

RESUMEN: El objetivo del presente trabajo fue comparar la penetración dentinaria in vitro entre las concentraciones de hipoclorito de sodio (NaClO) al 5 % y al 2,5 % con técnicas de irrigación convencional e irrigación ultrasónica pasiva. Este fue un estudio transversal, prospectivo y experimental. Se trabajó con 40 segmentos radiculares (especímenes) de 5 mm de longitud, divididos en 4 grupos. Todos los especímenes se sumergieron en violeta cristal durante 24 horas. Se realizó la preparación biomecánica con sistema rotatorio Pro Taper. Al primer grupo se irrigó con NaClO al 2,5 % con irrigación convencional, al segundo grupo con NaClO al 2,5 % con irrigación convencional más irrigación ultrasónica pasiva por 30 segundos, al tercer grupo con NaClO al 5 % con irrigación convencional y al cuarto grupo con NaClO al 5 % con irrigación convencional más irrigación ultrasónica pasiva por 30 segundos. Al final de la preparación a todos los especímenes se les realizó un corte mesio distal. La profundidad de la penetración del NaClO fue deterrminado por el blanqueamiento de la mancha y medido con un microscopio de luz con una magnificación de 40 X. La prueba estadística usada fue ANOVA con un nivel de significancia de 5 %. El NaClO al 5 % con técnica de irrigación ultrasónica pasiva presentó la mayor penetración dentinaria in vitro.

ABSTRACT: The objective of the present study was to compare in vitro dentin penetration between 5 % and 2.5 % sodium hypochlorite (NaClO) concentrations using conventional irrigation and passive ultrasonic irrigation techniques. This was a cross-sectional, prospective and experimental study. It was worked with 40 root segments (specimen) of 5 mm length, divided into 4 groups. All specimens were immersed in crystal violet for 24 hours. The biomechanical preparation was performed with Pro Taper rotary system. The first group was irrigated with 2.5 % NaClO with conventional irrigation, the second group with 2.5 % NaClO with conventional irrigation plus ulrasonic passive irrigation for 30 seconds, the third group with 5 % NaClO with conventional irrigation and the fourth with 5 % NaClO with conventional irrigation plus ultrasonic passive irrigation for 30 seconds. At the end of the preparation, all specimens had a distal mesio cut. The depth of NaClO penetration was determined by bleaching of the stain and measured with a light microscope at a magnification of 40 X. The statistical test used was ANOVA with a significance level of 5 %. The 5 % NaClO with passive ultrasonic irrigation showed the highest dentin penetration in vitro.

Comparison of two methods of irrigant agitation in the removal of residual filling material in retreatment

Abstract: The aim of this study was to compare the efficacy of passive ultrasonic irrigation and EasyClean for removing residual filling material in retreatment. Twenty-two maxillary lateral incisors with apical curvature were instrumented with ProTaper files and filled with Endofill using the lateral compactation technique. Removal of filling material was performed with Reciproc, Mtwo and ProDesign Logic 50/.01 files. The teeth were inserted in a silicone mould, which was placed in a metal muffle, and split to visualize the residual filling material. The samples were divided into two groups (n = 11) according to the irrigation protocol: Passive ultrasonic irrigation (PUI group) with 3 activations of 20 seconds and EasyClean (Easy Equipamentos Odontológicos, Belo Horizonte, Brazil) (EC group) used in continuous rotation with 3 activations of 20 seconds, both using NaOCl and EDTA. Environmental scanning electron microscopic images of the apical, middle, and cervical thirds were taken before and after the irrigant activation. The Kappa test was used to determine interexaminer agreement. Statistical analysis was performed using Kruskal-Wallis, Mann-Whitney, and Wilcoxon tests (p < 0.05). PUI and EC improved the removal of remnant filling material in all root canal thirds (p < 0.05). PUI and EC presented similar performance in the final step of retreatment (p > 0.05). No significant difference was observed in the removal of filling material in the apical, middle, and cervical thirds in both groups (p > 0.05). EasyClean in continuous rotary motion is useful in retreatment and was shown to be as effective as ultrasonic activation in the removal of remnant filling material.

Efficacy of ultrasonic activation of NaOCl and orange oil in removing filling material from mesial canals of mandibular molars with and without isthmus

Objectives The aim of this study was to evaluate the volume of remaining filling material after passive ultrasonic irrigation (PUI) of sodium hypochlorite (NaOCl) and orange oil in mesial canals of mandibular molars, with and without isthmus. Material and Methods Thirty mesial roots of mandibular molars were divided according to the presence or absence of isthmus. Canals were prepared and filled (Micro-CT #1). Filling was removed using rotary instruments, and specimens were sub-divided into three groups according to the irrigation procedures: Conventional – conventional irrigation with NaOCl, PUI/NaOCl – PUI of NaOCl (three activations, 20 seconds each), and PUI/orange oil – PUI of orange oil (Micro-CT#2). Specimens were enlarged using the X2 and X3 ProTaper Next instruments and submitted to the same irrigation protocols (Micro-CT #3). Results No differences were found between the experimental groups in each stage of assessment (P>0.05). The volume of residual filling material was similar to that in Micro-CT #2 and Micro-CT #3, but lower than that observed in Micro-CT #1 (P<0.05). When groups were pooled according to the presence or absence of an isthmus, volume of residual filling material was higher in specimens presenting isthmus (P<0.05). Conclusions PUI of NaOCl or orange oil did not improve filling removal. Isthmus consists in an anatomical obstacle that impairs the removal of filling material.

Ultrasound therapy and transcutaneous electrical neuromuscular stimulation for management ofpost-mastectomy upper limb lymphedema / Terapia de ultrassom e estimulação elétrica transcutânea neuromuscular para a tratamento do linfedema de membro superior pós-mastectomia

Objetivo: Avaliar o efeito da estimulação elétrica transcutânea ou terapia de ultra-som no tratamento de pós-mastectomia linfedema do membro superior. Método: revisão sistemática da literatura foi realizada 1980-2012 do MedLine, Cochrane Library, LILACS e SciELO. Os termos utilizados na pesquisa foram (neoplasia de mama ou câncer de mama ou de linfedema) e (hipertermia, induzido ou diatermia ou terapia de ultra-som ou ultra-som ou a estimulação elétrica nervosa transcutânea ou dezenas). As seleções dos estudos eram de pacientes mulheres com linfedema pós-mastectomia membro superior que foram submetidos a diatermia por terapia de ultra-som e estimulação elétrica nervosa transcutânea. Só randomizado (RCT) e projetos quase randomizados do estudo foram incluídos (ambos estreita e Broad Therapy). Somente estudos publicados no formato de artigo completo foram incluídos. Depois de analisar os 2.158 resumos resultantes da pesquisa, foram selecionados apenas dois artigos. Dois pesquisadores analisaram os dois artigos, usando o Van Tulder e JADAD escalas para avaliação da qualidade. Resultados: Ambos os trabalhos avaliaram o uso da terapia de ultra-som e estimulação elétrica para o tratamento do linfedema pós-mastectomia. Um total de 132 indivíduos foram incluídos em ambos os estudos, e pouca melhora foi observada em redução ou a qualidade de vida da dor. Somente o estudo usando a terapia de ultra-som identificada uma pequena redução nos sintomas de linfedema. No entanto evidências que suportam a aplicação deste método está faltando. Conclusão: Mais estudos são necessários para avaliar o uso da terapia de ultra-som ou eletroterapia para o tratamento de linfedema pós-mastectomia e para avaliar o efeito potencial dessas terapias no desenvolvimento posterior da doença metastática.

Objective: This article aims to assess the effect of transcutaneous electrical stimulation or ultrasound therapy in the treatment of post-mastectomy upper limb lymphedema. Method: A systematic literature review was performed from 1980 to 2012 from the MedLine, Cochrane Library, LILACS and SciELO databases. The terms used in the search were (breast neoplasm OR breast cancer OR lymphedema) and (hyperthermia, induced OR diathermy OR ultrasonic therapy OR ultrasound OR transcutaneous electrical nerve stimulation OR TENS). The selections of the studies concerned female patients with post-mastectomy upper limb lymphedema who underwent diathermy by ultrasound therapy and transcutaneous electric nerve stimulation. Only randomized (RCT) and quasi-randomized study designs were included (both Narrow and Broad Therapy). Only studies published in the full paper format were included. After reviewing the 2,158 abstracts resulting from the search, only two papers were selected. Two researchers analyzed the two articles, using the Van Tulder and JADAD scales for quality assessment. Results: Both papers evaluated the use of ultrasound therapy and electric stimulation for treatment of post-mastectomy lymphedema. A total of 132 subjects were included in these two studies, and little improvement was observed in pain reduction or quality of life. Only the study using ultrasound therapy identified a small reduction in lymphedema symptoms; however, evidence supporting the application of this method is lacking. Conclusion: Further studies are needed to evaluate the use of ultrasound therapy or electrotherapy for treatment of post-mastectomy lymphedema and to evaluate the potential effect of these therapies on later development of metastatic disease.

Efetividade e segurança do ultrassom terapêutico nas afecções musculoesqueléticas: overview de revisões sistemáticas Cochrane / Effectiveness and safety of therapeutic ultrasound in musculoskeletal disorders: overview of Cochrane systematic reviews

O Ultrassom terapêutico (UST) é um recurso frequentemente utilizado na prática clinica do fisioterapeuta. Entretanto, não há consenso na literatura em relação à efetividade desse recurso. Objetivo: Os objetivos do presente estudo foram verificar e sintetizar as informações contidas nas revisões sistemáticas Cochrane relacionadas ao tratamento das afecções musculoesqueléticas com o UST. Método: Foi realizada uma busca na base de dados ?Cochrane Library? e selecionadas as revisões sistemáticas que abordavam o UST como modalidade de tratamento. Resultados: Foram incluídas seis revisões sistemáticas Cochrane que analisaram a efetividade do UST em diferentes afecções musculoesqueléticas demonstrando redução significativa da dor apenas na osteartrite de joelho; não há relatos de eventos adversos decorrentes do UST em todas as revisões incluídas, sendo considerado um tratamento seguro. Conclusão: Os resultados apresentados nesse estudo devem ser analisados com cautela, pois a baixa qualidade metodológica e a heterogeneidade dos ensaios clínicos randomizados (ECRs) incluídos nas revisões sistemáticas são fatores limitantes para a confiabilidade dos dados apresentados.

Ultrasound therapy (UST) is a feature often used in clinical practice of the physiotherapist. However, there is no consensus in the literature regarding the effectiveness of this feature. Objective: The purpose of this article was to assess and synthesize the information contained in systematic reviews Cochrane related to the treatment of musculoskeletal disorders with UST. Method: We performed a search in the database ?Cochrane Library? and selected the RS that addressed the UST as a treatment modality. Results: Were included six RS Cochrane who analyzed the effectiveness of UST in different musculoskeletal demonstrating significant reduction of pain in osteoarthritis of the knee only, there are no reports of adverse events resulting from UST in all revisions included, is considered a safe treatment. Conclusion: The results presented in this study should be treated with caution because of the low methodological quality and heterogeneity of randomized controlled trials (RCTs) included in RS are limiting factors for the reliability of the data presented.

Utilização de aparelho sônico na remoção de cálculo em implantes osseointegrados - Caso clínico / Use of ultrasonic device for the removal of calculus in osseointegrated implants - Case report

A completa remoção do cálculo dental, que retêm bactérias na sua superfície, é essencial para o controle da inflamação periodontal incluindo a periimplantite. Contudo, o manejo do cálculo dental é diferente nos dentes naturais e nos implantes. Naqueles, a estruturado tecido duro (cemento e dentina) é muito favorável à remoção completa do cálculo. Não obstante, nos implantes, a estrutura de titânio é desenhada com superfícies metálicas com roscas e uma geometria favorável ao alojamento e adesão do cálculo dificultando suaremoção e agindo como fator etiológico predisponente. Existem vários métodos de remoção do cálculo nos implantes, desde curetas de plástico e titânio, aparelhos de ultrassom até a ação de raios laser. Neste trabalho apresenta-se um caso clínico onde a remoção de cálculo em implantes foi realizada mediante utilização de aparelho sônico.

The complete removal of dental calculus, which retains bacteria in its surface, is essential for controlling periodontal inflammation including perimplantitis. However, the management of dental calculus is different in natural teeth and dental implants. The structure of hardtissue (radicular cementum and dentine) presents in natural teeth is more favorable to the complete removal of dental calculus. Nevertheless in cases of dental implants, the structure of titanium is drawn on metallic surfaces with threads and a geometry that is favorable to the lodging and adhesion of calculus, difficulting calculus removal and actingas a predisponent etiological factor. There are several methods of calculus removal of dental implants, such as plastic curettes, ultrasonic devices and laser. The present study has shown a clinical case of calculus removal in osseointegrated dental implants performed by using a sonic device.

Incidencia de granulomas en el lecho tiroideo con el uso de bisturí ultrasónico en pacientes sometidos a tiroidectomía total por cáncer / Postoperative thyroid bed granuloma incidence using ultrasonic knife in total thyroidectomy in cancer patients

Background: The postoperative thyroid bed granuloma incidence is high and it is an adittional difficulty for the ultrasound differential diagnosis of eventual local cancer recurrence. The ultrasonic knife utilization eventually can reduce the incidence of these granuloma when is compare with other traditional ligatures methods. Objective: to evaluate the postoperative thyroid bed granuloma incidence with the ultrasonic knife utilization, detected by ultrasound. Methods: retrospective study of 57 evaluable thyroidectomy performed for cancer between March and September 2010. In 46 patients were used traditional ligatures (silk or linen) and in 11, ultrasonic knife. Results: of the 57 patient included, 47 were females. The age average was 44 years old. Postoperative thyroid bed granuloma incidence was 36.3 percent (CI95 percent, 7.9 percent-64.7 percent) in the group where ultrasonic knife was used and 36.9 percent (IC95 percent, 23.0 percent-50.9 percent) in which traditional ligatures were used. No statistical difference was found (p = 0.974). Conclusions: The ultrasonic knife utilization had not reduced the postoperative thyroid bed granuloma incidence, when was compared with conventional ligatures. In this sense, this device is probably unable to add benefits for the differential diagnosis of thyroid cancer local recurrence.

Introducción: La incidencia de granulomas postoperatorios en el lecho tiroideo es alta y dificulta el diagnóstico diferencial ecográfico de posibles recidivas locales en cáncer. La utilización de bisturí ultrasónico disminuiría la incidencia de estos granulomas en comparación con métodos de sutura y hemostasia tradicionales con ligaduras. Objetivo: Evaluar si el uso de bisturí ultrasónico disminuye la incidencia de granulomas postoperatorios en el lecho tiroideo, que se detectan ecográficamente. Métodos: Retrospectivamente se revisaron los hallazgos ecográficos postoperatorios de 57 pacientes evaluables con cáncer de tiroides operados entre marzo y septiembre de 2010. En 46 pacientes se utilizó ligaduras (lino o seda) y en 11, bisturí ultrasónico. Resultados: De los 57 pacientes, 47 fueron mujeres. La edad promedio fue 44 años. La incidencia de granulomas fue 36,3 por ciento (IC95 por ciento de 7,9 por ciento-64,7 por ciento) en los pacientes en que se utilizó bisturí ultrasónico y 36,9 por ciento (IC95 por ciento de 23,0 por ciento-50,9 por ciento) en los pacientes en que se utilizó ligadura convencional. No hubo diferencia estadística (p = 0,974). Conclusiones: El uso de bisturí ultrasónico no disminuyó la incidencia de granulomas del lecho tiroideo, comparado con suturas convencionales. De esta forma, este recurso no aportaría beneficio en la diferenciación ecográfica de nódulos en el lecho tiroideo que pueden corresponder a recidivas tumorales o granulomas cicatriciales.

Biossegurança e aferição de equipamentos de eletrotermofototerapia. Quando devemos fazer? / Biosafety and electrothermal measurement equipment. When we must make it?

Introdução: A eletrotermofototerapia tem sido amplamente utilizada nas últimas décadas no tratamento de afecções músculo-esqueléticas. Objetivos: Investigar a importância da aferição periódica dos aparelhos de eletrotermofototerapia e discutir suas questões de biossegurança. Métodos: Foi realizada uma revisão da literatura por meio de artigos científicos nacionais e internacionais que relatassem questões de aferição dos equipamentos. Resultados: O uso de aparelhos descalibrados pode levar a uma terapia ineficiente, influenciando na duração do tratamento estipulado. Aparelhos usados sem devida aferição podem levar a conseqüências deletérias aos usuários. Conclusão: A falta de aferição causa malefícios à saúde tanto do paciente como do fisioterapeuta.

A comparative evaluation of the efficacy of manual, magnetostrictive and piezoelectric ultrasonic instruments: an in vitro profilometric and SEM study

OBJECTIVES: The debridement of diseased root surface is usually performed by mechanical scaling and root planing using manual and power driven instruments. Many new designs in ultrasonic powered scaling tips have been developed. However, their effectiveness as compared to manual curettes has always been debatable. Thus, the objective of this in vitro study was to comparatively evaluate the efficacy of manual, magnetostrictive and piezoelectric ultrasonic instrumentation on periodontally involved extracted teeth using profilometer and scanning electron microscope (SEM). MATERIAL AND METHODS: 30 periodontally involved extracted human teeth were divided into 3 groups. The teeth were instrumented with hand and ultrasonic instruments resembling clinical application. In Group A all teeth were scaled with a new universal hand curette (Hu Friedy Gracey After Five Vision curette; Hu Friedy, Chicago, USA). In Group B CavitronTM FSI - SLI TM ultrasonic device with focused spray slimline inserts (Dentsply International Inc., York, PA, USA) were used. In Group C teeth were scaled with an EMS piezoelectric ultrasonic device with prototype modified PS inserts. The surfaces were analyzed by a Precision profilometer to measure the surface roughness (Ra value in µm) consecutively before and after the instrumentation. The samples were examined under SEM at magnifications ranging from 17x to 300x and 600x. RESULTS: The mean Ra values (µm) before and after instrumentation in all the three groups A, B and C were tabulated. After statistically analyzing the data, no significant difference was observed in the three experimental groups. Though there was a decrease in the percentage reduction of Ra values consecutively from group A to C. CONCLUSION: Within the limits of the present study, given that the manual, magnetostrictive and piezoelectric ultrasonic instruments produce the same surface roughness, it can be concluded that their efficacy for creating a biologically compatible surface of periodontally diseased teeth is similar.

Ultramorphology of the root surface subsequent to hand-ultrasonic simultaneous instrumentation during non-surgical periodontal treatments: an in vitro study

OBJECTIVE: The purpose of this study was to investigate the ultramorphology of the root surfaces induced by mechanical instrumentation performed using conventional curettes or piezoelectric scalers when used single-handedly or with a combined technique. MATERIAL AND METHODS: Thirty single-rooted teeth were selected and divided into 3 groups: Group A, instrumentation with curettes; Group B instrumentation with titanium nitride coated periodontal tip mounted in a piezoelectric handpiece; Group C, combined technique with curette/ultrasonic piezoelectric instrumentation. The specimens were processed and analyzed using confocal and scanning electron microscopy. Differences between the different groups of instrumentation were determined using Pearson's χ2 with significance predetermined at α=0.001. RESULTS: Periodontal scaling and root planing performed with curettes, ultrasonic or combined instrumentation induced several morphological changes on the root surface. The curettes produced a compact and thick multilayered smear layer, while the morphology of the root surfaces after ultrasonic scaler treatment appeared irregular with few grooves and a thin smear layer. The combination of curette/ultrasonic instrumentation showed exposed root dentin tubules with a surface morphology characterized by the presence of very few grooves and slender remnants of smear layer which only partially covered the root dentin. In some cases, it was also possible to observe areas with exposed collagen fibrils. CONCLUSIONS: The curette-ultrasonic simultaneous instrumentation may combine the beneficial effects of each instrument in a single technique creating a root surface relatively free from the physical barrier of smear layer and dentin tubules orifices partial occlusion.

Estudo experimental comparativo de métodos de diérese tecidual no tratamento endoscópico do divertículo faringo-esofágico / Experimental study comparing two methods of tissue diaeresis for endoscopic treatment of pharingoesophageal diverticulum

O divertículo faringo-esofágico (DFE), também conhecido como cricofaríngeo ou de Zenker (DZ), é doença rara, com prevalência estimada entre 0,01% e 0,11%, e que acomete os muito idosos, para os quais tratamentos menos invasivos podem ser úteis, destacando-se o endoscópico. A despeito das inovações com equipamentos e acessórios, hemorragias e perfurações ocorrem em até 10 e 15% dos pacientes, respectivamente. A constatação de divertículo faríngeo em porcos domésticos transformou-se em modelo experimental de grande interesse para fins didáticos e científicos. Pretendeu-se, neste sentido, introduzir inovação técnica e compará-la com o tratamento endoscópico convencional do DFE. O objetivo deste estudo foi comparar, em modelo experimental, a diérese do septo do DFE efetuada através do bisturi harmônico Ultracision (Grupo U) com a do eletrocautério monopolar (Grupo M). Foram utilizados 20 porcos domésticos com peso médio de 20,2 Kg (1,35). Os animais foram alocados entre os grupos M e U de forma não aleatorizada. Não houve diferença significativa quanto ao tamanho do divertículo (p=0,0897) ou quanto ao tempo de inserção do diverticuloscópio flexível (p=0,7387). No grupo U, o tempo médio para a incisão do septo e o tempo total do procedimento foram menores (p<0,0001) para as duas comparações. Quanto à extensão da borda seccionada, houve diferença significativa (p=0,0047) entre os grupos, com maior média de tamanho no grupo U. Em relação aos parâmetros microscópicos, apenas a extensão da lesão provocada pela corrente monopolar (Grupo M) foi maior (p<0,0001). Em relação aos parâmetros de profundidade e à presença de inflamação, não houve diferença entre os grupos. Observou-se hemorragia apenas no grupo M (p=0,01), sempre controlada endoscopicamente. Em comparação com a técnica de seção feita com uso de estilete endoscópico e corrente monopolar mista, a diverticulotomia endoscópica experimental com uso de diverticuloscópio flexível e bisturi harmônico se mostrou...

The pharyngoesophageal diverticulum (PED), also known as cricopharyngeal orZenker diverticulum (ZD), is a rare disease with estimated incidence ranging from0.01% to 0.11% and more present in elderly patients, for whom a less invasivetreatment can be desirable. Despite innovations in endoscopic equipment andaccessories, bleeding and perforation occur in up to 10 and 15% of the cases,respectively. The finding of pharyngeal diverticulum in domestic pigs turned into anexperimental model of major interest for training and scientific purposes. For thisreason, the introduction of a technical innovation and its comparison with PEDconventional treatment were focused. Our aim was to compare the diaeresis of thePED septum by the harmonic scalpel Ultracision (Group U) with that bymonopolar electrocautery (Group M) in an experimental model. Twenty domesticpigs (mean weight 20.2 kg; 1.35) were divided into groups M and U nonrandomly.No significant differences were found related to diverticulum size (p=0.0897) orinsertion time of soft diverticuloscope (p=0.7387). In group U, mean time to dividethe septum and total procedure time were significantly shorter (p<0.0001) for bothcomparisons. Regarding incision extension, mean length was significantly higher ingroup U (p=0.0047). In relation to microscopic parameters, the lateral thermal spreadcaused by monopolar current (Group M) was found to be more intense (p<0.0001).As for depth and inflammation presence, no differences were verified between thegroups. Hemorrhage was exclusively observed in group M (p=0.01) and it wasendoscopically managed at all times. When compared to endoscopic incision withneedle-knife and monopolar blend current, the experimental endoscopicdiverticulostomy using soft diverticuloscope and harmonic scalpel demonstrated tobe faster and related to less tissue damage.

Avaliação de cavidades apicais realizadas com pontas ultrassônicas lisas, diamantadas e combinação de ambas / Evaluation of apical cavity preparation with ultrasonic, stainless steel, diamond coated lips and both

OBJETIVO: O objetivo deste trabalho foi avaliar, por meio do microscópio clínico e eletrônico devarredura, as paredes de cavidades apicais, as irregularidades produzidas com as pontas ultrassônicas diamantadas,lisas e com a combinação de ambas. MATERIAL E MÉTODO: Dezoito dentes pré-molaresinferiores de humanos, com apenas um conduto, foram apicetomizados e, no ápice, foram realizadascavidades para obturação retrógrada divididas em três grupos: grupo 1: cavidades preparadas com pontaultrassônica lisa; grupo 2: cavidades preparadas com ponta ultrassônica diamantada e grupo 3: cavidadespreparadas, iniciando com a ponta diamantada e seguida pela lisa. As paredes das cavidades foramobservadas inicialmente sob microscópio clínico e, a seguir, os ápice foram seccionados, metalizados eanalisados no microscópio eletrônico de varredura, atribuindo-se-lhes os seguintes escores: 1 - adequada;2 - regulares e 3 - irregulares. RESULTADOS: A ponta diamantada produziu 3 cavidades adequadas, 2regulares e 1 irregular; a ponta lisa, 5 adequadas, 1 regular e nenhuma irregular. A associação de ambaspropiciou 2 cavidades adequadas, 3 regulares e 1 irregular. CONCLUSÃO: Não houve diferença estatísticana qualidade das cavidades preparadas com pontas lisas, diamantadas ou na associação das duas. Quanto àavaliação realizada com os microscópios clínico e o de varredura, não houve diferença estatística entre eles.

OBJECTIVE: To evaluate the quality of root-end preparations using ultrasonic stainless steel and diamond coated tips used individually or associated. The cavity walls were analyzed using a clinical microscope and by scanning electron microscopy (SEM). MATERIAL AND METHOD: Eighteen single rooted mandibular premolars weresubmitted to apicectomy and root-end cavities were performed using ultrasonic tips. The teeth were divided according to the ultrasonic tip used. Group 1 (n=6) stainless steel tips. Group 2 (n=6) diamond coated tips. Group 3 (n=6) the cavity was done initially with a diamond coated tip and finished using a non-coated tip. Three scores were assigned to evaluate the quality of the cavity walls: 1 adequate; 2 regular; 3 inadequate. RESULTS: Diamond coated tip preparation showed 3 adequate cavities, 2 regulars and 1 inadequate. The stainless steel tip preparation showed 5 adequate cavities and 1 regular. The association of the tips showed 2 adequate cavities, 3 regulars and 1 inadequate. CONCLUSION: There was no statistically difference in the quality preparation for the analyzed groups. There was no statistically difference in the evaluation using a clinical microscope or SEM.

Hand and ultrasonic instrumentation for orthograde root canal treatment of permanent teeth

Root canal treatment is a frequently performed dental procedure and is carried out on teeth in which irreversible pulpitis has led to necrosis of the dental pulp. Removal of the necrotic tissue remnants and cleaning and shaping of the root canal are important phases of root canal treatment. Treatment options include the use of hand and rotary instruments and methods using ultrasonic or sonic equipment. OBJECTIVES: The objectives of this systematic review of randomized controlled trials were to determine the relative clinical effectiveness of hand instrumentation versus ultrasonic instrumentation alone or in conjunction with hand instrumentation for orthograde root canal treatment of permanent teeth. MATERIAL AND METHODS: The search strategy retrieved 226 references from the Cochrane Oral Health Group Trials Register (7), the Cochrane Central Register of Controlled Trials (CENTRAL) (12), MEDLINE (192), EMBASE (8) and LILACS (7). No language restriction was applied. The last electronic search was conducted on December 13th, 2007. Screening of eligible studies was conducted in duplicate and independently. RESULTS: Results were to be expressed as fixed-effect or random-effects models using mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95 percent confdence intervals. Heterogeneity was to be investigated including both clinical and methodological factors. No eligible randomized controlled trials were identifed. CONCLUSIONS: This review illustrates the current lack of published or ongoing randomized controlled trials and the unavailability of high-level evidence based on clinically relevant outcomes referring to the effectiveness of ultrasonic instrumentation used alone or as an adjunct to hand instrumentation for orthograde root canal treatment. In the absence of reliable research-based evidence, clinicians should base their decisions on clinical experience, individual circumstances and in conjunction with patients' preferences where appropriate. Future randomized controlled trials might focus more closely on evaluating the effectiveness of combinations of these interventions with an emphasis on not only clinically relevant, but also patient-centered outcomes.

Sealing ability of MTA and amalgam in different root-end preparations and resection bevel angles: an in vitro evaluation using marginal dye leakage

This in vitro study evaluated the effect of different apicoectomy angles, instruments used in root-end preparation, and dental materials used in retrofilling on apical sealing. Root ends were resected at 45 or 90 degrees in 80 single-rooted teeth. For each type of apicoectomy, root-end cavities were prepared with either a round carbide #2 bur or an S12/90D ultrasonic tip. The root-end cavities in each subgroup (apicoectomy + root-end preparation) were filled with silver amalgam without zinc (Am) or with gray mineral trioxide aggregate -Angelus (MTA), and the specimens were immediately immersed in 0.2 percent rhodamine B for 24 h. Sealing was evaluated based on the dyed cross-sectional dentin area. Data were analyzed statistically by the Kruskal-Wallis test at 5 percent significance level. No group showed complete sealing of root-end areas. The only significant factor affecting microleakage was dental material, with MTA exhibiting less leakage.

Este estudo in vitro avaliou o efeito de diferentes ângulos de apicectomia, instrumentos utilizados na retrocavitação e materiais odontológicos usados na retrobturação sobre selamento apical. Oitenta dentes unirradiculares, tratados endodonticamente, foram apicectomizados. Quarenta raízes tiveram seu ápice radicular seccionado com angulação de 45º e a outra metade com angulação de 90º. Para cada tipo de apicectomia realizou-se retrocavidades com broca esférica carbide nº 2 ou com retroponta ultra-sônica S12/90D. Cada subgrupo (apicectomia/retrocavidade) foi retrobturado com MTA ou amálgama, sendo os espécimes imediatamente imersos no corante Rodamina B a 0,2 por cento por 24 h. O selamento apical foi avaliado com base na área transversal de dentina corada ao redor da retrobturação. Os dados foram submetidos á análise estatística utilizando os testes de Kruskal-Wallis e Mann-Whitney. Nenhum grupo foi capaz de selar totalmente a região apical. O tipo de material utilizado na retrobturação foi o único fator que mostrou significativa diferença no selamento apical em relação à infiltração de corante.