Irrigation protocols effects on radicular dentin: Cleaning, disinfection and remaining ultrastructure / Efecto del protocolo de irrigación en la dentina radicular: limpieza, desinfección y ultraestructura remanente

A successful endodontic treatment requires a combination of satisfactory mechanical instrumentation, adequate irrigation protocols, and three-dimensional obturation of the canal system. Irrigation is considered the most critical procedure to ensure cleaning and disinfection. To date, a large variety of irrigants has been proposed. However, sodium hypochlorite (NaOCl) remains the gold standard. In order to achieve complete cleaning and disinfection, final irrigation with EDTA and ultrasonic devices has been used as an ideal protocol. Most endodontic research focuses on the cleaning and antibacterial properties of the irrigant solutions. Recent evidence demonstrated that the irrigation protocols cause erosion, affecting the radicular dentin ultrastructure. This article aims to describe the clinical features of the present knowledge concerning the effect of irrigation protocols on radicular dentin.

Un tratamiento de endodoncia exitoso requiere de una satisfactoria instrumentación mecánica, protocolos de irrigación adecuados y obturación tridimensional del sistema de conductos radiculares. La irrigación se considera el procedimiento más crítico para garantizar la limpieza y desinfección. Hasta la fecha, se ha propuesto una gran variedad de irrigantes. Sin embargo, el hipoclorito de sodio (NaOCl) sigue siendo el estándar de oro. Para lograr una limpieza y desinfección completa, se ha utilizado como protocolo ideal la irrigación final con EDTA y dispositivos ultrasónicos. La mayor parte de la investigación en endodoncia se enfoca en las propiedades antibacterianas y de limpieza de las soluciones de irrigación. Reciente evidencia demostró que los protocolos de irrigación provocan erosión, afectando la ultraestructura de la dentina radicular. Este artículo tiene como objetivo describir algunas consideraciones clínicas del conocimiento actual sobre el efecto de los protocolos de irrigación en la dentina radicular.

Effects of dentinary contamination by endodontic irrigants on bonding strength of adhesive systems

This study aimed to evaluate if 2.5% sodium hypochlorite compromises the adhesion of bonding materials. The factors in the study were the irrigation solutions in two levels: 2.5% sodium hypochlorite and saline solution; and the adhesive systems used in three levels: three-step adhesive, universal adhesive, and two-step self-etch adhesive systems. The answer variable used was the microshear bond strength obtained through a universal testing machine and fracture mode. Six groups were obtained (n=10) : Etch-and-rinse/Saline (saline solution + 3-step adhesive system - Scotchbond Multipurpose, 3M ESPE); Universal/saline (saline solution + universal adhesive system ­ Prime&Bond,); Self-etch/saline (saline solution + 2-step self-etch adhesive systems - Clearfil SE Bond); Etch-and-rinse/Hypo (sodium hypochlorite 2,5% + 3-step adhesive system - Scotchbond Multiuso); Universal/Hypo (sodium hypochlorite 2,5% + universal adhesive system ­ Prime&Bond); Self-etch/Hypo (sodium hypochlorite 2,5% + 2-step self-etch adhesive system - Clearfil Se Bond). The specimens were obtained from 60 healthy bovine incisors. The crowns were separated from the roots, and the regularization of the buccal surface was performed. The groups received saline solution and 2.5% sodium hypochlorite for 30 minutes, respectively. A matrix of 1mm and 3mm oh height was stabilized by Scotch tape to obtain the resin sticks. Afterward, the bond strength test was performed in a universal testing machine at 1mm/min speed. The data were analyzed with normality Shapiro-Wilk, two-way ANOVA, and Tukey's tests (p<0.001). Etch-and-rinse and Self-etch adhesives presented the highest bond strength values after irrigation with saline solution and 2.5% sodium hypochlorite, respectively (P < 0.01). The irrigation with 2.5% sodium hypochlorite decreased the bond strength values of Etch-and-rinse and Universal (P < 0.01). On the other hand, 2.5% sodium hypochlorite improved the bond strength values of Self-etch (P < 0.01). In conclusion, 2.5% sodium hypochlorite negatively impacted the bond strength of Etch-and-rinse and Universal but improved the adhesion of Self-etch.

Evaluation of the dentinal tubule penetration of an endodontic bioceramic sealer after three final irrigation protocols

Introduction: This study aimed to evaluate the dentinal tubule penetration of an endodontic bioceramic sealer, Sealer Plus BC, after three final irrigation protocols. Methods: Thirty distobuccal roots of maxillary molars were selected. Root canal preparation was performed up to an #40.06 instrument (X1 Blue) under 2.5% sodium hypochlorite irrigation. Specimens were randomly divided into three groups (n=10), according to the final irrigation protocol: G-NaOCl (2.5% sodium hypochlorite + PUI), G-SS (0.9% saline solution + PUI) and G-H20 (Deionized water + PUI). After final irrigation protocols, all specimens were irrigated with phosphate buffer solution. Root canal obturation was performed using the single cone technique and Sealer Plus BC, stained with a specific fluorophore. Specimens were transversely sectioned and each root third was evaluated in a confocal scanning laser microscopy. Images obtained were analyzed for sealer penetration in the dentinal tubules. Results: Dentinal tubule penetration of Sealer Plus BC was not observed in any root third, regardless of the final irrigation protocol investigated. Conclusions: Sealer Plus BC dentinal tubule penetration was not observed after none of the protocols tested. Dentinal tubule penetrability of Sealer Plus BC may be related to other factors rather than the final irrigation protocol.

Bioseguridad en el laboratorio dental / Biosafety in the dental laboratory

Una enfermedad infecciosa es aquella producida por un agente infeccioso (bacterias, hongos, virus, etc.) que ingresa y se desarrolla en el organismo de un hospedero. Posteriormente, puede trasmitirse de un individuo a otro directamente por contacto entre ambos, o bien, indirectamente, por medio de un vec-tor biológico (de naturaleza animal o vegetal), o de un fómite (objeto inanimado). Las vías por las que un agente infeccioso puede ingresar a un hospedero son: inhalación (respiración de aerosoles), ingestión (salpicaduras de gotas), penetración de mucosas (na-sal, ocular y bucal) o lesiones en la piel o mucosas. Las fuentes de infección pueden ser los pacientes, el personal del consultorio o laboratorio, las superficies e instrumental contaminados y las prótesis o com-ponentes de éstas. Para evitar la propagación de los agentes microbianos se debe interrumpir el proceso de transmisión de los mismos. Todo profesional debe fortalecer y readecuar normas y protocolos de biose-guridad en la tarea diaria, para minimizar el riesgo de transmisión directa y cruzada entre el profesional, su equipo auxiliar, el laboratorista y los pacientes (AU)

An infectious disease is one caused by an infectious agent (bacteria, fungi, virus, etc.) that enters and develops in a host. Then it can be transmitted from one individual to another directly by contact between the two or, indirectly through a biological vector (an animal or plant nature), or a fomite (an inanimate object). The routes by which an infectious agent can enter a host are: inhalation (breathing of aerosols), ingestion (splash of droplets), penetration of mucous membranes (nasal, ocular and oral) and skin or mucous lesions. Sources of infection can be patients, office or laboratory personnel, contaminated surfaces and instruments and the prosthesis or component thereof. To prevent the spread of microbial agents, the process of their transmission must be interrupted. Every professional must strengthen and readjust biosafety standards and protocols in daily work to minimize the risk of direct and cross-transmission between the professional, his auxiliary team, the laboratory technician and the patients (AU)

Comparación de la efectividad antimicrobiana entre hipoclorito de sodio 2, 5% y ácido hipocloroso 5% frente a Enterococcus faecalis: prueba in vitro / Comparison of antimicrobial effectiveness between sodium hypochlorite 2.5% and hypochlorous acid 5% against Enterococcus faecalis: an in vitro test

La terapia endodóntica tiene como uno de sus objetivos lograr la completa desinfección del sistema de conductos radiculares. Por esto, se deben seleccionar sustancias irrigantes que tengan la capacidad de eliminar todo el contenido de dicho sistema. La acción antimicrobiana es una de las características más importantes a tener en cuenta en la elección. El hipoclorito de sodio (NaOCl) tiene capacidad bactericida sobre muchos de los microorganismos de la flora endodóntica. El Enterococcus faecalis es una bacteria altamente resistente a antibacterianos que sobrevive en condiciones extremas. El ácido hipocloroso (HOCl) es una molécula derivada del NaOCl que ha demostrado tener alto poder bactericida sobre cepas patogénicas bucales. El objetivo de este trabajo fue evaluar y comparar la efectividad antimicrobiana in vitro del NaOCl 2.5% y el HOCl al 5% frente a Enterococcus faecalis. Una suspensión de Enterococcus faecalis (ATCC29212), de turbidez 0.5 en escala de McFarland, fue inoculada en varios tubos de ensayo, los cuales contenían cada antimicrobiano. Se dejaron actuar durante 1, 5 y 10 minutos para luego neutralizarlos e inclubarlos a 37º C en condiciones de capnofilia durante 48 hs. Todo el procedimiento se realizó por quintuplicado. Los resultados se midieron mediante recuento de UFC/ml. No se evidenció presencia de Enterococcus faecalis en las placas que contenían la solución de NaOCl al 2.5% como tampoco en aquellas que contenían HOCl al 5%. In vitro, el HOCl y el NaOCl en las concentraciones probadas, eliminaron completamente las cepas de Enterococcus faecalis (AU)

Determination of sodium hypochlorite concentrations in the activation of the irrigant by passive technique with ultrasonic, during the ex vivo endodontic protocol

ABSTRACT: Introduction: Sodium hypochlorite and ultrasonic activation have a synergistic and improving effect on canal disinfection. Some authors found irrigant decrease after activation with ultrasonic, while others described an increased concentration in later stages. The aim of this study was to determine if activation of sodium hypochlorite by passive ultrasonic irrigation reduces its concentration compared to a technique without activation. Materials and methods: A ex-vivo descriptive study was conducted with teeth, randomized into two groups: 10 controls and 20 experimental. The hypochlorite of groups undergoing endodontic treatment was collected, and the post-irrigation residual with saline was gathered. The activation by ultrasonic was performed in stage 4.5 with Ultrasonic Scaler NSK®, three cycles of 20 seconds each per tooth. Irrigant concentration was measured by spectrophotometry. Results. In the first 4 stages, there were no concentration differences between groups. Stage 4.5 demonstrated a significant difference between the treated and control group. At saline irrigation stages, there was only a significant difference in stage E5. When activation was performed, the sodium hypochlorite curve maintained concentration values close to 5% in more stages in comparison to the control group. Conclusions: Passive ultrasonic activation demonstrated higher significant concentration of sodium hypochlorite, compared to a technique without activation.

Sellado marginal aplicando hipoclorito de sodio versus ácido fosfórico como acondicionador dental / Marginal sealing applying sodium hypochlorite versus phosphoric acid as dental conditioner

RESUMEN Introducción: La microfiltración es uno de los problemas principales de todas las obturaciones a base de resina. Muchos estudios buscan optimizar un buen sellado marginal utilizando diversos acondicionadores, como el hipoclorito de sodio, que permite que el adhesivo penetre bien, al generar desproteinización, y el ácido fosfórico que permite remover el barro dentinario, y así de esta manera formar una capa híbrida al colocar el adhesivo. Objetivo: Evaluar el grado de sellado marginal de la resina Bulk Fill aplicando gel de hipoclorito de sodio 10 por ciento comparado con el gel de ácido fosfórico al 37 por ciento en el acondicionamiento dental in vitro. Métodos: El universo fue de 72 dientes con cavidades clase I; se separaron en 4 grupos por muestra de 18 dientes cada uno; después de obturar se realizó el termociclaje a 500 ciclos entre 5 °C a 55 °C; luego se sumergieron en azul de metileno 2 por ciento, durante 12 h y 24 h a temperatura de 37 °C. Finalmente se evaluó el sellado marginal en el estereomicroscopio, según el ISO / TS 11405: 2015, con los criterios siguientes: grado 0 (sin microfiltración), grado 1 (microfiltración hasta esmalte), grado 2 (microfiltración hasta dentina) y grado 3 (microfiltración hasta piso pulpar). Resultados: El acondicionamiento con ácido fosfórico 37 por ciento a las 12 h presentó grado 0 (55,6 por ciento) y grado 1 (33,3 por ciento), y a las 24 h, grado 1 (55,6 por ciento). Con respecto al hipoclorito de sodio 10 por ciento a las 12 h, grado 0 (44.4 por ciento) y a las 24 h predominó grado 1 (55,6 por ciento). Para la contrastación de hipótesis en muestras relacionadas se obtuvo en ácido fosfórico 37 por ciento e hipoclorito de sodio al 10 por ciento a las 12 h y 24 h un p= 0,052 y p= 0,584, respectivamente. Para comparaciones entre muestras independientes a las 12 h y 24 h se obtuvo p= 0,462 y p= 0,406, respectivamente. Conclusiones: El gel de hipoclorito de sodio al 10 por ciento presenta similar eficacia en el sellado marginal respecto al gel de ácido fosfórico al 37 por ciento, al utilizarlo como acondicionador dental(AU)

ABSTRACT Introduction: Microfiltration is one of the main problems of all resin sealings. Many studies aim to optimize marginal sealing using a variety of conditioners, such as sodium hypochlorite, which allows good penetration of the adhesive by generating deproteinization, and phosphoric acid, which allows removal of the dental smear layer, thus creating a hybrid layer when the adhesive is placed. Objective: Evaluate the marginal sealing degree of Bulk Fill resin applying 10 percent sodium hypochlorite gel versus 37 percent phosphoric acid gel in in vitro dental conditioning. Methods: The study universe was 72 teeth with class I cavities, divided into four groups of 18 teeth. Upon sealing, thermal cycling was performed at 500 cycles from 5 ºC to 55 ºC. Next the teeth were submerged in 2 percent methylene blue for 12 h and 24 h at a temperature of 37 ºC. Finally marginal sealing was evaluated in the stereo microscope according to ISO / TS 11405: 2015, using the following scale: grade 0 (no microfiltration), grade 1 (microfiltration as far as the enamel), grade 2 (microfiltration as far as the dentin), and grade 3 (microfiltration as far as the pulp floor). Results: Conditioning with 37 percent phosphoric acid was grade 0 (55.6 percent) and grade 1 (33.3 percent) at 12 h, and grade 1 (55.6 percent) at 24 h, whereas conditioning with 10 percent sodium hypochlorite was grade 0 (44.4%) at 12 h, and predominantly grade 1 (55.6 percent) at 24 h. Hypothesis contrast in related samples yielded 37 percent phosphoric acid and 10 percent sodium hypochlorite at 12 h and 24 h, p= 0.052 and p= 0.584, respectively. Comparison between independent samples at 12 h and 24 h yielded p= 0.462 and p= 0.406, respectively. Conclusions: The 10 percent sodium hypochlorite gel has similar marginal sealing effectiveness as the 37 percent phosphoric acid gel when used as dental conditioners(AU)

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.

Effectiveness of XP-Endo Finisher in the reduction of bacterial load in oval-shaped root canals

Abstract: This study investigated the effectiveness of XP-Endo Finisher (XPF) associated with XP-Endo Shaper (XPS) or Reciproc Blue (RB) files in reducing bacterial load in oval-shaped root canals (RC) during chemomechanical preparation (CMP) using 0.9% saline solution (NaCl) or 2.5% sodium hypochlorite (NaOCl). Eighty mandibular incisors with single oval-shaped RC were contaminated with Enterococcus faecalis. The teeth were randomly assigned to eight experimental groups (n = 10) according to the CMP, as follows: G1: XPS, G2: XPS + XPF, G3: RB, and G4: RB + XPF. CMP was performed with NaCl or NaOCl. The reduction of bacterial load was assessed by colony-forming unit count before (S1) and after (S2) CMP. Data normality was verified by using Shapiro-Wilk test. ANOVA, Tukey's test, and Bonferroni post-hoc test were used at a 5% significance level. Culturable bacteria were present in all S1 samples (p>0.05). All instrumentation techniques were effective in reducing bacterial load, irrespective of the irrigating solution (p < 0.05). With the use of NaCl, RB was more effective than XPS (p = 0.035). With the use of NaOCl, XPS and RB presented similar effectiveness (p = 0.779). XPF enhanced the bacterial reduction of both systems tested (p < 0.05). The use of NaOCl improved the CMP, irrespective of the instrumentation technique used (p < 0.05). In conclusion, XPS and RB files are effective in reducing bacterial levels in oval-shaped RC. The use of XPF as a method of agitation of the irrigating solution improved the cleaning efficiency of both file systems tested. Mechanical preparation performed with saline solution decreased culturable bacteria from the root canal, but antimicrobial substances such as NaOCl should be used to achieve a significantly better disinfection.

Irrigation trends among members of the Chilean Endodontic Society

Introduction: the aim of this study is to determine the current trends of irrigation during root canal therapy by specialists who are members of the Chilean Endodontic Society. materials and method: a survey (survey monkey -SurveyMonkey.com) was e-mailed to the 485 members of the Chilean Endodontic Society. the instrument was translated and adapted from the survey "irrigation trends among American Association of Endodontists members: a web-based survey" applied in the USA in 2012. participants answered a set of 16 questions that included irrigant selection, irrigant concentration, the adopted protocol, techniques or devices for irrigant activation. results: 99 percent of respondents use sodium hypochlorite as the main irrigant. data indicate that 74 percent of respondents use hypochlorite at a concentration of 5 percent. most respondents (94 percent) also include EDTA in their usual practice. In addition, 90 percent of respondents reported that they activate the irrigating agent, and 94 percent confirmed that they perform a final irrigation protocol. conclusion: the majority of respondents use sodium hypochlorite as the main irrigant at a concentration of 5 percent, use ethylenediaminetetraacetic acid (EDTA) as a smear removal agent, activate the irrigant, and perform a final irrigation protocol.

Sodium hypochlorite and its use as root canal irrigant: a survey among ghanaian dental practitioners

Background: The majority of endodontic treatment in Ghana is provided by general dental practitioners due to the absence of specialists in endodontics. Sodium hypochlorite has been described as one of the commonly used irrigation solutions during endodontic treatment. However, there are no published reports on its use in Ghana. Aim: The study was to determine the proportion of Ghanaian dental practitioners who have used sodium hypochlorite for irrigation and the concentrations they usually use. Materials and methods: Self -administered questionnaires were mailed to dental practitioners in private clinics, government hospitals and clinics, teaching hospitals and training institutions across the country between December 2015 and March 2016. The collated data was analyzed using Microsoft Excel 2010 and SPSS 20.0.Results: The most commonly used root canal irrigant was 2.5% Sodium Hypochlorite (Milton®). This was routinely used by 31 (73.7%) of the respondents as root canal irrigant while normal saline solution was used regularly by only 6(15.8%) respondents. The various concentrations of sodium hypochlorite used were 0.5%, 2.5%,1%and 5.0%; with the following percentage-use respectively, 42.9%, 32.1%,21.4%and 6.1%. Three (10.7%) respondents had reported experiencing some complications with the use of sodium hypochlorite. Conclusion: Sodium hypochlorite is the most commonly used root canal irrigant by dental practitioners in Ghana. The concentrations usually used ranges between 0.5% and 5.0%

Can intra-radicular cleaning protocols increase the retention of fiberglass posts? A systematic review

Abstract The presence of residues within the root canal after post-space preparation can influence the bond strength between resin cement and root dentin when using fiberglass posts (FGPs). Currently, there is no consensus in the literature regarding what is the best solution for the removal of debris after post-space preparation. This systematic review involved "in vitro" studies to investigate if cleaning methods of the root canal after post-space preparation can increase the retention of FGPs evaluated by the push-out test. Searches were carried out in PubMed (MEDLINE) and Scopus databases up to July2017. English language studies published from 2007 to July 2017 were selected. 475 studies were found, and 9 were included in this review. Information from the 9 studies were collected regarding the number of samples, storage method after extraction, root canal preparation, method of post-space preparation, endodontic sealer, resin cement, cleaning methods after post-space and presence of irrigant activation. Five studies presented the best results for the association of sodium hypochlorite (NaOCl) and ethylenediamine tetra-acetic acid (EDTA), while in the other 4 studies, the solutions that showed improved retention of FGPs were photon-induced photoacoustic streaming (PIPS), Qmix, Sikko and EDTA. The results showed heterogeneity in all comparisons due to a high variety of information about cleaning methods, different concentrations, application time, type of adhesive system and resin cements used. In conclusion, this review suggests that the use of NaOCl/EDTA results in the retention of FGPs and may thus be recommended as a post-space cleaning method influencing the luting procedure.

Leafy Vegetables Free Of Coliforms And Parasites After Washing In Chlorine Treated Water

The production and preparation of vegetables for consumption involve procedures that pose health risks to consumers. In this context the water plays an important role in the quality of minimally processed vegetables. We assessed the hygienic-sanitary quality of leafy vegetables and obtained data of interest to health surveillance agencies and public health. They were tested for the presence of total and faecal coliforms, and also parasitic protozoa and helminths. The vegetable samples were purchased in supermarkets of the Midwest of the State of Santa Catarina, Brazil. We performed bacteriological analyses of wash water samples using chromogenic substrates to obtain the most probable number of the coliform group at 35 °C and Escherichia coli. We used Hoffman's spontaneous sedimentation technique for the parasitological analysis in order to check the occurrence of heavy and light helminths eggs and protozoan cysts. The analyses indicated the presence of coliforms, nematodes and freeliving protozoa, except for the last wash. We concluded that the washing process using running water and no active chlorine was not efficient in reducing the load of microorganisms in the vegetables. Therefore, intensive educational programmes should be implemented by health authorities to encourage hygienic-sanitary practices and risk reduction of food-borne diseases.(AU)

Fungal contamination and disinfection of dental chairs, Teresina, Piauí, Brazil / Contaminação de fungos e desinfecção em cadeiras odontologicas, Teresina, Piauí, Brasil

The aim of this study was to analyze fungal contamination on dental chairs at the clinic of a Higher Education Institution in TeresinaPI, Brazil, and to evaluate the effectiveness of different disinfectants: 70% alcohol and 1% sodium hypochlorite. We selected the five sites with most contact between patient and chair: headrest, backrest, armrests, seat and foot rest. Samples were collected from these sites on 14 chairs and inoculated in agar Sabouraud culture medium containing chloramphenicol. Pathogenic fungi were isolated from all sampling sites on the chairs. Highest frequencies were found on footrest, followed in decreasing order by seat, backrest, armrests and headrest. Fourteen species of filamentous fungi were identified, belonging to the genera Alternaria, Aspergillus, Cladosporium, Curvularia, Drechslera, Fusarium, Penicillium and Paecillomyces. After sampling, seven chairs were disinfected with 70% alcohol and seven with 1% sodium hypochlorite, and samples were taken again using the same procedure. No fungal growth was detected following disinfection with sodium hypochlorite, which was clearly more effective than alcohol, after which there was still fungal growth. This study highlights the need for the biosafety protocol to include cleaning and disinfection of dental chairs with 1% sodium hypochlorite after each attendance in order to prevent crossinfection.

O objetivo deste estudo foi analisar contaminação fúngica em cadeiras odontológicas na clínica de uma Instituição de Educação Superior em TeresinaPI, Brasil, e avaliar a efetividade de diferentes desinfetantes: álcool 70% e hipoclorito de sódio 1%. Nós selecionamos os cinco locais com maior contato entre o paciente e a cadeira: encosto da cabeça, das costas, dos braços, assento e encosto dos pés. As amostras foram coletadas destes locais das 14 cadeiras e inoculadas em meio de cultura agarSabouraud contendo cloranfenicol. Fungos patogênicos foram isolados de todos os locais de amostragem das cadeiras. As frequências mais altas foram encontradas no encosto dos pés, seguido em ordem decrescente pelo assento, encosto das costas, dos braços e encosto da cabeça. Quatorze espécies de fungos filamentoso foram identificados, pertencente aos gêneros Alternaria, Aspergillus, Cladosporium, Curvularia, Drechslera, Fusarium, Penicillium e Paecillomyces. Após a coleta, sete cadeiras foram desinfe tadas com álcool 70% e sete com hipoclorito de sódio 1%, e as amostras foram colhidas novamente usando o mesmo procedimento. Não foi detectado crescimento fúngico após desinfecção com hipoclorito de sódio, que foi claramente mais efetivo que o álcool, do qual ainda houve crescimento fúngico.Este estudo destaca a necessidade da inclusão no protocolo de biossegurança a limpeza e desinfecção das cadeiras odontológicas com o hipoclorito 1% após cada atendimento, a fim de prevenir infecções cruzadas.

Influência da agitação do hipoclorito de sódio como protocolo de irrigação final quanto à atividade antibacteriana no sistema de canais radiculares / Influence of sodium hypochlorite agitation as a final irrigation protocol on antibacterial activity in the root canal system

Diferentes manobras para promover agitação do hipoclorito de sódio têm sido propostas para incrementar a desinfecção do sistema de canais radiculares (SCR). O objetivo deste trabalho foi comparar, ex vivo, diferentes formas de agitação do NaOCl usado na irrigação final do SCR, avaliando a mais eficaz na redução de UFC/ml, a partir de biofilme de Enterococcus faecalis. Oitenta e cinco incisivos inferiores humanos extraídos, com canais ovais e obtidos do banco de dentes da UERJ foram acessados, contaminados com uma suspensão de E. faecalis (ATCC 29212) e incubados por 30 dias possibilitando crescimento bacteriano em biofilme. Os espécimes foram preparados com o instrumento Primary (25/08) do sistema Wave One TM. Foram formados cinco grupos contendo 15 dentes cada um, que foram irrigados com hipoclorito de sódio a 2,5% e, posteriormente, submetidos à agitação do irrigante como protocolo de irrigação final com o auxílio de diferentes instrumentos/ equipamentos, como a seguir: o EndoActivator ® (EA), o Easy Clean® (EC), a espiral de Lentulo (EL), a lima manual tipo K número 10 (LM) e o inserto ultrassônico Irrisonic - E1 (US). Foi formado o grupo controle positivo (n=5) o qual foi contaminado, sem a realização de nenhum procedimento. Foi formado também o grupo controle negativo (n=5) que não foi contaminado, mas seus espécimes foram irrigados com o NaOCl e submetidos a cada um dos protocolos de agitação da substância química auxiliar. As amostras microbiológicas foram coletadas usando cone de papel estéril antes da instrumentação (S1), após a instrumentação (S2) e após o protocolo final de irrigação (S3). Tais cones foram transferidos para tubos contendo meio BHI e incubados durante 48 horas. O crescimento bacteriano foi contado em unidades formadoras de colônia (UFC/ml). Os resultados foram submetidos aos testes Shapiro-Wilks, Wilcoxon e Kruskall-Wallis, para análise estatística ( P< 0.05) e demostraram que não houve diferença estatística significativa entre os grupos EA e EC, o grupo US quando comparado aos grupos EL e LM, foi significantemente mais eficiente na redução bacteriana. De acordo com os resultados do presente estudo, é possível afirmar que a agitação do NaOCl tem influência na atividade antibacteriana no SCR, e que o uso de ultrassom é mais eficiente quando comparado ao uso da espiral de lentulo e da lima manual.

Different maneuvers to promote agitation of sodium hypochlorite have been proposed to increase the disinfection of the root canal system. The objective of this study was to compare, ex vivo, different forms of agitation of chemical substance used in irrigation of the root canal system, evaluating the most effective in reducing or eliminating biofilms of Enterococcus faecalis. Eighty-five human mandibular incisors extracted with oval shape and obtained from UERJ teeth bank were accessed, contaminated with a suspension of E. faecalis (ATCC 29212) and incubated for 30 days allowing bacterial growth in biofilms. The specimens were prepared with the instrument Primary (25 / 0.08) Wave One TM system. Five groups were formed containing 15 teeth each, which were irrigated with sodium hypochlorite to 2.5% and then subjected to agitation of the irrigator as the final irrigation protocol with the help of different instruments / equipment, as follows: the EndoActivator ® (EA), Easy Clean® (EC), the Lentulo spiral (EL), the manual K file number 10 (LM) and the ultrasonic insert Irrisonic -E1 (US). The positive control group was formed (n=5), which was contaminated, without performing any procedure. It has also formed the negative control group containing (n=5), which was not infected but was irrigated with NaOCl and subjected to each of the agitation protocols of the irrigator. Microbiological samples were collected using sterile paper points before instrumentation (S1) after instrumentation (S2) and after the end of the irrigation protocol (S3). These points were transferred to Eppendorf containing BHI and incubated for 48 hours. Bacterial growth was counted in colony forming units (CFU / ml). The results were submitted to the Shapiro-Wilks test, Wilcoxon and Kruskal-Wallis test for statistical analysis and demonstrated a significant difference between the groups. US group compared to EL and LM groups was significantly more efficient in bacterial reduction. According to the results of this study it is clear that the agitation of NaOCl influences the antibacterial activity in the root canal system and that the use of ultrasonic is more efficient when compared to the use of lentullo and manual file.

Water and Physiological Saline to Prevent the Formation of P-Chloroaniline / Agua y Suero Fisiológico para Prevenir la Formación de Paracloroanilina

This study determined if p-chloroaniline (PCA) can be minimized by using distilled water and physiological saline solution following sodium hypochlorite but before chlorhexidine. Hypochlorite 5%, 0.5%, 0.05%, 0.005% and 0.0005% dissolved in 0.9% NaCl and in distilled water were mixed with 2% chlorhexidine for the formation of PCA. The PCA was determined using UV-VISIBLE spectrometry, with spectral curve was determined the wavelength of maximum absorption of PCA. Formed PCA absorbance was measured between 0.025%, 0.02%, 0.015%, 0.01%, 0.005% and 0.0025% hypochlorite and 2% chlorhexidine. 2% chlorhexidine and hypochlorite with physiological saline form a white precipitate which prevents the measurement of PCA. Colored PCA is formed with 0.05%, 0.005% hypochlorite aqueous dilutions and 2% chlorhexidine. The lwavelength of maximum absorption obtained was 470 nm and absorbance of PCA showed a linear decrease. 0.005% NaClO produces the least amount of PCA. The best solvent to prevent the formation of PCA during the interaction of sodium hypochlorite with chlorhexidine is distilled water.

Este estudio determinó si la p-cloroanilina (PCA) puede ser minimizada mediante el uso de agua destilada y solución salina fisiológica seguido de la aplicación de hipoclorito de sodio, previo a la aplicación de clorhexidina. Hipoclorito al 5%, 0,5%, 0,05%, 0,005% y 0,0005% fue disuelto en 0,9% de NaCl y en agua destilada se mezcló con 2% de clorhexidina para la formación de PCA. El PCA se determinó mediante espectrometría UV-Visible, y con curva espectral se determinó la longitud de onda máxima del PCA. La absorbancia del PCA formado se midió con 0,025%, 0,02%, 0,015%, 0,01%, 0,005% y 0,0025% de hipoclorito y 2% de clorhexidina. La combinación de 2% de clorhexidina e hipoclorito en solución salina fisiológica forman un precipitado blanco que impide la medición del PCA. El PCA coloreado es formado con 0,05%, 0,005% diluciones acuosas de hipoclorito y 2% de clorhexidina. La longitud de onda máxima obtenida fue de 470 nm y la absorbancia del PCA mostró una disminución lineal. NaClO al 0,005% produce menor cantidad de PCA. El mejor disolvente para evitar la formación de PCA durante la interacción de hipoclorito de sodio con clorhexidina es agua destilada.

Effects of various irrigation/aspiration protocols on cleaning of flattened root canals

This study aimed to evaluate, by means of scanning electron microscopy (SEM), the cleaning of flattened root canals, varying irrigation/aspiration protocols during biomechanical preparation. Thirdy human mandibular incisors were distributed into three groups (n = 10) according to the aspiration/irrigation protocols: conventional, conventional + brush, and apical negative pressure irrigation. Irrigation procedure was performed with 5 mL of 1% NaOCl at each change of instrument; final irrigation was conducted with 17% EDTA for 5 min. After biomechanical preparation, the roots were sectioned and prepared for SEM analysis. The images obtained were evaluated under 35× and 1,000× magnification by three calibrated examiners, following a double-blind design. All data were analyzed using Kruskal–Wallis and Dunn’s post hoctests (α = 0.05). Canals wherein the conventional method and apical negative pressure irrigation were employed revealed less debris, statistically different from the conventional + brush group (p < 0.05). Regarding the presence of smears, apical negative pressure irrigation was more effective in cleaning, showing lowest scores (p < 0.05), compared with the other tested protocols. Comparing each root canal third revealed that the apical portion was difficult to clean as all the tested protocols showed similar high scores (p > 0.05), both for the presence of debris and smear layer. In conclusion, although none of the studied irrigation/aspiration protocols have completely cleaned flattened root canals, apical negative pressure irrigation was more effective in smear layer removal, whereas the conventional + brush protocol was the least effective in removing the debris and smear layer.

Tratamento do biofilme intracanal de Enterococcus faecalis com suspensões de diferentes nanopartículas e irrigantes convencionais / Treatment of the Enterococcus faecalis root canal biofilm with nanoparticle suspensions and conventional irrigants

Objetivo: O objetivo deste estudo foi avaliar e comparar a efetividade das soluções de hipoclorito de sódio (NaOCl) 1% e 5%, clorexidina (CHX) 2%, suspensões de nanopartículas de prata (Np Ag) 1% e nanopartículas de óxido de zinco (Np ZnO) 26% contra o biofilme de E. faecalis. Material e Métodos: Setenta e seis dentes humanos unirradiculados foram modelados, montados em um aparato específico e esterilizados. Após, 100 μL de uma suspensão de E. faecalis foi inserida nos canais, sendo renovada diariamente por 7 dias. Quatro segmentos radiculares foram analisados por meio de microscopia eletrônica de varredura (MEV) para confirmar a presença do biofilme. Os segmentos radiculares remanescentes foram divididos aleatoriamente em 6 grupos (n = 12), de acordo com a solução irrigadora empregada: G1) solução salina 0,85% (controle); G2) NaOCl 1%; G3) NaOCl 5%; G4) CHX 2%; G5) suspensão de Np Ag 1%; e G6) suspensão de Np ZnO 26%. Concluída a irrigação, a susceptibilidade do biofilme às soluções irrigadoras (n = 10) foi determinada pelo método de plaqueamento e contagem de unidades formadoras de colônias (UFC). Uma análise por meio de MEV foi conduzida em 2 segmentos de cada grupo para visualização da estrutura do biofilme. O conjunto de dados, representados pelos valores médios de UFC para cada grupo, foi analisado estatisticamente pelos testes Kruskal-Wallis e Mann-Whitney (p < 0,05). Resultados: A efetividade das soluções de NaOCl 5% e Np Ag 1% contra o biofilme intracanal de E. faecalis foi superior comparada à solução salina 0,85% (p < 0,05). NaOCl 5% reduziu 100% das UFC comparado ao grupo controle, seguido pela suspensão de Np Ag 1% (97,6%), Np ZnO 26% (96,1%), NaOCl 1% (94,1%) e CHX 2% (93,1%). Conclusão: Com base na metodologia aplicada, as soluções de NaOCl 5% e Np Ag 1% apresentaram excelente efetividade contra o biofilme de E. faecalis estabelecido no canal radicular...

Avaliação radiográfica da obturação utilizando diferentes substâncias químicas auxiliares / Radiagraphic evaluatian af roat canal filling using different auxiliary chemical substances

O objetivo deste estudo clínico prospectivo randomizado foi analisar a influência de duas substâncias quimicas auxiliares na identificação de canais acessórios e no selamento do forame apical pelo cimento endodôntico e a prevalência desses canais na faixa etária de 13 a 79 anos, nos diferentes grupos dentários, em dentes vitais, não vitais e nos retratamentos endodônticos. Trezentos e um tratamentos endodônticos foram concluídos em 240 pacientes. f';s substâncias químicas auxiliares utilizadas foram a clorexidina gel 2% (n= 145) e o hipoclorito de sódio 5.25% (n= 156). Os dentes foram preparados pela técnica coroa-ápice com patência e ampliação do fora me apical e obturados pela técnica de termoplastificação da guta-percha. Três observadores independentes (triplo cego) avaliaram, radiograficamente, o preenchimento de canais acessórios e do forame apical que foi registrado e expresso em dados percentuais. Os dados foram analisados, estatisticamente, e os resultados mostraram que o forame apical foi selado pelo cimento endodôntico em 98.34% (296/301) e os canais acessórios foram preenchidos e visíveis radiograficamente em 47.84% (144/301) dos dentes tratados. Canais acessórios foram encontrados em 55% (99/180) dos dentes multirradiculares e em 37.20% (45/121) dos dentes unirradiculares. De acordo com o estado pulpar, canais acessórios foram encontrados em 55,20% (69/125) dos dentes vitais, 49.00% (49/100) dos dentes não vitais e 34.21% (26/76) dos retratamentos endodônticos. Concluiu-se que, entre os fatores analisados, não houve diferença estatisticamente significativa entre os dois grupos das substâncias químicas auxiliares analisadas.

The aim of this prospective randomized study, conducted in vivo, was to analyze the influence of two auxiliary chemicals in filling accessory canais and apical foramen by sealer and the prevalence of these channels in the age group 13 to 79 years, in various dental groups, in vital and non-vital teeth and root canal retreatment. Two hundred forty patients were treated and 301 endodontic treatments were completed. The auxiliary chemicals used were 2% chlorhexidine gel [n = 145) and 5.25% sodium hypochlorite (n = 156). The teeth were instrumented by crown-down technique with patency and enlargement of the apical foramen and obturated by the thermoplastic gutta-percha technique. Three independent observers (triple blind) evaluated radiographically obturation of accessory canais and apical foramen by the sealer that was recorded and expressed as a percentage. Data were statistically analyzed using the Binominal and Qui Quadrado tests. The results showed that the apical foramen was filled in 98.34% (296/301) and the accessories channels were filled and radiographically visible in 47.84% (144/301) of teeth treated. Accessory canais were found in 55% (99/180) of the teeth multirooted and 37.20% (45/121) of single-rooted teeth. According to the state of pulp, accessory canais were found in 55.20% (69/125) of vital teeth, 49.000/0 (49/100) of non-vital teeth and 34.21% (26/76) of endodontic retreatment. It was concluded that among the factors examined, there was no statistically significant difference between the two groups.

Monitoring the effectiveness of root canal procedures on endotoxin levels found in teeth with chronic apical periodontitis

Objective: The aim of this study was to monitor the effectiveness of root canal procedures by using different irrigants and intracanal medication on endotoxin levels found in root canals of teeth with chronic apical periodontitis. Material and Methods: Thirty root canals of teeth with pulpal necrosis associated with periapical lesions were selected and randomly divided into groups according to the irrigants used: GI - 2.5% NaOCl, GII - 2% chlorhexidine (CHX) gel, and GIII - saline solution (SS) (all, n=10). Samples were collected with sterile/apyrogenic paper points before (S1) and after root canal instrumentation (S2), after use of 17% ethylenediaminetetraacetic acid (EDTA) (S3), and after 30 days of intracanal medication (Ca(OH)2+SS) (S4). A turbidimetric kinetic Limulus Amebocyte Lysate assay was used for endotoxin measurement. Results: Endotoxins were detected in 100% of the root canals investigated (30/30), with a median value of 18.70 EU/mL. After S2, significant median percentage reduction was observed in all groups, irrespective of the irrigant tested: 2.5% NaOCl (99.65%) (GI), 2% CHX (94.27%) (GII), and SS (96.79%) (GIII) (all p<0.05). Root canal rinse with 17% EDTA (S3) for a 3-minute period failed to decrease endotoxin levels in GI and a slight decrease was observed in GII (59%) and GIII (61.1%) (all p>0.05). Intracanal medication for 30 days was able to significantly reduce residual endotoxins: 2.5% NaOCl (90%) (GI), 2% CHX (88.8%) (GII), and SS (85.7%) (GIII, p<0.05). No differences were found in the endotoxin reduction when comparing s2 and s4 treatment groups. Conclusion: Our findings demonstrated the effectiveness of the mechanical action of the instruments along with the flow and backflow of irrigant enduring root canal instrumentation for the endotoxin removal from root canals of teeth with chronic apical periodontitis. Moreover, the use of intracanal medication for 30 days contributed for an improvement ...