Effect of Laser Photobiomodulation on Postoperative Pain in Endodontics: A Systematic Review.

Objective: Photobiomodulation therapy has proven benefits in various dental treatments. The current systematic review aims to explore the role of laser photobiomodulation in modulating postoperative pain followed by endodontic treatment. Methods: In this systematic review, randomized controlled clinical trials on low-level laser therapy/photobiomodulation in endodontic therapy were analyzed. Database search was performed in PubMed/Medline, Web of Science, Scopus, and Cochrane Library, followed by literature search in Google Scholar. Results: A total of 12 studies were included as per the set criteria. The included studies utilized diode laser (808-970 nm) and indium gallium aluminum. All the included studies evaluated postendodontic pain after root canal therapy and endodontic surgery. A majority of the included studies showed significant benefits of photobiomodulation in postoperative pain management in endodontic therapy.Heterogeneity of the laser parameters and lack of power calculations for sampling among the included studies preclude solid recommendation of use of photobiomodulation therapy (PBMT) for postendodontic pain management. Conclusions: Although PBMT has proven potential benefits being a possible adjunct in postoperative pain management in endodontic therapy, it requires robust standardized randomized control trials to confirm the results of the systematic review.

Caracterização fitoquímica, avaliação dos efeitos sinérgicos e antibiofilmes dos extratos de Rosmarinus officinalis L. e Plinia cauliflora sobre microrganismos envolvidos na infecção endodôntica secundária / Phytochemical characterization, evaluation of the synergistic and antibiofilm effects of Rosmarinus officinalis L. and Plinia cauliflora extracts on microorganisms involved in secondary endodontic infection

Com o aumento de microrganismos resistentes nos canais radiculares, os estudos de extratos de plantas com ação antibacteriana têm aumentado visando terapias alternativas. O objetivo deste estudo foi avaliar os efeitos sinérgicos sobre Enterococcus faecalis, Enterococcus faecium, Candida albicans, Fusobacterium nucleatum e Porphyromonas gingivalis e a ação antibiofilme dos extratos hidroetanólicos de Rosmarinus officinalis L. (alecrim) e Plinia cauliflora (jabuticaba). Foram determinadas a Concentração Inibitória Mínima (CIM) e Concentração Microbicida Mínima (CMM) por microdiluição em caldo e Índice de Concentração Inibitória Fracionada e Índice de Concentração Microbicida Fracionada por microdiluição checkerboard. Posteriormente, a ação da concentração efetiva dos extratos foi avaliada sobre biofilmes formados em poços de placa de microtitulação. Os biofilmes foram expostos a dois diferentes períodos de tratamento com os extratos, por 5 min e 24 h, sendo n=10 para cada grupo experimental. Como controles foram utilizados solução salina 0,9% (C+) e hipoclorito de sódio 2,5% (C-), totalizando 5 grupos para cada microrganismo e cada tempo experimental. Em seguida, os biofilmes foram submetidos ao teste de MTT. Foram realizadas análises da atividade citotóxica dos extratos sobre as linhagens de queratinócitos humanos (HaCat) pelo teste de MTT. A análise estatística foi feita aplicando método ANOVA e teste de Dunn (significância de 5%). Ambos os extratos demonstraram fitocompostos fenólicos e flavonóides e possuem ação antioxidante. Os extratos apresentam ação antimicrobiana para as cepas estudadas e quando foram associados, apresentaram concentrações aditivas para cepa de E. faecalis. Em relação a propriedade antibiofilme, o extrato de alecrim apresentou boa redução da viabilidade microbiana de E. faecalis, com redução de 52% para o tempo de 5 min e de 40% para 24 h. Para as cepas de microrganismos anaeróbios, para a cepa de F. nucleatum, o extrato de jabuticaba reduziu em até 73% o biofilme. Para a cepa de P. gingivalis houve redução de até 41% para o extrato de jabuticaba e de até 57% para o extrato de alecrim. Quanto a citotoxicidade em HaCat, demonstrou que após tratamento com diferentes concentrações dos extratos, ambos apresentaram citotoxicidade estatisticamente semelhante ao hipoclorito de sódio 2,5%. Diante disso, pode-se concluir que ambos os extratos apresentam ação antioxidante e antimicrobiana em culturas planctônicas, exceto o extrato de jabuticaba para C. albicans. Quanto a associação dos extratos, não houve ação sinérgica, mas obteve-se resultado aditivo para cepa clínica de E. faecalis 2. A ação antibiofilme foi efetiva para as cepas de E. faecalis, F nucleatum e P. gingivalis. A citotoxicidade dos extratos apresentou semelhança estatística com o hipoclorito de sódio 2,5% para ambos. (AU)

With the increase in resistant microorganisms in root canals, studies of plant extracts with antibacterial action have increased aiming at alternative therapies. The objective of this study was to evaluate the synergistic effects on Enterococcus faecalis, Enterococcus faecium, Candida albicans, Fusobacterium nucleatum and Porphyromonas gingivalis and the antibiofilm action of hydroethanolic extracts of Rosmarinus officinalis L. (rosemary) and Plinia cauliflora (jabuticaba). The Minimum Inhibitory Concentration (MIC) and Minimum Microbicide Concentration (MCC) were determined by broth microdilution and the Fractional Inhibitory Concentration Index and Fractional Microbicide Concentration Index by checkerboard microdilution. Subsequently, the effect of the effective concentration of the extracts was evaluated on biofilms formed in microtiter plate wells. The biofilms were exposed to two different periods of treatment with the extracts, for 5 min and 24 h, with n=10 for each experimental group. As controls, 0.9% saline solution (C+) and 2.5% sodium hypochlorite (C-) were used, totaling 5 groups for each microorganism and each experimental time. Then, the biofilms were subjected to the MTT test. Analysis of the cytotoxic activity of the extracts on human keratinocyte lines (HaCat) was carried out using the MTT test. Statistical analysis was performed using the ANOVA method and Dunn's test (5% significance level). The results that both extracts demonstrated phenolic and flavonoid phytocompounds and have antioxidant action. The extracts have antimicrobial action for the strains studied and when they were combined, they presented additive concentrations only for the E. faecalis strain. Regarding the antibiofilm property, the rosemary extract showed a good reduction in the microbial viability of E. faecalis, with a reduction of 52% for 5 min and 40% for 24 h. For strains of anaerobic microorganisms, in contact with the F. nucleatum strain, the jabuticaba extract reduced biofilm by up to 73%. For the P. gingivalis strain, there was a reduction of up to 41% for the jabuticaba extract and up to 57% for the rosemary extract. As for cytotoxicity in HaCat, it was demonstrated that after treatment with different concentrations of extracts, both showed cytotoxicity statistically similar to 2.5% sodium hypochlorite. Given this, it can be concluded that both extracts have antioxidant and antimicrobial action in planktonic cultures, except the jabuticaba extract for C. albicans. Regarding the association of extracts, there was no synergistic action, but an additive result was obtained for the clinical strain of E. faecalis 2. The antibiofilm action was effective for the strains of E. faecalis, F nucleatum and P. gingivalis. The cytotoxicity of the extracts showed statistical similarity with 2.5% sodium hypochlorite for both.(AU)

Acidente de hipoclorito de sódio durante retratamento endodôntico / Sodium hypochlorite accident during endodontic retreatment / Accidente con hipoclorito de sodio durante retratamiento

O retratamento endodôntico é uma intervenção executada em um dente que já apresenta um tratamento realizado anteriormente que foi mal sucedido clínica e/ou radiograficamente. O objetivo deste trabalho foi o de relatar um caso de retratamento endodôntico na clínica de Atenção Básica III da Faculdade de Odontologia de Pernambuco devido ao desconforto estético do incisivo lateral superior que estava fraturado e necessitando de prótese fixa. Após anamnese, exames extra e intra-oral e exames radiográficos, constatou-se o canal do dente 12 havia sido tratado endodonticamente há aproximadamente quatro anos. A remoção da gutta percha contaminada foi realizada com as limas rotatórias EasyLogic RT® 25mm sequência 30.10 torque 4N e 900 RPM, 25.08 torque 4Ne 900 RPM. Após remoção da guta-percha, realizou-se o protocolo de irrigação com solução de hipoclorito de sódio a 2,5% (Biodinâmic). A odontometria foi realizada com localizador apical e confirmada por radiografia periapical e o repreparo do canal radicular confeccionado com a Lima EasyLogic 2® de número 35.06 e posterior irrigação com a solução de Labarraque. Nesse momento, o paciente relatou dor e após aspiração com sugador endodôntico, notou-se sangramento abundante, correspondendo ao extravasamento do hipoclorito de sódio (Enfizema por hipoclorito de sódio. O paciente foi medicado com Amoxacilina 875mg de 12 em 12 horas durante sete dias, Predisin 20mg ­ Corticóide - um comprimido pela manhã por 4 dias e Nimesulida 100mg de 12 em 12 horas durante 5 dias. Após 24 horas o paciente não relatou dor nem edema. Na segunda sessão, 10 dias após o acidente, a obturação foi realizada com cone único de guta-percha 35.06 HBassi (Easy, associado ao cimento Bio C Sealer Fillapex (Angelus®). Concluiu-se que a conduta terapêutica imediata instituída para este caso, foi efetiva para o controle da dor e prevenção de complicações adicionais após injeção acidental de hipoclorito de sódio.

Endodontic retreatment is an intervention performed on a tooth that already has a previously performed treatment that was clinically and/ or radiographically unsuccessful. The objective of this study was to report a case of endodontic retreatment at the Primary Care Clinic III of the Faculty of Dentistry of Pernambuco due to the aesthetic discomfort of the maxillary lateral incisor that was fractured and required a fixed prosthesis. After anamnesis, extra and intraoral exams and radiographic exams, it was found that the root canal of tooth 12 had been endodontically treated for approximately four years. Removal of contaminated gutta percha with those performed with EasyLogic RT® 25mm rotary files sequence 30.10 torque 4N and 900 RPM, 25.08 torque 4N and 900 RPM. After removing the gutta-percha, the irrigation protocol was performed with a 2.5% sodium hypochlorite solution (Biodynamic). Odontometry was performed with an apex locator and confirmed by periapical radiography and root canal re-preparation made with EasyLogic 2® File number 35.06 and subsequent irrigation with Labarraque's solution. At that moment, the patient reported pain and after aspiration with an endodontic sucker, there was profuse bleeding, corresponding to sodium hypochlorite extravasation (Sodium hypochlorite emphysema. The patient was medicated with Amoxicillin 875mg every 12 hours for seven days, Predisin 20mg - Corticosteroid - one tablet in the morning for 4 days and Nimesulide 100mg every 12 hours for 5 days. After 24 hours the patient did not report pain or swelling. In the second session, 10 days after the accident, the filling was performed with a single cone of gutta-percha 35.06 HBassi (Easy, associated with Bio C Sealer Fillapex cement (Angelus®). It was concluded that the immediate therapeutic approach instituted for this case was effective for pain control and prevention of complications. additional doses after accidental injection of sodium hypochlorite.

El retratamiento endodóntico es una intervención que se realiza sobre un diente que ya tiene un tratamiento realizado previamente que resultó clínica y/o radiográficamente fallido. El objetivo de este estudio fue relatar un caso de retratamiento endodóntico en la Clínica de Atención Básica III de la Facultad de Odontología de Pernambuco debido a la incomodidad estética del incisivo lateral maxilar que estaba fracturado y requirió prótesis fija. Después de anamnesis, exámenes extraorales, intraorales y exámenes radiográficos, se encontró que el conducto radicular del diente 12 había sido tratado endodónticamente durante aproximadamente cuatro años. Eliminación de gutapercha contaminada con las realizadas con limas rotatorias EasyLogic RT® 25mm secuencia 30.10 torque 4N y 900 RPM, 25.08 torque 4N y 900 RPM. Tras retirar la gutapercha, se realizó el protocolo de irrigación con una solución de hipoclorito de sodio al 2,5% (Biodynamic). Se realizó odontometría con localizador de ápices y se confirmó mediante radiografía periapical y repreparación del conducto radicular realizada con EasyLogic 2® File número 35.06 y posterior irrigación con solución de Labarraque. En ese momento el paciente refirió dolor y luego de aspiración con ventosa endodóntica presentó sangrado profuso, correspondiente a extravasación de hipoclorito de sodio (Enfisema por hipoclorito de sodio. El paciente fue medicado con Amoxicilina 875mg cada 12 horas por siete días. Predisin 20mg - Corticosteroide - una tableta por la mañana por 4 días y Nimesulida 100mg cada 12 horas por 5 días, luego de 24 horas el paciente no refirió dolor ni hinchazón, en la segunda sesión, 10 días después del accidente, se realizó el relleno con un solo cono de gutapercha 35.06 HBassi (Easy, asociado al cemento Bio C Sealer Fillapex (Angelus®). Se concluyó que el abordaje terapéutico inmediato instituido para este caso fue eficaz para el control del dolor y la prevención de complicaciones. dosis adicionales después de accidente inyección de hipoclorito de sodio.

Resistencia a la fractura de premolares superiores con tratamientos de endodoncia por accesos conservador y tradicional / Resistance to Fracture of Upper Premolars with Endodontic Treatment by Conservative and Traditional Access

Introducción: Las piezas dentarias luego de tratamiento de endodoncia aumentan su susceptibilidad a la fractura, lo que está asociado, principalmente, con la pérdida de la estructura dental. Objetivo: Evaluar in vitro, la resistencia a la fractura de premolares superiores con tratamientos de endodoncia mediante acceso tradicional, conservador y conservador Ninja, con restauración provisoria y final. Métodos: Estudio prospectivo de diseño experimental longitudinal con 42 premolares superiores donados, separados en 3 grupos según el tipo de acceso de endodoncia a aplicarse y luego cada uno en dos subgrupos según el tipo de restauración, y un grupo control, al cual no se le realiza endodoncia. Luego de realizar el tratamiento y la restauración, se evaluó la resistencia a la fractura mediante carga compresiva oblicua (45°), en una máquina de carga universal. Las cargas requeridas para la fractura se registraron en newtons y fueron comparadas estadísticamente. Resultados: Las piezas tratadas mediante acceso conservador Ninja con restauración provisoria y final, requirieron una carga promedio para la fractura de 513,45 N y 638,13 N, respectivamente. Fuerzas significativamente mayores a las resistencias ofrecidas por los otros tratamientos con p 0,05. Conclusiones: En la endodoncia in vitro, el diseño del acceso a la cavidad, tipo conservador Ninja, afectó significativamente la resistencia a la fractura de los premolares superiores, adquiriendo un comportamiento biomecánico similar al de las piezas control(AU)

Introduction: Tooth pieces, after endodontic treatment, increase their susceptibility to fracture, a phenomenon mainly associated with loss of tooth structure. Objective: To evaluate, in vitro, the resistance to fracture of upper premolars with endodontic treatment by traditional, conservative and conservative ninja access, with temporary and final restoration. Methods: A prospective study of longitudinal experimental design was carried out with 42 donated upper premolars, separated into three groups, according to the type of endodontic access to be applied; in turn, each was then divided into two subgroups, according to the type of restoration, and a control group, not performed endodontic treatment. After treatment and restoration, fracture resistance was evaluated using oblique compressive loading (45°) in a universal loading machine. The loads required for fracture were recorded in newtons and statistically compared. Results: The parts treated by conservative ninja access with provisional and final restoration required an average fracture load of 513.45 N and 638.13 N, respectively; this forces were significantly higher than the resistance values offered by the other treatments, with p < 0.05. Likewise, there were no significant differences in the resistance values obtained between the cases of conservative access and traditional access, nor when comparing the types of applied restoration, with P<0.05. Conclusions: In in vitro endodontics, the design of the access to the cavity of conservative ninja type significantly affected the resistance to fracture of the upper premolars, acquiring a biomechanical behavior similar to that of the control pieces(AU)

Tooth color change after photodynamic therapy in endodontics: A systematic review.

BACKGROUND: A smile is considered one of the most important soft skills in social interaction. And discolored teeth may effect this. It is known that some photosensitizer agents (PS) used in photodynamic therapy (PDT) during root canal treatment could play a significant role in tooth color change, and thus the main objective of this systematic review is to address whether performing PDT can influence tooth color change and to synthesize the most effective methods to remove PS from the root canal system. METHODS: This study followed the PRISMA 2020 statement, and the protocol was registered at the Open Science Framework. Two blinded reviewers searched five databases up to November 20th, 2022: Web of Science, PubMed, Scopus, Embase, and the Cochrane Library. The eligibility criteria were studies that investigated tooth color change after PDT in endodontics. RESULTS: A total of 1695 studies were retrieved, and 7 were included in the qualitative analysis. All the included studies were in vitro evidence and investigated five different PS: methylene blue, toluidine blue O, malachite green, indocyanine green, and curcumin. Besides curcumin and indocyanine green, the remaining agents all caused tooth color change, and no method employed was effective in fully removing these PS from inside the root canal system CONCLUSIONS: Even though the findings showed that curcumin and indocyanine green did not influence tooth color change, the present evidence should be interpreted with caution since it is based on laboratory studies with questionable methods, and all efforts should be employed to avoid this undesirable side effect during clinical practice.

The Involvement of Photobiology in Contemporary Dentistry-A Narrative Review.

Light is an emerging treatment approach that is being used to treat many diseases and conditions such as pain, inflammation, and wound healing. The light used in dental therapy generally lies in visible and invisible spectral regions. Despite many positive results in the treatment of different conditions, this therapy still faces some skepticism, which has prevented its widespread adoption in clinics. The main reason for this skepticism is the lack of comprehensive information about the molecular, cellular, and tissular mechanisms of action, which underpin the positive effects of phototherapy. However, there is currently promising evidence in support of the use of light therapy across a spectrum of oral hard and soft tissues, as well as in a variety of important dental subspecialties, such as endodontics, periodontics, orthodontics, and maxillofacial surgery. The merging of diagnostic and therapeutic light procedures is also seen as a promising area for future expansion. In the next decade, several light technologies are foreseen as becoming integral parts of modern dentistry practice.

Efeitos antimicrobianos do óleo essencial de Lavandula dentata sobre cepas clínicas de Enterococcus faecalis e Enterococcus faecium / Antimicrobial effects of essential oil of Lavandula dentata on clinical strains of Enterococcus faecalis and Enterococcus faecium

O principal foco do tratamento endodôntico de sucesso, é a eliminação total de microrganismo, endotoxinas e biofilme bacteriano do sistema de canais radiculares. Quando há falha nesse processo, as bactérias de maior prevalência são Enterococcus spp. Desta forma, é evidente a necessidade de novas alternativas eficazes para erradicá-los dos canais radiculares. O uso de fitoterápicos antimicrobianos como os óleos essenciais (OEs) de plantas ganhou grande notoriedade na comunidade cientifica como uma alternativa muito satisfatória, além de efeitos antimicrobianos sobre diversas cepas bacterianas e fúngicas apresentam efeitos anti-inflamatório. Assim, o objetivo deste trabalho foi avaliar in vitro os efeitos antimicrobianos do OE de Lavandula dentata sobre cepas clínicas e cepas padrão de Enterococcus faecalis e Enterococcus em culturas planctônicas e em biofilme monotípico. Para isso foi determinada a Concentração Bactericida Mínima (CBM) do óleo essencial de L. dentata pela técnica de microdiluição em placa de 96 poços em caldo BHI com semeadura, segundo Clinical and Laboratory Standards Institute (CLSI), norma M7- A6 (E. faecalis e E. faecium). Para a análise da atividade antibiofilme dos microrganismos foram utilizados o teste colorimétrico de MTT nos períodos de 30 minutos e 24 horas de contato com o OE. Os dados obtidos nos testes in vitro apresentaram distribuição normal e foram analisados pelo teste ANOVA complementado pelo teste de Tukey (significância de 5%). Os resultados obtidos mostraram que o OE de L. dentata apresentou atividade antibacteriana e antibiofilme para todas as cepas testadas, com a CBM do óleo de L. dentata de 32%. Em relação a atividade antibiofilme do OE de L. dentata houve redução da carga bacteriana no período de 30 minutos e de 24 horas, este promoveu redução de até 79,25% no tratamento de 30 minutos e até 74,51% no tratamento de 24 horas. Concluiu-se que o óleo essencial de L. dentata apresentou atividade antibacteriana contra cepas clínicas resistente a antibióticos e cepas padrão de E. faecalis e E. faecium com concentração bactericida mínima de 32%, e atividade antibiofilme com tempo de ação de 30 minutos e 24 horas, com resultados semelhantes a clorexidina na maioria das cepas testadas (AU)

The main focus of successful endodontic treatment is the total elimination of microorganisms, endotoxins and bacterial biofilm from the root canal system. When this process fails, the most prevalent bacteria are Enterococcus spp. Thus, the need for new effective alternatives to eradicate them from root canals is evident. The use of antimicrobial phytotherapics such as essential oils (EOs) from plants has gained great notoriety in the scientific community as a very satisfactory alternative, in addition to antimicrobial effects on several bacterial and fungal strains that have anti-inflammatory effects. Thus, the objective of this work was to evaluate in vitro the antimicrobial effects of Lavandula dentata EO on clinical and standard strains of Enterococcus faecalis and Enterococcus faecium in planktonic cultures and in monotypic biofilm. For this, the Minimum Bactericidal Concentration (MBC) of the essential oil of L. dentata was determined by the microdilution technique in a 96-well plate in BHI broth with seeding, according to the Clinical and Laboratory Standards Institute (CLSI), M7-A6 (E. faecalis and E. faecium). For the analysis of the antibiofilm activity of the microorganisms, the MTT colorimetric test was used in the periods of 30 minutes and 24 hours of contact with the EO. The data obtained in the in vitro tests showed normal distribution and were analyzed by the ANOVA test complemented by the Tukey test (5% significance). The results obtained showed that the EO of L. dentata showed antibacterial and antibiofilm activity for all strains tested, with the CBM of L. dentata oil of 32%. Regarding the antibiofilm activity of the EO of L. dentata, there was a reduction in bacterial load in the period of 30 minutes and 24 hours, which promoted a reduction of up to 79.25% in the 30-minute treatment and up to 74.51% in the 24-hour treatment. hours. It was concluded that the essential oil of L. dentata showed antibacterial activity against antibiotic-resistant clinical strains and standard strains of E. faecalis and E. faecium with a minimum bactericidal concentration of 32%, and antibiofilm activity with an action time of 30 minutes and 24 hours, with results similar to chlorhexidine in most strains tested.K (AU)

Laser photobiomodulation effect on fibroblasts viability exposed to endodontic medications

Aim: The literature has not yet reported investigations about the effect of laser photobiomodulation (LPBM) over the cytotoxicity of drugs for endodontic treatments. Thus, the aim of this study was to evaluate, in vitro, the effect of the association between LPBM and intracanal medications on fibroblasts viability in different exposure times. Methods: Calcium hydroxide (Ca(OH)2) and iodoform (IO) were used pure or associated to LPBM. Eluates of medications were prepared and placed in contact with the cells in three different periods: 24h, 48h and 72h. Laser irradiation (emitting radiation λ 660nm, power density of 10mW, energy density of 3 J/cm²) has been performed in two sessions within a six hour interval, for 12s per well. After each experimental time, the colorimetric assay (MTT) has been performed. Statistical analysis was applied for Mann-Whitney test with 5% α error admitted test. Results: At 24h, the use of LPBM did not increase cell viability while after 72h cell proliferation was stimulated in the group without medications. LPBM application did not increase cell viability in Ca(OH)2 group and IO at any tested time. Ca(OH)2 cytotoxicity at 24h was higher than iodoform, while at 72h not difference was observed. Therefore, after 72 hours was no statistical difference between the IO and Ca(OH)2 groups. Conclusion: LPBM was able to increase cell viability in 72h in the group without medication, although no improvement was observed in the other groups. Thus, LPBM was not able to reduce the cytotoxic effects of the materials on fibroblasts in vitro

Exploring mindfulness and artworks/drawings to predict dental students' performance.

PURPOSE/OBJECTIVES: To explore and assess self-reported trait mindfulness and artwork/drawings as tools to predict students' performance. METHODS: This longitudinal study explored whether year 2 dental students' artwork/drawings produced during the first week of a preclinical endodontics course and Mindfulness Attention Awareness Scale (MAAS) scores could be used as a predictor of performance (grades/rank) at the end of the course. A convergent design of mixed methods approaches was used to integrate the quantitative and qualitative datasets. Qualitative analysis consisted of a multilayered process of thematic analysis of artwork/drawings that was used to generate codes, categories, and themes-according to lower and higher students' grades. Quantitative analysis consisted of statistical correlation between mindfulness scores and final grades. Findings were independently analyzed and further merged to answer our research question. RESULTS: The bivariate analysis found nonsignificant relationship between students' grades/rank and mindfulness scores: Pearson's correlation r = -0.097 (p = 0.578) and Spearman's correlation rho = 0.120 (p = 0.494). Codes, categories, and themes resulting from graphical data collected from the artwork/drawings strongly suggested that the higher students' grades group depicted solutions to deal with negative feelings/emotions and presented traits of confidence to reach goals. Artworks produced from students with lower grades left questions, such as in relation to competency in dentistry, unanswered, but at the same time, they seemed to perceive everything as emotion related. Upon merging the findings, we recognized more image components suggestive of positive feelings exuding from the artworks/drawings of higher grades group; but an increase in mindfulness was not associated with increase (or decrease) in final grade. CONCLUSION: Feelings/emotions represented in the artwork/drawings produced in the beginning of the course predicted students' performance at the end of the course; however, self-reported trait mindfulness was not correlated with performance.

Efetividade da ozonioterapia contra microrganismos endopatogênicos: revisão de literatura / Effectiveness of ozone therapy against endopathogenic microorganisms: literature review

Introdução: A comunidade científica está em constante busca por alternativas terapêuticas que promovam a desinfecção dos canais radiculares. Dentre os diversos protocolos existentes, a terapia com o ozônio tem se mostrado uma técnica viável para tal finalidade. Assim, o objetivo da presente revisão de literatura é descrever a efetividade da ozonioterapia na redução de microrganismos endopatogênicos. Revisão de literatura e discussão: A literatura apresenta, em sua maioria, estudos laboratoriais e carece de estudos clínicos sobre o tema. Esses estudos demonstram que o ozônio líquido e gasoso possui propriedades antimicrobianas e é eficiente na desinfecção do sistema de canais radiculares. No entanto, devido aos diferentes protocolos de utilização da ozonioterapia, associado às diferenças metodológicas dos estudos, pode-se afirmar que a ozonioterapia parece ser eficiente na desinfecção dos canais radiculares, mas há controvérsias sobre a sua utilização como técnica complementar ou substituta às soluções irrigadoras tradicionais. Conclusão: Ainda não é possível afirmar que o ozônio pode ser um substituto ao hipoclorito de sódio. No entanto, alguns autores relatam que o ozônio pode ser utilizado como um agente coadjuvante na redução de microrganismos presentes nos canais radiculares e é uma alternativa viável para os casos em que o hipoclorito de sódio está contraindicado.

Introduction: The scientific community is in constant search for therapeutic alternatives that promote the disinfection of root canals. Among the various existing protocols, ozone therapy has been shown to be a viable technique for this purpose. Thus, the aim of the present literature review is to describe the effectiveness of ozone therapy on reduction of endopathogenic microorga-nisms. Literature review and discussion: Most part of the literature presents in vitro and clinical studies on the subject and demonstrate that the liquid and gaseous ozone have antimicrobial properties and are efficient in disinfecting the root canal system. However, due to the different protocols for ozone therapy use associated with the methodological differences from the studies, it can be indicated that ozone therapy seems to be an efficient disinfection of root canals, but there are controversies about its use as a complementary or substitute technique in place of traditional irrigation solutions. Conclusion:It is not yet possible to consider ozone as a substitute for hypochlorite sodium. However, some authors report that ozone can be used as a supporting agent on reduc-tion of microorganisms present in the root canals and a viable alternative for cases in which hypochlorite is contraindicated.

Terapia regenerativa con plasma rico en plaquetas en adultos afectados por lesiones endoperiodontales / Regenerative therapy with platelets rich-plasm in adults affected by endoperiodontal lesions

Introducción: El uso de plasma rico en plaquetas para la regeneración de defectos óseos periodontales constituye una terapéutica eficaz. Objetivo: Identificar la evolución de pacientes con lesiones endoperiodontales tratados con plasma rico en plaquetas. Métodos: Se realizó un estudio observacional, descriptivo y longitudinal de 11 adultos con enfermedad endoperiodontal y tratamiento endodóntico finalizado, atendidos en la consulta de Periodoncia y Medicina Regenerativa del Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba, desde febrero del 2018 hasta diciembre del 2019, quienes requerían intervención quirúrgica periodontal y cumplían los criterios para recibir plasma rico en plaquetas. A tal efecto, se analizaron variables sociodemográficas, clínicas, radiográficas y de respuesta terapéutica, las que fueron expresadas estadísticamente por medio de frecuencias absolutas y relativas y de la media aritmética. Resultados: En la serie resultaron más frecuentes, antes de la terapia, el sangrado al sondaje (81,8 %), las características alteradas de las encías (72,7 %), la movilidad dentaria (72,7 %) y las bolsas periodontales de 7 a 9 milímetros, con pérdida ósea en el tercio apical (63,6 %); todo lo cual se revirtió a menores porcentajes luego de 6 meses de tratamiento. Conclusiones: La evolución de los pacientes afectados por lesiones periodontales fue satisfactoria con el empleo del plasma rico en plaquetas, lo que se evidenció clínica y radiográficamente.

Introduction: The use of platelets rich-plasm for the regeneration of periodontal bony defects constitutes an effective therapy. Objective: To identify the clinical course of patients with endoperiodontal lesions treated with platelets rich-plasm. Methods: An observational, descriptive and longitudinal study of 11 adults with endoperiodontal disease and concluded endodontics treatment was carried out. They were assisted in the Periodontics and Regenerative Medicine Service of Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba, from February, 2018 to December, 2019; who required periodontal surgical intervention and fulfilled the approaches to receive platelets rich-plasm. To such an effect, sociodemographic, clinical, radiographic and of therapeutic response variables were analyzed, which were statistically expressed by means of absolute and relative frequencies and of mean arithmetic. Results: In the series, bleeding on probing (81.8 %), altered characteristics of the gums (72.7 %), dental mobility (72.7 %) and 7 to 9 millimeters periodontal bags, with bony loss in the third apical (63.6 %) were more frequent before therapy; all of which was reverted to lower percentages after 6 months of treatment. Conclusions: The clinical course of the patients affected by periodontal lesions was satisfactory with the use of platelets rich-plasm, which was clinical and radiographically evidenced.

Comparison of Detection Rate of Root Canal Orifices of Maxillary First Molar Using Various Techniques: An in-vivo Study

ABSTRACT Objective: To compare the detection rate of root canal orifices of maxillary first molar by various techniques in the Indian population. Material and Methods: A total of 50 maxillary 1st molar cases were selected and sequentially divided into four groups: Group I: Naked eye; Group II: Surgical loupe; Group III: Surgical operating microscope; and Group IV: Fluorescein sodium dye. After access opening, the number of root canal orifices was detected in all cases with these methods. Results: By naked eye and surgical loupe, a total of 171 root canal orifices were detected, by a surgical operating microscope, 176, and by fluorescein sodium dye, 177 root canal orifices were detected. The detection rate of root canal orifices is as follows: Group I (96.61%) = Group II (96.61%) < Group III (99.44%) < Group IV (100%) and detection rate of MB-2 canal orifices Group I (40%) = Group II (40%) < Group III (50%) < Group IV (52%). No significant difference in the number of canal orifices detected could be seen for any of the comparisons. No significant difference was observed between the naked eye and surgical loupe techniques. Although the surgical operating microscope detected more root canal orifices, it did not have a significantly higher detection than the other two techniques. Conclusion: No significant difference was seen among various methods. However, the use of a surgical operating microscope and fluorescein sodium dye increased the detection rate of root canal orifices.

Usos del láser en la terapia endodóntica: revisión de la literatura / Laser uses in endodontic therapy: literature review

Últimamente, el uso del láser en endodoncia ha ganado aceptación llegando a considerarse como un complemento a la terapia endodóntica, la cual tiene como objetivo realizar una efectiva conformación, limpieza y desinfección del sistema de canales radiculares (SCR), permitiendo una eliminación eficaz de microorganismos presentes, y así prevenir la reinfección del canal. Se han adoptado diferentes métodos de aplicación del láser para mejorar la desinfección del SCR, los cuales podrían ser eficaces para reducir la población microbiana presentes al interior de los canales, por medio de la activación del irrigante utilizado. El empleo de láser también podría ser útil en procedimientos endodónticos quirúrgicos los cuales tienen por objetivo mantener el diente y sus raíces cuando el tratamiento convencional ha fallado, los efectos positivos del láser se centrarían en el descenso de la inflamación y del aumento de volumen, además de la disminución de la filtración de los materiales de sello ortógrado en dientes apicectomizados. Otro de los usos de láser en esta materia está relacionado con el manejo del dolor post-terapia endodóntica, el que se ha visto ser prometedor. Se definen dos tipos de láseres: de baja potencia, que produce una acción bioestimulante, analgésica y antiinflamatoria de los tejidos biológicos, utilizada además en procesos de descontaminación del SCR, y de alta potencia o láser quirúrgico, con el que se pueden realizar incisiones, exéresis, realizando funciones de corte y coagulación.

Lately, the use of laser in endodontics has gained acceptance, being considered as a complement to endodontic therapy, which aims to carry out an effective shaping, cleaning and disinfection of the root canal system (RCS), allowing an effective elimination of microorganisms present, and thus prevent reinfection of the canal. Different laser application methods have been adopted to improve the disinfection of the RCS, which could be effective in reducing the microbial population present inside the canals, by activating the irrigant used. The use of laser could also be useful in surgical endodontic procedures which aim to maintain the tooth and its roots when conventional treatment has failed, the positive effects of laser would focus on reducing inflammation and increasing volume, in addition of the reduction in the filtration of orthograde seal materials in apicoectomized teeth. Another use of laser in this area is related to post-endodontic therapy pain management, which has shown promise. Two types of lasers are defined; low-power, which produces a biostimulant, analgesic and anti-inflammatory action of biological tissues, also used in RCS decontamination processes, and high-power or surgical laser, with which incisions, excision, performing cutting functions and coagulation.

Láser de baja potencia como coadyuvante en tratamiento endodóntico de pieza con reabsorción interna y lesión apical: reporte de un caso / Use of low level laser as an adjunct in endodontic treatment of teeth with internal resorption and apical lesión

La reabsorción radicular interna es infrecuente en dentición permanente, la mayoría de los casos se observan en dientes anteriores, su etiología no está del todo clara, es por esto que el tratamiento para este tipo de lesiones es la endodoncia. Se presenta el caso de una paciente sexo femenino, 38 años de edad, sin antecedes médicos relevantes, derivada para evaluación de diente 2.2 con mal pronóstico. El diagnóstico es de absceso apical agudo, pieza con reabsorción interna y lesión apical. Se realiza endodoncia con cementos biocerámicos y aplicación de láser terapéutico de 808 nm de longitud de onda, con parámetros específicos para acelerar la reparación del tejido óseo. La terapia de fotobiomodulación con láser de baja potencia parece ser útil como coadyuvante en el proceso de reparación ósea en piezas con lesión apical y reabsorción interna tratadas endodónticamente.

Internal root resorption is infrequent in permanent dentition, most cases are observed in anterior teeth, its etiology is not entirely clear, which is why the treatment for this type of lesion is endodontics.We present the case of a 38-year-old female patient, without relevant medical history, referred for evaluation of tooth 2.2 with a poor prognosis. Diagnosis Acute apical abscess, tooth with internal resorption and apical lesion. Endodontics are performed with bioceramic cements and the application of a 808 nm wavelength therapeutic laser, with specific parameters to accelerate bone tissue repair.Low-level laser photobiomodulation therapy appears to be useful as an adjunct in the bone repair process in endodontically treated teeth with apical lesion and internal resorption.

Aplicabilidade da ozonioterapia na odontologia: uma revisão de literatura / Applicability of ozone therapy in dentistry: a literature review

A Ozonioterapia, método que utiliza a mistura gasosa de ozônio e oxigênio, é uma das Práticas Integrativas aprovadas pelo Ministério da Saúde. Atualmente é utilizada na Odontologia devido, principalmente, às suas características estruturais que permitem vastas aplicações. Essa Prática tem como principal objetivo os fins terapêuticos, por meio de propostas cada vez mais efetivas, que corroboram para técnicas e métodos capazes de propiciar tratamentos complementares a fim de curar e prevenir patologias inerentes à cavidade oral, contribuindo para a potencialização de resultados das técnicas já existentes. Em virtude da busca por técnicas complementares, a Ozonioterapia ganhou destaque e tem se mostrado efetiva e segura em diversas práticas odontológicas. O presente trabalho tem por objetivo, por meio de uma revisão de literatura, ressaltar as aplicabilidades do Ozônio (O3) na área odontológica, explicitando meios de utilização e suas respectivas ações, bem como, as contraindicações frente às ocorrências que acometem a cavidade oral.

Ozone therapy, a method that uses a gaseous mixture of ozone and oxygen, is one of the Integrative Practices approved by the Brazilian Ministry of Health. It is currently used in dentistry mainly due to its structural characteristics that allow a wide range of applications. This Practice focuses on therapeutic purposes through increasingly effective proposals that corroborate techniques and methods capable of providing complementary treatments in order to cure and prevent pathologies inherent to the oral cavity, contributing to the potentiation of results from existing techniques. Due to the search for complementary techniques, ozone therapy has gained prominence and has proven to be both effective and safe in several dental practices. This work aims at highlighting the applicability of Ozone (O3) in the dental area through a literature review, explaining means of use and their respective actions, as well as the contraindications to occurrences that affect the oral cavity.

Antimicrobial activity of antibiotic pastes used in pulp therapy through direct contact with a multispecies biofilm: a pilot study

Objective: To evaluate the antimicrobial activity of antibiotic pastes used in lesion sterilization and tissue repair (LSTR) technique, through a novel membrane direct contact methodology against a multispecies biofilm and to establish appropriate dilutions for this method. Methods: CTZ (chloramphenicol, tetracycline, zinc oxide) and two formulations of 3Mix pastes (ciprofloxacin, metronidazole, and minocycline), 3Mix1 and 3Mix3, were evaluated with negative (0.9% saline) and positive (chlorhexidine 0.2%) control groups. Candida albicans and Enterococcus faecalis (24-hour) biofilms (n=10) grown on cellulose membranes were directly exposed to standardized amounts of fresh pastes and control solutions (n=2) for 24h. Membranes were immersed in 900 µl of saline solution, and seven serial dilutions were made for each sample. Plating for each dilution (n=2) was performed on culture media for microbial colony-forming unit (CFU) counting of total microorganisms, Candida spp. and Enterococcus spp. Aiming the comparison between groups, CFU quantification data were transformed into log10 CFU / mL and the Mann-Whitney test was applied (p<0.05). Results: Inhibition of CFU was observed for all pastes, with greatest effects for CTZ paste in medium selective for Candida spp. (p<0.001) and 3Mix1 in non-selective (p<0.000) and selective for Enterococcus spp. (p<0.004). Conclusion: The pastes showed antimicrobial activity against the tested multispecies biofilm, and the proposed direct contact methodology was efficient. Moreover, the dilutions used proved to be appropriate for this methodology.

Objetivo: Avaliar a atividade antimicrobiana de pastas antibióticas utilizadas na técnica Lesion Sterilization and Tissue Repair (LSTR), através de nova metodologia de contato direto com membrana contra um biofilme multiespécies e estabelecer diluições adequadas para avaliação. Métodos: CTZ (cloranfenicol, tetraciclina,óxido de zinco) e duas formulações de pastas 3Mix (Ciprofloxacina, Metronidazol e Minociclina), 3Mix1 e 3Mix3, foram avaliadas, além dos grupos controle, negativo (solução salina a 0,9%) e positivo (clorexidina 0,2%). Biofilmes de Candida albicans e Enterococcus faecalis cultivados sobre membranas de celulose (n=10) durante24 h foram expostos diretamente em contato com quantidades padronizadas de pastas frescas e controles (n = 2) por 24 h. As membranas foram imersas em 900µL de solução salina e sete diluições seriadas foram obtidas por amostra. O plaqueamento para cada diluição (n = 2) foi realizado em meios de cultura para microrganismos totais e seletivos para Candida spp. e Enterococcus spp. para contagem de unidades formadoras de colônias (UFC). Para comparação entre grupos, os dados da contagem de UFC foram convertidos em log10 UFC / mL e o teste Mann-Whitney foi aplicado (p<0,05). Resultados: Observou-se inibição de UFC para todas as pastas, maior para CTZ no meio seletivo para Candida (p<0,001)e 3Mix1 nos demais meios (p<0,004). Conclusão: Concluiu-se que as pastas apresentaram atividade antimicrobiana contra o biofilme multiespécies testado e que a nova metodologia de contato direto proposta foi eficiente. Além disso, as diluições utilizadas mostraram-se adequadas para essa metodologia.

Regenerative Endodontic Treatment as a Biologically Based Approach for Non-Surgical Retreatment of Immature Teeth.

INTRODUCTION: The goal of regenerative endodontic treatment (RET) is to regenerate the pulp-dentin complex in immature teeth with pulp necrosis. There is no consensus in using RET in previously treated teeth. This article reports on long-term outcomes of RET in previously treated immature teeth. METHODS: Previously treated immature teeth with signs/symptoms of failure were included. After local anesthesia and rubber dam isolation, the root canal filling material was removed without the use of chemical solvents. The root canals were irrigated with 6% sodium hypochlorite using an EndoVac (Kerr Endodontics, Culver City, CA), and a creamy mix of metronidazole and ciprofloxacin was placed in the canals for 4 weeks. At the second visit, the antibiotic dressing was removed using 17% EDTA. Bleeding was induced into the root canal space, and SynOss Putty (Collagen Matrix Inc, Oakland, NJ) was placed. Bioceramic putty was placed over the SynOss Putty, and the teeth were restored at a subsequent visit. RESULTS: Five teeth in 4 patients were included. The patients' ages ranged from 14-46 years. Recall examinations were performed from 20 to 72 months with an average of 54.4 months. The apical openings of the teeth ranged from 1-3.7 mm. All teeth were functional and asymptomatic at the recall visits. All periapical lesions resolved with partial or complete mineralization of the root canals, and all teeth showed partial to complete apical closure at the follow-up visits. CONCLUSIONS: RET can be a viable option for nonsurgical retreatment of immature teeth. This article adds a new perspective to the field of regenerative endodontics.

Anesthetic efficacy of anterior middle superior alveolar injection in single-visit endodontic therapy: an in vivo study.

OBJECTIVES: To evaluate and compare the anesthetic efficacy of anterior middle superior alveolar (AMSA) injection in single-visit endodontic therapy, an in vivo study. MATERIALS AND METHODS: Teeth in the maxillary anterior segment (N = 60) requiring single-visit endodontic (SVE) therapy were selected. A conventional syringe with 26-guage needle containing 1.5 ml lignocaine with 1:80,000 epinephrine was used for the AMSA injection. The SVE therapy was performed using standard protocol. Profoundness of anesthesia during therapy was evaluated at 15-, 30-, 60-, and 90-min intervals using pain rating score and marked on visual analogue scale. In patients who reported pain/ineffectiveness of anesthesia during the course of endodontic therapy, additional supplemental anesthesia (buccal/labial infiltration) was administered. Depending on effectiveness of anesthesia with the AMSA injection alone or the need for additional supplementary injections, patients were divided as: group I-only AMSA and group II-AMSA with one or two supplemental anesthesia. RESULTS: The AMSA injection was effective in 91.67% of the patients undergoing the SVE therapy and the duration of anesthesia for the AMSA injection alone was adequate until the completion of the SVE therapy. Supplementary injections were required in 8.33% of cases at 15-min interval to achieve profound anesthesia. CONCLUSION: The AMSA injection technique could be used as an alternative to the conventional infiltration technique for anesthetizing teeth in maxillary anterior segment during the SVE therapy. CLINICAL RELEVANCE: The AMSA injection provides profound pulpal anesthesia of teeth in maxillary anterior segment during endodontic therapy.

Comparison of the effect of photobiomodulation therapy and Ibuprofen on postoperative pain after endodontic treatment: randomized, controlled, clinical study.

The aim of the study was to compare the effect of Ibuprofen and the application of photobiomodulation therapy protocol on the reduction of postoperative pain in endodontically treated teeth using a randomized clinical trial design. Seventy patients, diagnosed with symptomatic irreversible pulpitis, were selected. Treatment was performed by a single operator; a reciprocal system was used to prepare the canals; they were obturated using the Tagger's hybrid technique and coronally sealed with glass-ionomer cement. After treatment, patients were randomly divided into 2 groups. In the active control group, two Ibuprofen 600 mg tablets were administered within a 12-h interval. In the photobiomodulation therapy group, the irradiation was applied after treatment. The evaluation of postoperative pain was performed by another researcher blinded to the groups at 6, 12, 24, and 72 h intervals after treatment. To measure the outcome, two pain scales were used: numerical rate scale (NRS) and verbal rate scale (VRS). Data were analyzed using the chi-square, Mann-Whitney, and Wilcoxon paired tests. Outcome was superior with photobiomodulation therapy at 6 h (p < 0.001), 12 h (p = 0.005), and 24 h (p < 0.001) intervals compared with Ibuprofen. The results for the 72 h (p = 0.317) interval were similar, both in the VRS and NRS scales. It may be concluded that the use of photobiomodulation therapy was effective in reducing pain within the first 24 h when compared with the administration of Ibuprofen 600 mg.

Bactericidal and Smear Layer Removal Efficacy of Herbal Alternatives Against Enterococcus Faecalis Dentinal Biofilm - An ex-vivo Study

Abstract Objective: To assess the antibacterial and smear layer removal ability of Trigonella foenum, Syzygium cumini, Terminalia chebula seed extracts against E. faecalis dentinal biofilm. Material and Methods: Agar well diffusion, micro broth dilution assay and time-kill curve assay were performed to determine the antibacterial activity. The ability of the herbal extracts to remove the smear layer on the root canal surface was assessed by scanning electron microscopy. Results: Antibacterial activity was observed for the extracts of S. cumini and T. chebula on E. faecalis dentinal biofilm and its planktonic counterparts. The smear layer was efficiently removed by the seed extracts of T. chebula alone. Seed extracts of T. foenum neither possessed antibacterial effect nor smear layer removal ability. Conclusion: The extracts of T. chebula seeds may replace conventional irrigant due to its antibacterial properties and smear layer removing the ability. The extracts of S. cumini may be used as an intracanal medicament as it exhibited a bactericidal effect against the E. faecalis dentinal biofilm following 18 hours of incubation.