Antibacterial and Solubility Analysis of Experimental Phytotherapeutic Paste for Endodontic Treatment of Primary Teeth

ABSTRACT Objective: To evaluate the antibacterial effect and the solubility of experimental root canal filling pastes containing the phytoconstituents terpineol and cinnamaldehyde. Material and Methods: Minimum Inhibitory Concentration (MIC) of each phytoconstituent was determined against Enterococcus faecalis. Five groups of antibiotic pastes based on zinc oxide were obtained by mixing: only terpineol, only cinnamaldehyde, terpineol and cinnamaldehyde combined, chlorhexidine (antibiotic control), and CTZ paste (control paste). Antibacterial activity was analyzed through direct contact test within 24 and 72 hours. Solubility was evaluated by spectrophotometry within 48 and 144 hours. Antibacterial activity data were analyzed descriptively, and solubility data was analyzed using ANOVA and Tukey tests (p<0.05). Results: The MIC obtained for terpineol and cinnamaldehyde were, respectively, 2000 µg/mL and 500 µg/mL. After 24h, only the terpineol paste did not inhibit E. faecalis growth. After 72h, all groups inhibited E. faecalis growth. After 48h, the highest solubility was verified in the terpineol paste (p<0.05), and no differences were detected among other groups (p>0.05). After and 144h, highest solubility was observed in the terpineol paste (p<0.05), followed by the CTZ paste (p<0.05). No differences were detected for cinnamaldehyde, terpineol+cinnamaldehyde and chlorhexidine pastes (p>0.05). Conclusion: Pastes containing cinnamaldehyde or terpineol+cinnamaldehyde showed antibacterial activity against E. faecalis similar to CTZ paste, with lower solubility.

Obturación con óxido de zinc-eugenol y formocresol en casos de fractura de instrumento intraconducto: seguimiento de 54 casos durante 8 años / Obturation with zinc oxide-eugenol and formocresol in cases of intracanal fractured instruments: 8 years follow-up study of 54 cases

Introducción: El objetivo de este estudio es presentar los resultados del seguimiento durante 8 años de 54 casos de instrumentos rotos intraconducto, que no pudieron ser removidos y/o sobrepasados, y que fueron obturados con óxido de zinc-eugenol (ZOE) y formocresol. Material y métodos: Se incluyeron 54 pacientes con fractura de instrumentos en conductos radiculares de dientes posteriores, 23 no presentaban lesión periapical y 31 tenían lesión. Los instrumentos fracturados tenían longitudes de 2-4 mm en tercio apical y no pudieron ser removidos y/o sobrepasados con ninguna técnica. Los conductos fueron preparados al borde del instrumento fracturado, hasta un calibre 45 en dirección apical con técnica telescópica, irrigando con hipoclorito de sodio al 3% y desmineralizando con 0,25 ml de EDTA al 16%, lavados con 3 ml de solución fisiológica y secados con puntas de papel, se obturaron utilizando 0,01 ml de formocresol, 0,05 ml de eugenol mezclados con óxido de zinc y cono de gutapercha calibre 45 mediante condensación lateral. Los conductos restantes fueron instrumentados telescópicamente y obturados con gutapercha y ZOE mediante condensación lateral. Resultados: Se realizaron controles clínicos y radiográficos a uno, tres, cinco y ocho años. Al año, los casos oscilaron entre 83,9-95,7% asintomáticos y negativos a la percusión, fístula ausente entre 93,5-100% y sin lesión periapical de 32,3-91,3%. A tres años, 96,8-100% asintomáticos y negativos a la percusión, ausencia de fístula y sin lesión de 80,6-95,7%. A cinco años, 96,8-100% asintomáticos y negativos a la percusión, ausencia de fístula y 93,5- 100% sin lesión. A ocho años, 100% asintomáticos, negativos a percusión, ausencia de fistula y 93,5-95,7% sin lesión. Conclusiones: La utilización de ZOE-formocresol es una alternativa terapéutica exitosa en casos de instrumentos fracturados que no pudieron ser removidos y/o sobrepasados

Introduction: The aim of this study is to present the results of monitoring over 8 years of 54 cases of intracanal broken instruments, which could not be removed and/or bypassed, and were sealed with zinc oxide-eugenol (ZOE) and formocresol. Material and methods: Fifty-four patients with broken instruments in root canals of posterior teeth, 23 had no periapical lesion and 31 had periapical lesion. Fractured instruments were had lengths of 2-4 mm in apical third and were not removed and/or exceeded with any technique. Root canals were prepared at the edge of the fractured instrument using the telescope technique up to 45 file. Irrigation was performed with sodium hypochlorite 3% and 0.25 ml of 16% EDTA. Then, the root canals were washed with saline solution 3 ml and dried with paper points. Obturation was carried out using 0.01 ml formocresol plus 0.05 ml of eugenol mixed with zinc oxide and a guttapercha master cone number 45 using lateral condensation. Remaining canals were telescopically instrumented and filled with guttapercha and ZOE by lateral condensation. Results: Clinical and radiographic controls at one, three, five and eight years were performed. After one year, 83.9-95.7% were asymptomatic and negative to percussion, absent fistula between 93,5-100%, without periapical lesion 32,3-91,3%. After three years 96,8-100% asymptomatic and negative on percussion, absence of fistula, without periapical lesion 80,6-95,7%. At five years 96,8-100% asymptomatic and negative on percussion, absence of fistula and 93,5- 100% without periapical lesion. In eight years, 100% asymptomatic, negative percussion and absence of fistula and 93,5-95,7% without periapical lesion. Conclusions: The use of zinc oxide-eugenol and formocresol is a successful therapeutic option in cases of fractured instruments that could not be removed and/or exceeded

Consideraciones metodológicas sobre el estudio de la adaptación del cemento sellador a las paredes del conducto: comparación entre el microscopio electrónico de barrido y el confocal láser / Methodological considerations on the study of endodontic sealer adaptation to root canal walls: comparison between scanning electronic and laser confocal microscopes

Objetivo: Evaluar la correlación entre las observaciones con el microscopio electrónico de barrido (MEB) y con el microscopio confocal láser (MCL) para el estudio de la adaptación a las paredes del conducto de TopSeal. Material y métodos: Diez dientes unirradiculares fueron instrumentados con el sistema de limas rotatorias MTwo hasta el 35/.04. Se irrigó con 5 ml de NaOCl (5,25%) entre limas y con 5 ml de EDTA (17%) como irrigante final. La obturación se realizó con condensación lateral utilizando conos de gutapercha y cemento TopSeal marcado con un fluorocromo. Se obtuvieron secciones transversales a 3, 5 y 8 milímetros del ápice, que fueron analizadas con MCL y luego metalizadas y observadas con MEB. Se estableció el grado de adaptación al perímetro del conducto en cada sección con ambos procedimientos. En el análisis estadístico se utilizaron el coeficiente de correlación de Pearson para la evaluación de la interfase cemento-dentina entre ambos métodos y el ANOVA para el análisis de la penetración intratubular del cemento evaluada con MCL. Resultados: El coeficiente de correlación de Pearson fue de 0,75 (p = 0,001) para los porcentajes medios de adaptación. Medias: MCL 71,40 y MEB 83,67. Los coeficientes para los tercios apical, medio y coronal fueron 0,940, 0,772 y 0,877 respectivamente, en todos los casos significativos. Respecto a la penetración del cemento sellador, no se encontraron diferencias significativas en los niveles estudiados. Conclusiones: Ambas técnicas microscópicas son complementarias, mientras que el MEB proporciona mayor seguridad en el estudio de la interfase, el MCL permite analizar la penetración intratubular del material

Aim: To compare two different microscopic techniques (SEM and CLSM) in studying filling materials adaptation to canal walls. Material and Methods: Ten sound extracted single-rooted teeth were selected, instrumented and filled with gutta-percha and TopSeal using lateral condensation technique. Following root filling, teeth were sectioned transversally at 3, 5 and 8 mm from the apex and analyzed using Confocal Laser Scanning Microscope and Scanning Electronic Microscope. Percentage of root canal perimeter with sealer penetration to the dentinal tubules and depth of penetration were compared between groups and statistically analyzed using a Pearson correlation analysis (p=0.001) and ANOVA test for intratubular penetration. Pearson’s correlation coefficient for the whole sample was 0.75 (p=0.001). Results: When comparing sealer adaptation to dentinal walls between thirds, apical medium and coronal, mean values were statistically significant: 0.940, 0.772 and 0.877 respectively. For intratubular penetration no significant difference between root canal thirds was found. Conclusions: Both techniques are complementary in the study of endodontic filling materials performance inside root Canals

Use of fluid filtration method to evaluate the effect of master cone size on the apical seal of severely curved root canals.

The apical third of most root canals shows some degree of curvature, which is important in cleaning/shaping and obturation during root canal treatment. The present study evaluated the effect of master cone size on the apical seal of severely curved root canals. Thirty-eight mesial roots of human mandibular first molars were prepared using the crown-down technique. All samples were mature roots with closed apices, had no carious lesions or resorption, and had a canal curvature of > 45º to 60º. Two samples were used as a negative and positive control to evaluate the fluid filtration equipment, and the remaining 36 samples were equally divided into groups A, B, and C based on master cone size, namely, gutta-percha #20, #25, and #30, respectively. The fluid filtration method was used to evaluate microleakage. No significant difference in microleakage was observed among groups (P = 0.31). In conclusion, an increase in master cone size up to #30 does not significantly influence apical microleakage.

Comparative study of the sealing ability of the lateral condensation technique and the BeeFill system after canal preparation by the Mtwo NiTi rotary system.

The purpose of this in vitro study was to compare the sealing ability of the lateral condensation technique and the BeeFill system after canal preparation by the Mtwo rotary system. Forty extracted single-rooted teeth were prepared by using the Mtwo rotary system. The teeth were then divided into 2 experimental groups (n = 15 each) and 2 control groups (n = 5 each). The specimens in groups 1 and 2 were obturated using the lateral condensation technique and the BeeFill system, respectively. The teeth in the negative control group were also obturated with the lateral condensation technique, and the specimens in the positive control group were not root-filled. The specimens were then immersed in an aqueous solution of 2% China ink for 1 week, after which the roots were cleared and the linear extent of dye penetration was measured with a stereomicroscope by 2 endodontists. The data collected were then analyzed by using the 1-sample Kolmogorov-Smirnov test and independent t test, with a significance level of P < or = 0.05. Although the mean (+/- standard deviation) dye leakage in the BeeFill thermoplasticized injection group was less than that in the lateral condensation group (1.497 +/- 0.7 vs. 2.521 +/- 1.733), there was no significant difference between the experimental groups on the parametric independent t-test (P = 0.209).

Analysis of the gutta-percha filled area in C-shaped mandibular molars obturated with a modified MicroSeal technique.

AIM: To analyse the gutta-percha filled area of C-shaped molar teeth root filled with the modified MicroSeal technique with reference to the radiographic features and the C-shaped canal configuration. METHODOLOGY: Twenty-three mandibular second molar teeth with C-shaped roots were classified according to their radiographic features as: type I--merging, type II--symmetrical and type III--asymmetrical. The canals were root filled using a modified technique of the MicroSeal system. Horizontal sections at intervals of 600 mum were made 1 mm from the apex to the subpulpal floor level. The percentage of gutta-percha area from the apical, middle and coronal levels of the radiographic types was analysed using the Kruskal-Wallis test. Complementary analysis of the C-shaped canal configurations (C1, C2 and C3) determined from cross-sections from the apical third was performed in a similar way. RESULTS: No significant differences were found between the radiographic types in terms of the percentage of gutta-percha area at any level (P > 0.05): apical third, type I: 77.04%, II: 70.48% and III: 77.13%, middle third, type I: 95.72%, II: 93.17%, III: 91.13% and coronal level, type I: 98.30%, II: 98.25%, III: 97.14%. Overall, the percentage of the filling material was lower in the apical third (P < 0.05). No significant differences were found between the C-shaped canal configurations apically; C1: 72.64%, C2: 79.62%, C3: 73.51% (P > 0.05). CONCLUSIONS: The percentage of area filled with gutta-percha was similar in the three radiographic types and canal configuration categories of C-shaped molars. These results show the difficulty of achieving predictable filling of the root canal system when this anatomical variation exists. In general, the apical third was less completely filled.

Perforation repair and one-step apexification procedures.

As with any dental treatment, procedural mishaps can occur during root canal therapy. One such occurrence is the perforation of a root or pulpal floor. After a perforation occurs, the goals are to "sterilize" (decontaminate) the site and then seal the perforation. The material most widely used in endodontics to seal perforations is mineral trioxide aggregate (MTA). MTA us extremely biocompatible, and it has been shown historically that osteoidlike material grows right into MTA. The technique of one-step apexification offers an alternative to draw-out cases with several medicament-changing appointments that often result in a failed attempt at root-end closure. With the favorable histologic response of MTA, this material is the best current choice for this procedure. Completion of these cases in an effective and efficient way allows for permanent restorations to be done in a more timely manner, prolonging the longevity of these teeth.

MTA: sus posibilidades de uso en endodoncia y odontología integral / MTA: possibilities of use in endodontics and comprehensive dentistry

El MTA es un material inicialmente desarrollado para uso endodóntico; sin embargo ha demostrado poseer cualidades que le otorgan grandes posibilidades para ser utilizado en otras especialidades clínicas relacionadas. Es fácil de usar, y al ser hidrofílico, su empleo resulta sumamente útil en obturaciones retrógradas, perforaciones radiculares o de furcación, áreas donde generalmente existe humedad o contaminación sanguínea. Las investigaciones pertinentes han demostrado que sus excelentes propiedades fisicoquímicas y biológicas lo transforman en un material que presenta muchas ventajas sobre otros materiales alternativos, especialmente porque, a diferencia de ellos, promueve y favorece en forma consistente el desarrollo y aposición de hueso y cemento y la regeneración de los tejidos periodontales. Por ser un material tan promisorio se hace necesaria una evaluación exhaustiva de su uso clínico en humanos, a efectos de establecer una correlación más adecuada con los resultados obtenidos en las experiencias realizadas in vitro y en animales de experimentación (AU)

MTA: sus posibilidades de uso en endodoncia y odontología integral / MTA: possibilities of use in endodontics and comprehensive dentistry

El MTA es un material inicialmente desarrollado para uso endodóntico; sin embargo ha demostrado poseer cualidades que le otorgan grandes posibilidades para ser utilizado en otras especialidades clínicas relacionadas. Es fácil de usar, y al ser hidrofílico, su empleo resulta sumamente útil en obturaciones retrógradas, perforaciones radiculares o de furcación, áreas donde generalmente existe humedad o contaminación sanguínea. Las investigaciones pertinentes han demostrado que sus excelentes propiedades fisicoquímicas y biológicas lo transforman en un material que presenta muchas ventajas sobre otros materiales alternativos, especialmente porque, a diferencia de ellos, promueve y favorece en forma consistente el desarrollo y aposición de hueso y cemento y la regeneración de los tejidos periodontales. Por ser un material tan promisorio se hace necesaria una evaluación exhaustiva de su uso clínico en humanos, a efectos de establecer una correlación más adecuada con los resultados obtenidos en las experiencias realizadas in vitro y en animales de experimentación

Coronal leakage: effects of smear layer, obturation technique, and sealer.

Coronal microleakage may be a major factor in the etiology of treatment failure. This study examined the effect of obturation technique, sealer, and the presence of smear layer on coronal microleakage. Two hundred extracted human teeth were assigned to 20 treatment groups. Groups were examined with the smear layer present or smear layer removed (17% REDTA). Access cavities were exposed to artificial saliva then Pelikan Ink. Teeth were cleared and linear dye penetration measured. When all groups with the smear layer removed were compared with all groups with the smear layer present, significantly less leakage was seen when the smear layer was removed. Ultrafil displayed significantly more leakage than all other groups. Vertical compaction of lateral condensation and Thermafil obturations significantly reduced leakage. AH-26 displayed significantly less leakage than Roth's 811 sealer. These results indicate that removal of the smear layer, the use of AH-26, and vertical compactin have cumulative effects in reducing coronal leakage.

[The use of biocompatible materials in apicoectomy]. / Het gebruik van biocompatibele materialen voor de apicotomie.

The use of more biocompatible materials in comparison with silver, gutta-percha and amalgam was introduced a decade ago. First titanium was used, later followed by alumina. Both clinical as well as radiological results favor their use. Yet it appears that the system is mainly confined to the maxillary front teeth and mandibular canines.