Procedimentos regenerativos endodônticos com clorexidina a 2% e hidróxido de cálcio: relato de caso / Endodontic regenerative procedures with 2% chlorhexidine and calcium hydroxide: case report

Introdução: Muitas substâncias têm sido utilizadas como irrigantes e curativos intracanal nos tratamentos de dentes com rizogênese incompleta, visando obter a regeneração pulpar. A clorexidina a 2% em associação com hidróxido de cálcio P.A. pode ser uma alternativa. Métodos: No presente caso clínico, o dente #45 com periodontite apical, em um paciente com 13 anos de idade, foi tratado com solução de clorexidina a 2% como irrigante. A clorexidina na forma de gel a 2% foi utilizada como auxiliar da instrumentação e, em associação com o hidróxido de cálcio, foi utilizada como curativo durante 14 dias. Após esse período, o canal foi irrigado com solução fisiológica e, sob anestesia alveolar mandibular, uma lima K #70 foi utilizada ultrapassando levemente o ápice, para causar sangramento. Após observar que o sangue dentro dos canais alcançou a porção cervical, o cimento biocerâmico MTA Branco foi colocado na porção cervical do canal. Resultados: A apicificação e o desenvolvimento da raiz em comprimento e largura puderam ser observados já no controle de três meses, e continuaram até a última revisão, no controle de um ano. Alterações de cor não foram observadas nese período de acompanhamento. Conclusões: A clorexidina associada ao hidróxido de cálcio pode ser uma alternativa aos procedimentos de regeneração pulpar (AU).

Introduction: Many substances have been used as irrigating solutions to promote pulp regeneration and root development in teeth with incomplete rhizogenesis. The use of 2% chlorhexidine as an irrigating solution in association with Calcium Hydroxide could be an alternative. Methods: In the case of the patient, a 13-year-old boy, here presented, tooth 45 with apical periodontitis was treated with 2% Chlorhexidine solution as irrigant adjuvant to instrumentation, in association with Calcium Hydroxide used as a dressing for 14 days. After this period, the canal was cleaned with a physiological solution and under mandibular alveolar anesthesia, a # 70 K file was used slightly over the apex to cause bleeding. After observing that blood inside the canals had reached the cervical portion. White MTA was placed in the cervical portion of the canal. Results: Induced apexification and development of increasing root length and width could already be observed in the three-month control exam, and this continued until the last review in the one-year control exam. No color changes were observed in this follow-up period. Conclusions: Chlorhexidine and calcium hydroxide could be used as an alternative to pulp regeneration procedures (AU).

Uso do endoactivator no tratamento endodôntico / Use of the endoactivator in endodontic treatment

Introdução: a irrigação é uma das etapas essenciais no preparo biomecânico e, buscando aumentar a eficiência desta, novos métodos vem sendo empregados no intuito de melhorar a ação e o alcance das soluções irrigadoras. Objetivo: analisar a eficácia do sistema EndoActivator em várias etapas do tratamento endodôntico. Resultados e discussão: apesar de diferenças de metodologias na literatura, o EndoActivator apresentou bons resultados em comparação com a irrigação convencional quando empregado em diferentes fases do tratamento endodôntico. Conclusão: o sistema EndoActivator é seguro e eficaz durante o preparo biomecânico, porém, assim como outros dispositivos de agitação mecânica da solução irrigante, não é capaz de promover completa limpeza dos canais radiculares.

Introduction: the irrigation is an essential part of biomechanical preparation and seeking increase the efficiency of this, new methods have been used in order to expand the effect of irrigating solutions, and promote the reach for areas with difficult access. Objective: the objective of this literature review was to analyze the effectiveness of the EndoActivator system in several stages of endodontic treatment. Results and Discussion: despite differences in methodologies in the literature, the EndoActivator presented good results in comparison to conventional irrigation when used in different phases of endodontic treatment. Conclusion: the EndoActivator system is safe and effective during biomechanical preparation, but, like other mechanical agitation devices of the irrigating solution, it is not able to promote complete cleaning to root canals.

Use of a 660-nm Laser to Aid in the Healing of Necrotic Alveolar Mucosa Caused by Extruded Sodium Hypochlorite: A Case Report.

The extrusion of sodium hypochlorite through the apical foramen is an accident that can occur during the flushing procedure in endodontic treatment. The symptomatology is immediate and intense, and there is a long period before the tissues return to normal. Low-level laser therapy might be useful as an adjunctive treatment for damaged soft tissues because of its anti-inflammatory and analgesic effects, which may reduce edema and prevent infection. In this clinical case, the accidental leakage of 1% sodium hypochlorite during the preparation of the root canal of a maxillary right central incisor is reported. This leakage caused immediate and intense pain and edema formation and resulted in an extensive necrotic area in the alveolar mucosa adjacent to the root of the treated tooth. The conventional treatment protocol was combined with low-level laser therapy. Clinical and radiographic examinations after 7 months revealed complete repair of the necrotic area with no paresthesia and further indicated the integrity of the apical region of the tooth where the extrusion of sodium hypochlorite occurred. The combination of low-level laser therapy with a conventional treatment protocol in this case of the extrusion of 1% sodium hypochlorite resulted in the healing of the wounds.

Antibacterial Properties Associated with Chitosan Nanoparticle Treatment on Root Dentin and 2 Types of Endodontic Sealers.

INTRODUCTION: The aim of this study was to evaluate the efficacy of carboxymethyl chitosan (CMCS) and chitosan nanoparticles (CNps) to inactivate bacteria and prevent biofilm formation at sealer-dentin interfaces. METHODS: The study was divided into 3 stages: first stage, the experiment was conducted to analyze the antibacterial properties of CMCS in different formulations against biofilms; second stage, direct-contact and membrane-restricted methods were used to evaluate the antibacterial properties of an epoxy resin (ThermaSeal Plus; Dentsply Tulsa Dental, Tulsa, OK) and calcium silicate (MTA Fillapex; Angelus SA, Londrina, PR, Brazil) based-sealers with or without CNps; and third stage, biofilm formation at the sealer dentin interfaces of root dentin treated with CMCS and filled with gutta-percha and CNp incorporated sealer were analyzed after 1- and 4-week aging periods. The samples were treated and filled as follows: (1) distilled water: unaltered sealer (control group), (2) CMCS: sealer+CNps (CMCS group), and (3) CMCS/rose bengal: sealer+CNps (CMCS/RB group). Enterococcus faecalis was used to infect all the samples. Microbiological and microscopic analyses were used to assess the antibacterial characteristics. RESULTS: CMCS-based treatments effectively killed bacteria adherent on root dentin (P < .05). The addition of CNps to ThermaSeal enhanced its antibacterial ability by direct-contact and membrane-restricted tests (P < .05). The CNp incorporation significantly increased the antibacterial efficacy of root canal sealers even after a 4-week aging time (P < .05). CONCLUSIONS: This study highlighted the ability of CMCS to disinfect root canal dentin and inhibit bacterial adhesion. CNps in root canal sealers are capable of maintaining their antibacterial activity even after prolonged aging.

Reação do tecido subcutâneo de rato à implantação do MTA branco e Ultrapex com e sem própolis / Reaction of connective tissues rats to implantation of white MTA and Ultrapex with or without propolis

O objetivo deste estudo foi comparar a reação do tecido subcutâneo de rato, frente a implantação de MTA branco-Angelus® e Ultrapex® com e sem própolis. Tubos de polietileno, preenchidos com MTA branco, MTA branco+própolis, Ultrap ex® e Ultrapex®+própolis foram implantados em tecido subcutâneo de 21 ratos Wistar (Rattus norvegicus). Os animais foram mortos aos 30, 45 e 60 dias. O tecido contendo o implante foi removido e processado histologicamente.Cortes seriados de 5μm foram corados pela hematoxilina e eosina em que se avaliou a intensidade do infiltrado inflamatório, característica da cápsula fibrosa e dispersão do material. A esses dados foi aplicado o teste do Qui-quadrado o qual se observou diferença estatisticamente significante entre os quatro materiais experimentais. O MTA branco+própolis foi o que apresentou uma menor reação tecidual, seguido do MTA branco, Ultrapex®+própolis e Ultrapex®. A adição da própolis melhorou o comportamento biológico dos materiais em teste

The aims of this study was to compare the reaction of white MTA-Angelus® and Ultrapex® with and without propolis. Polyethylene tubes filled with white MTA, white MTA+propolis, Ultrapex, Ultrapex®+propolis were implanted in subcutaneous tissue of 21 Wistar rats (Rattus norvegicus). The animals were killed at 30, 45 and 60 days. The tissue containing the implant was removed and processed histologically. Serial sections of 5μm were stained with hematoxylin and eosin. They were evaluated the inflammatory infiltrate, and characteristic of fibrous capsule anddispersal of the material. The data was applied to the Chi-square where there was a statistically significant difference among the four experimental materials. White MTA + propolis showed a more favorable tissue reaction, followed by white MTA, Ultrapex® + propolis and Ultrapex®. The propolis has improved the biological behavior of materials under test

Capacidade de limpeza de alguns agentes auxiliares do preparo biomecânico em dentes portadores de canais laterais (Estudo em microscopia eletrônica de varredura) / Cleaning efficiency assessment of some auxiliary substances during the preparation of teeth with lateral canals (a SEM study)

O objetivo deste trabalho foi avaliar a eficiência de limpeza de diferentes substâncias irrigadoras auxiliares durante o preparo biomecânico em dentes portadores de canais laterais. Foram utilizados 40 dentes pré-molares inferiores humanos recém-extraídos, com canal único. Confeccionou-se em cada dente, três canais laterais (terços cervical, médio e apical). Os dentes foram divididos em quatro grupos, em função das substâncias utilizadas: Grupo I-Hipoclorito de sódio a 1% + EDTA; Grupo II-Endo-PTC + hipoclorito de sódio a 0,5%; Grupo III-File-Eze; Grupo IV-Clorexidina a 2%, em forma de gel. O preparo biomecânico dos canais radiculares foi realizado utilizando o sistema de instrumentação rotatória, Profile 0.04, técnica “crown-down”. Apos o preparo dos canais as raízes foram seccionadas longitudinalmente e então preparadas para análise das paredes dos canais em microscopia eletrônica de varredura, a qual se analisou a obstrução ou não dos canais laterais.O hipoclorito de sódio associado ao EDTA propiciou menor obstrução dos canais laterais; mais obstruções ocorreram no terço apical.

The aim of this work was to assess the cleaning efficiency of different auxiliary substances during the biomechanical preparation of teeth with lateral canals. 40 human lower pre-molar teeth with just one canal were used; three lateral canals (cervical, mid and apical thirds) were made in each tooth. The teeth were divided into 4 groups of 10 specimens each according to the substance used: Group I-1% sodium hypochlorite + EDTA; Group II-Endo-PTC + 0,5% sodium hypochlorite; Group III-File-Eze; Group IV-2% Chlorexidine gel. The root canal biomechanical preparation was carried out using rotating instrumentation, Profile 04 with “crown-down” technique.The teeth were split along their long axis in a buccolingual direction and prepared for scanning electron microscopic analysis. The results concluded that the sodium 1% sodium hypochlorite + EDTA showed best cleaning of lateral canal; apical third showed most obstruction of lateral canal.

Antibacterial activity of propolis-based toothpastes for endodontic treatment / Atividade antibacteriana de pastas dentífricas com base de própolis para tratamento endodôntico

This study evaluated the antibacterial activity of propolis-based toothpastes used as intracanal medication in endodontic treatment. The propolis-based toothpastes were prepared using an extract established in previous studies (identified as A70D and D70D). Calcium hydroxide paste was used as a control. The bacteria employed were Streptococcus mutans (ATCC 25175), Staphylococcus aureus (ATCC 6538), Staphylococcus aureus (ATCC 25923), Kocuria rhizophila (ATCC 9341), Escherichia coli (ATCC 10538), Pseudomonas aeruginosa (ATCC 27853), Enterococcus hirae (ATCC 10541), Streptococcus mutans (ATCC 25175). Five field strains isolated from saliva were used: Staphylococcus spp. (23.1 - coagulase positive), Staphylococcus spp. (23.5 - coagulase negative), Staphylococcus spp. (26.1 - coagulase positive), Staphylococcus spp. (26.5 - coagulase negative) and Staphylococcus epidermidis (6epi). The diffusion-well method on double-layer agar was used in a culture medium of Tryptic Soy Agar. The plates were kept at room temperature for two hours to allow the diffusion of pastes in the culture medium, and then incubated at 35º C for twenty-four hours in aerobiosis and in microaerophilia (S. mutans). After this period, the total diameter of the inhibition halo was measured. The results were analyzed by ANOVA analysis of variance, followed by the Tukey test at p<0.05. The propolis-based toothpastes presented antibacterial activity against 83.3 percent of the analyzed bacteria. For 66.7 percent of these bacteria, the propolis-based toothpastes exhibited greater antibacterial activity than calcium hydroxide. The present results allow us to conclude that the experimental pastes A70D and D70D showed good activity against aerobic bacteria, proving more effective than calcium hydroxide.

O objetivo deste estudo foi avaliar a atividade antibacteriana de formas farmacêuticas a base de própolis para uso no tratamento endodôntico como medicação intracanal. As formulações de própolis, em forma de pastas, foram preparadas a partir de um extrato pré-estabelecido em estudos anteriores e identificadas como A70D e D70D. Como controle, foi utilizado pasta de hidróxido de cálcio. As bactérias utilizadas foram: Streptococcus mutans (ATCC 25175), Staphylococcus aureus (ATCC 6538), Staphylococcus aureus (ATCC 25923), Kocuria rhizophila (ATCC 9341), Escherichia coli (ATCC 10538), Pseudomonas aeruginosa (ATCC 27853), Enterococcus hirae (ATCC 10541), Streptococcus mutans (ATCC 25175) e 5 cepas de campo isoladas da saliva: Staphylococcus spp. (23.1 - coagulase positiva), Staphylococcus spp. (23.5 - coagulase negativa), Staphylococcus spp. (26.1 - coagulase positiva), Staphylococcus spp. (26.5 - coagulase negativa) e Staphylococcus epidermidis (6epi). Foi utilizado o método poço difusão em camada dupla de ágar, em meio de cultura Tryptic Soy Agar. As placas foram mantidas à temperatura ambiente por 2 h para permitir a difusão das pastas no meio de cultura, e então incubadas a 35 ºC por 24 h em aerobiose e em microaerofilia (S. mutans). Após este período, foi medido o diâmetro total do halo de inibição. Os resultados foram submetidos ao teste de análise de variância ANOVA seguido do teste de Tukey com p<0,05. As pastas a base de própolis apresentaram atividade antibacteriana contra 83,3 por cento das bactérias analisadas. Para 66,7 por cento das bactérias, as pastas de própolis apresentaram maior atividade antibacteriana que o hidróxido de cálcio, e este foi mais efetivo apenas para Streptococcus mutans (ATCC 25175), Staphylococcus aureus (ATCC 25923) e Pseudomonas aeruginosa (ATCC 27853). De acordo com a metodologia utilizada, pode-se concluir que as pastas experimentais A70D e D70D apresentam boa atividade contra bactérias aeróbias...