Comparative evaluation of fracture resistance among conventional versus herbal irrigants in root canal treated teeth: In vitro study.

To evaluate the efficacy of conventional irrigants and herbal extracts materials which helps to resist fracture of endodontically treated teeth. 75 maxillary human permanent incisor teeth instrumented using ProTaper rotary files till apical size(F4). Instrumented samples divided into 5 groups with n = 15 based on various irrigants used. Group I: normal saline, Group II: 5% sodium hypochlorite (NaOCl), Group III: 2% chlorohexidine, Group IV: 10% Azadirachta indica (neem extract) and Group V: 10% Ocimum sanctum (tulsi extract).After that, root canals were proceeded to be filled by using single gutta-percha cone and Sealapex sealer. Specimens were then prepared and loaded until root fracture occurred. Maximum mean flexural strength of dentin (fracture resistance) was obtained from group treated with 2% chlorohexidine and 10% neem extract. Least fracture resistance was observed with 5% NaOCl. Herbal irrigants can be used as an alternative to NaOCl as they exhibit high fracture resistance.

Comparison of the push-out bond strength of AH Plus sealer to dentin after using different herbal irrigation solutions as the final rinse.

The aim of the present study was to evaluate the push-out bond strength of AH Plus sealer to dentin treated with the essential oils of Cumimum cyminum and Cinnamomum zeylanicum as herbal final irrigants. Forty human mandibular first premolars were selected. After smear layer removal, the samples were divided into 4 groups and irrigated with experimental solutions for 1 min and later with distilled water. G1: Cinnamomum zeylanicum (CZ) in minimum inhibitory concentration (MIC); G2: Sodium hypochlorite 2.5%; G3: Sodium hypochlorite in MIC; G4: Cuminum cyminum (CC) in MIC. After obturation, the roots were sectioned in order to obtain 1-mm discs for push-out assessment. The push-out test was performed using a universal testing machine. The slices were examined using a stereomicroscope at 30× to determine the mode of failure. The data were analyzed using one-way analysis of variance and Tukey's post-hoc test. The teeth irrigated with CZ showed significantly lower push-out resistance than those irrigated with NaOCl 2.5% and NaOCl at MIC. The other groups had no significant difference. The modes of failure were predominantly mixed. Under the limitations of the present study, CC does not have adverse effects on the bond strength of AH Plus and can be used as a good alternative for currently used final irrigants.

Long-term porosity and retreatability of oval-shaped canals obturated using two different methods with a novel tricalcium silicate sealer.

OBJECTIVE: To evaluate the percentage volume of voids and gaps in oval-shaped canals obturated using two different methods with a tricalcium silicate-based sealer after short- or long-term storage. The long-term effect of storage on the efficiency of removing filling material was also investigated. MATERIALS AND METHODS: Forty premolar teeth with oval-shaped canals were instrumented to Reciproc R25 and obturated using single cone obturation (SCO) or warm vertical compaction (WVC) techniques with gutta-percha and HiFlow sealer. The specimens were stored at 100% humidity and 37°C for 2 weeks or 6 months and scanned using micro-computed tomography. Initial retreatment was performed up to a Reciproc R40, and the operating time was recorded. The residual material in the canal received a supplementary procedure using XP-endo Finisher R (XPFR) files. After each retreatment procedure, the specimens were rescanned. RESULTS: The percentage volume of voids and gaps in the SCO group was higher than that of the WVC group at both 2 weeks and 6 months (P < 0.05). The percentage volume of the filling material removed after initial retreatment and XPFR cleaning was significantly higher in the 6-month group than in the 2-week groups (P < 0.05). The proportion of the residual material decreased significantly when XPFR files were used, compared to the initial retreatment group (P < 0.05) in both storage times. CONCLUSION: The efficiency of retreatment in the oval-shaped canal was closely related to the storage time rather than the filling technique using a tricalcium silicate sealer. The XPFR instrument proved effective in the removal of the remaining materials from the oval-shaped canal. CLINICAL RELEVANCE: Obturation of the oval-shaped canal with TSBS using the SCO technique in the coronal area needs to be optimized. The retreatment was less efficacious in freshly filled canals than aged filled canals.

Uso da fototerapia como método complementar no retratamento endodôntico: revisões sistemáticas e meta-análise de ensaios clínicos / Use of phototherapy as a complementary method in endodontic reintervention: systematic reviews and meta-analysis of clinical trials

Este trabalho objetivou realizar duas revisões sistemáticas com as seguintes propostas: 1) Avaliar se a fototerapia com laser resultaria em menor dor pós-operatória (PP) em pacientes submetidos a reintervenção endodôntica; e 2) Avaliar se o uso da terapia fotodinâmica antimicrobiana (aPDT) seria eficaz na desinfecção de canais radiculares em casos de reintervenção endodôntica. As Revisões Sistemáticas foram registradas no PROSPERO (CRD42021243500 e CRD42021260013, respectivamente) e seguiram as diretrizes dos Itens de Relatório Preferenciais para Revisões Sistemáticas e Meta-análise (PRISMA). As buscas foram realizadas nas bases de dados eletrônicas PubMeb, Scopus, Web of Science, Embase, Web of Science, Clinical Trials e Cochrane Library e nos bancos de dados da literatura cinza. A qualidade metodológica e o risco de viés foram avaliados pela ferramenta Cochrane Risk of Bias para ensaios clínicos randomizados (RCT) e pelo qualificador NewcastleOttawa (NOS) para estudos não RCT (prospectivos). A análise da qualidade de evidência foi realizada com base na abordagem GRADE. A meta-análise foi realizada com o R software Meta package, utilizando um intervalo de confiança (IC) de 95%. Quanto aos resultados do Artigo 1: Cinco artigos foram incluídos para análise. Os estudos foram classificados como "baixo" risco de viés. Dos cinco estudos clínicos, quatro estudos mostraram uma diminuição significativa da PP após a reintervenção endodôntica nos grupos de fototerapia a laser quando comparados ao grupo controle, principalmente nos primeiros dias após a intervenção. A certeza de evidência foi classificada como baixa. Devido à alta heterogeneidade clínica entre os estudos, não foi possível realizar qualquer meta-análise. Apesar das limitações desta revisão sistemática, a fototerapia se mostrou uma alternativa promissora na redução e controle da PP na reintervenção endodôntica não cirúrgica. Nos resultados do Artigo 2, dez estudos atenderam aos critérios de elegibilidade e foram incluídos, sendo 8 utilizados na síntese quantitativa. A meta-análise mostrou que todos os dados dos estudos apresentaram diferença significativa antes e depois da terapia fotodinâmica antimicrobiana na redução da carga microbiana em infecções endondônticas secundárias (OR 0,15 [0,07; 0,32], p < 0,0001). No geral, os estudos apresentaram baixo risco de viés e a análise das evidências foi classificada como moderada. Sugere-se que a terapia fotodinâmica seja uma ferramenta benéfica e promissora, mostrando eficácia na redução da carga microbiana nos casos de reintervenção endodôntica. Em suma, a abordagem da utilização da fototerapia se demonstrou eficaz na diminuição da dor pós-operatória e na desinfecção dos canais radiculares, podendo ser uma terapia indicada nos casos de reintervenção endodôntica(AU)

This study aimed to carry out two systematic reviews with the following proposals: 1) Evaluate whether laser phototherapy would result in less postoperative pain (PP) in patients undergoing endodontic reintervention; and 2) Evaluate whether the use of antimicrobial photodynamic therapy (aPDT) would be effective in disinfection of root canals in cases of endodontic reintervention. Systematic Reviews were registered in PROSPERO (CRD42021243500 and CRD42021260013, respectively) and followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Metaanalysis (PRISMA). Searches were performed in the electronic databases PubMeb, Scopus, Web of Science, Embase, Web of Science, Clinical Trials and Cochrane Library and in the gray literature databases. Methodological quality and risk of bias were assessed by the Cochrane Risk of Bias tool for randomized clinical trials (RCT) and by the Newcastle-Ottawa (NOS) qualifier for non-RCT (prospective) studies. The analysis of the quality of evidence was performed based on the GRADE approach. The meta-analysis was performed using the R Meta package software, using a 95% confidence interval (CI). As for the results of Article 1: Five articles were included for analysis. Studies were classified as "low" risk of bias. Of the five clinical studies, four studies showed a significant decrease in PP after endodontic reintervention in the laser phototherapy groups when compared to the control group, mainly in the first days after the intervention. The certainty of evidence was rated low. Due to the high clinical heterogeneity between studies, it was not possible to perform any meta-analysis. Despite the limitations of this systematic review, phototherapy proved to be a promising alternative for the reduction and control of PP in conventional endodontic reintervention. In the results of Article 2, ten studies met the eligibility criteria and were included, being 8 used in the quantitative synthesis. The meta-analysis showed that all data from the studies showed a significant difference before and after antimicrobial photodynamic therapy in reducing the microbial load in secondary endodontic infections (OR 0.15 [0.07; 0.32], p < 0.0001). Overall, the studies presented a low risk of bias and the analysis of evidence was rated as moderate. It is suggested that photodynamic therapy is a beneficial and promising tool, showing efficacy in reducing the microbial load in cases of endodontic reintervention. In summary, the approach to the use of phototherapy has been shown to be effective in reducing postoperative pain and disinfection of root canals, and may be an indicated therapy in cases of endodontic reintervention(AU)

An in vitro study on the effects of serum proteins on Enterococcus faecalis adhesion to three types of root sealers and gutta-percha.

BACKGROUND: The extrusion of overfilled materials that extend beyond the apical foramina into the periradicular tissue may serve as a reservoir for bacterial adhesion and further affect recovery from periapical diseases. The aim of this study was to evaluate the effects of serum proteins on Enterococcus faecalis adhesion and survival on the surface of a calcium hydroxide-based root canal sealer (Apexit Plus), an epoxy resin sealer (AH-Plus) and a bioceramic sealer (iRoot SP). METHODS: Apexit Plus, AH-Plus and iRoot SP were evenly coated on gutta-percha, using gutta-percha alone as the control. After root canal sealer setting, the number of E. faecalis adhering to the root canal sealers and gutta-percha was counted in fetal bovine serum (FBS) or tryptic soy broth supplemented with 1% glucose (TSBG) by viable cell plate counts. The morphology of 7-day-old E. faecalis biofilms in FSB and TSBG was observed by scanning electron microscopy (SEM). Furthermore, E. faecalis biofilms on the three root canal sealers were labeled with a LIVE/DEAD BacLight™ Bacterial Viability Kit, and the ratios of viable to dead cells were analyzed using laser scanning microscopy operative software (Zen software). RESULTS: In the assays, after 1 and 7 days, the number of E. faecalis adhering to the root canal sealers or gutta-percha in FBS were significantly lower than those in TSBG (P < 0.05). In FBS, E. faecalis adhesion to iRoot SP and gutta-percha was reduced to a greater extent than that adhered to Apexit Plus and AH-Plus. Few E. faecalis accumulated on iRoot SP in FBS, whereas many bacteria assembled on iRoot SP and formed biofilms in TSBG. The ratio of viable cells in the E. faecalis biofilm on iRoot SP was the lowest. CONCLUSIONS: Calcium hydroxide-based root canal sealers, epoxy resin sealers and bioceramic sealers may provide a substrate for E. faecalis adhesion, and the bioceramic sealer in this study showed the least E. faecalis adhesion in the presence of serum proteins compared to the other two sealers.

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.

The effect of smear layer on bacterial penetration through roots obturated using zinc oxide eugenol-based sealer.

BACKGROUND: Smear layer removal has been shown to reduce bacterial penetration through root canal obturations when resin-based endodontic sealer is used. The purpose of this in vitro study was to test this effect when a non-resin-based sealer is used. MATERIAL AND METHODS: Thirty root segments were assigned to the following groups: Smear layer removed (n = 8); smear layer retained (n = 8); negative controls (n = 10; 5 with smear layer, 5 without); and positive controls (n = 4; 2 with smear layer, 2 without). After rotary instrumentation, smear layers were removed in the treatment group and half of controls using 17% ethylenediamenetetraacetic acid (EDTA) prior to obturation. Each obturated root was affixed into a dual-chamber leakage model employing Streptococcus mutans. Roots were incubated at 37 °C for 120 d. Days until lower chamber turbidity occurred was recorded for each sample, and data were analyzed using Kaplan-Meier survival curve analysis (p = 0.05). RESULTS: No negative controls leaked, while all positive controls were turbid within 1 day. Mean days to leakage for roots with smear layer intact was 82.75 (+/- 33.29, 95% CI), although three never leaked. Mean days to leakage through roots with smear layer removed was 46.25 (+/- 26.67, 95% CI), and all leaked. Treatment survival curves were significantly different (p = 0.048). CONCLUSIONS: Under the conditions and limitations of this study, retaining the smear layer reduced the rate of bacterial penetration through canals which had been obturated using zinc oxide eugenol (ZOE) -based sealer.

Effect of Root Canal Disinfection with a Diode Laser on Postoperative Pain After Endodontic Retreatment.

Objective: The aim of this randomized clinical trial was to evaluate the influence of root canal disinfection with a 940-nm diode laser on the intensity of pain after endodontic retreatment. Background data: Microorganisms are the most common causes of tooth pain. Therefore, clinical studies are needed to explore the effect of disinfection techniques on postoperative pain. Methods: Eighty-four patients scheduled for endodontic retreatment were allocated to two groups in a 1:1 ratio (n = 42 each). After root canal filling removal and chemomechanical procedures, the root canals were disinfected with a 940-nm diode laser in one group [laser disinfection (LD) group]. In the other group, a mock application of laser was made with the power off [pseudo-laser disinfection (PLD) group]. All retreatment procedures were completed in a single visit. The patients assessed their pain levels at 24, 48, and 72 h after retreatment using a numeric rating scale. The number of analgesic pills used during this period was also recorded. The collected data were statistically analyzed using Mann-Whitney U and Wilcoxon tests. Results: Postoperative pain on the first 2 days was significantly lesser in the LD group than in the PLD group (p < 0.05), and the difference became insignificant on the third day (p > 0.05). Moreover, analgesic intake over 3 days and pain on percussion on the fourth day were significantly lesser in the LD group than in the PLD group (p < 0.05). Conclusions: Elimination of microorganisms from root canals is important for preventing postoperative complications. Our findings suggest that diode LD can reduce postoperative pain and provide comfort after endodontic retreatment. This study is registered in www.ClinicalTrials.gov database with the identifier number NCT03584880.

Micro-CT evaluation of the removal of root fillings using the ProTaper Universal Retreatment system supplemented by the XP-Endo Finisher file.

AIM: To compare the removal of root fillings in extracted teeth using the ProTaper Universal Retreatment system (PTUR) followed by a supplementary preparation with the XP-Endo Finisher file. METHODOLOGY: The mesiobuccal root canals of 30 extracted mandibular first molars were instrumented with ProTaper Universal NiTi files up to F2 and filled with one of the following sealers using a single-cone technique (n = 10): AH Plus, NeoMTA Plus and EndoSequence BC. The root fillings were removed using the PTUR system with additional apical preparation using ProTaper F2 and F3 files. Then, an additional preparation with an XP-Endo Finisher file was performed. The samples were scanned using micro-CT before and after retreatment and again after the use of the XP-Endo Finisher to assess the volume of remaining filling material. Data were analysed by Kruskal-Wallis and Friedman's two-way analysis of variance tests with Bonferroni correction. RESULTS: No significant difference in the initial filling volume was observed amongst the groups (P > 0.05). The amount of filling materials in each group decreased significantly after retreatment with rotary files (P < 0.05). After initial retreatment, the volume of the remaining filling amongst the groups was similar (P > 0.05). Additional preparation with the XP-Endo Finisher improved the removal of filling materials regardless of the sealer type (P < 0.05). CONCLUSIONS: In the mesiobuccal root canals of extracted mandibular first molars, additional preparation using an XP-Endo Finisher file, after using the PTUR system and F3 ProTaper instruments, enhanced the removal of filling materials from root canals.

Tendências atuais no tratamento endodôntico por cirurgiões dentistas no Brasil / Current trends in endodontic treatment by dental surgeons in Brazil

Objetivo: conhecer as principais práticas adotadas atualmente por cirurgiões dentistas, clínicos gerais e endodontistas na realização do tratamento endodôntico. Material e Métodos: um questionário contendo 21 perguntas de múltipla escolha foi enviado para os profissionais, nas cinco regiões do país. As perguntas abordaram o tempo de experiência, tipos de técnicas, materiais e recursos auxiliares. Resultados: a maior parte dos respondentes são do Sudeste e Sul, endodontistas há menos de 10 anos. Realizam até 20 tratamentos/mês, utilizam localizador apical, instrumentação manual com limas de aço inoxidável associada a brocas gates glidden/largo, lupa e isolamento absoluto. O hipoclorito de sódio (2,5 a 5%) e o EDTA são os irrigantes mais utilizados juntamente com o ultrassom. O tratamento é feito em sessão única, porém o diagnóstico pulpar pode alterar o número de sessões. Quando é necessário o uso de medicação intracanal, o hidróxido de cálcio associado a outras formulações é a primeira escolha. Para obturação do sistema de canais radiculares é utilizada a técnica de condensação lateral e o cimento à base de óxido de zinco e eugenol. O selamento coronário entre sessões é feito com coltosol e com cimento de ionômero de vidro ao término do tratamento, quando os pacientes são encaminhados a outro profissional para restauração final. Atualizam-se através de artigos científicos e mostram abertura para testar novos produtos. Conclusão: a maioria dos participantes aderem a práticas atuais com uso de novas tecnologias durante o tratamento e se atualizam através da leitura de artigos científicos

Objective: to be aware of the main practices currently adopted by general dentists and endodontists when performing endodontic treatments. Material and methods: a questionnaire containing 21 multiple-choice questions was sent to professionals in the five regions of Brazil. These questions covered experience time, techniques, materials and auxiliary resources. Results: most participants are from the Southeast and South regions of Brazil and have been specialized in endodontic for less than 10 years. They perform up to 20 treatments per month, use apex locator, manual instrumentation with stainless steel files associated with gates-glidden or largo burs, magnifying loupes and absolute isolation. Sodium hypochlorite (2.5 to 5.0%) and EDTA are the most used substances for irrigation associated with ultrasound. The treatment is done in a single visit, but pulp diagnosis might alter the number of visits. When intracanal medication is required, calcium hydroxide associated with other formulations is the first choice. For root canal filling, lateral condensation technique, zinc oxide and eugenol based sealers are used. Coronal sealing between sessions is done with Coltosol® and glass ionomer cement at the end of treatment, when patients are referred to another professional for final restoration. These professionals update their knowledge with scientific articles and show availability to test new products. Conclusion: most participants have been adhering to current practices (new technologies) during treatment and has kept updated by reading scientific articles

[Assessment of the efficiency of root canals sealing depending on the type of root dentin treatment (experimental study)]. / Otsenka effektivnosti germetizatsii kornevykh kanalov v zavisimosti ot vida obrabotki (eksperimental'noe issledovanie).

Research objective was a comparative assessment of quality of sealing of root canals, subjected to a standard method of processing, processing by the laser and processing by LAI equipment, with sealer and the gutta-percha. The study included 20 teeth extracted because of chronic periodontitis and divided into four groups. Root canals were processed according to the traditional protocol using as an irrigant 3% NaOCl and 17% EDTA solution, LAI equipment, the Er laser; Cr; YSGG 2780 nm at a power 1W and 1,5W and sealed up using single protocol by means of an epoxy siler of AH+ and gutta-percha by continuous wave by means of the CalamusDual (DentsplayMaillefer) device. Scanning electronic microscopy was used to study the efficiency of sealing depending on a type of processing. The highest sealing of the obturation material to the canal walls was revealed in teeth processed by the laser at a power of 1.5 W confirmed by lack of emptiness between a material and a dentine. Conventional irrigation protocol did not result in an optimal obturation with the extent of empty spaces up to 13 microns. The results of the pilot research are the basis for more extensive studies.

Efficacy of chlorhexidine as a final irrigant in one-visit root canal treatment: a prospective comparative study.

AIM: To evaluate postoperative pain and radiographic evidence of periapical healing in teeth with apical periodontitis treated in one visit with an additional final irrigation using 2% chlorhexidine (CHX) and to compare the results with conventional two-visit root canal treatment (RCT) with an intracanal calcium hydroxide (CH) dressing as a control group. METHODOLOGY: Ninety asymptomatic maxillary anterior teeth with periapical lesions were treated by a single operator. Root canals were prepared using the step-back technique with manual instrumentation with 2.5% NaOCl and 5% EDTA as irrigants. Half of the teeth were randomly assigned to the one-visit (OV) group and received an additional final rinse with 2% CHX before canal filling. The other teeth were treated in two visits (TV) with a CH paste made by mixing CH powder and distilled water as an interappointment dressing. All patients were recalled and investigated clinically and radiographically for 24 months. Postoperative pain at 24-48 h and changes in apical bone density indicating radiographic healing were evaluated statistically using the Mann-Whitney U-test followed by the Friedman and the Wilcoxon tests (α = 0.05). RESULTS: There were no significant differences between two groups regarding the incidence of postoperative pain at 24 h (OV group 50% no pain, 47.6% mild, 2.4% moderate pain/TV group 55% no pain, 42.5% mild, 2.5% moderate pain) and at 48 h (OV group 95% no pain, 5% mild pain/TV group 98% no pain, 2% mild pain). None of the patients reported severe postoperative pain, swelling and/or flare-ups during the follow-up period. There was no significant difference in the radiographic healing rates (OV group 97.6% PAI 1 and/or PAI 2 and 2.4% PAI 3/TV group 95% PAI 1 and/or PAI 2 and 5% PAI 3; P > 0.05). CONCLUSION: Both groups provided favourable and similar postoperative pain and periapical healing rates at 24 months. Thus, one-visit RCT with a final rinse with 2% CHX is an acceptable alternative to two-visit RCT with CH as temporary dressing in maxillary anterior teeth.

Survival and periapical health after root canal treatment with carrier-based root fillings: five-year retrospective assessment.

AIM: This retrospective study explored survival and periapical healing outcomes in teeth root filled with Thermafil obturators. METHODOLOGY: Root canals of 213 teeth (94 subjects, mean age 48 ± 13 years), instrumented with a step-down technique, irrigated with 5% NaOCl and 10% EDTA and filled with Thermafil and AH Plus sealer, were involved in a recall programme. Teeth were retrospectively re-examined after 5 ± 1 years in a controlled environment. Clinical and radiographic data that were collected included the following: preoperative Periapical Index (PAI) score and signs/symptoms, treatment type, root filling length and presence/absence of voids, restoration type, follow-up PAI score and signs/symptoms. Teeth were considered 'healthy' (PAI ≤ 2, no signs/symptoms) or 'diseased' (PAI ≥ 3, signs/symptoms present, retreated, extracted for endodontic reasons). Two PAI-calibrated examiners assessed outcomes blinded to preoperative status. Bivariate and multilevel analyses were performed at level of patient and tooth (α = 5%). RESULTS: Of 213 teeth treated, 187 (88%) survived and 26 were extracted, six (3%) for persistent endodontic infection (considered 'diseased'), and 20 (9%) for root fracture, periodontal disease or coronal fracture (excluded from analysis). Whilst survival was significantly associated with tooth type (P = 0.015), type of treatment (P = 0.012) and pulpal/periapical diagnosis (P = 0.035), none of these variables were substantiated as survival predictors by the multilevel analysis. A total of 164 of 193 teeth (85%) were assessed as 'healthy', with significantly higher (chi-square; P < 0.04) 'healthy' rates for teeth with PAI score ≤2 and root fillings of adequate length. Multilevel analysis identified PAI score ≤2 (P = 0.002) as the only predictor of periapical health. CONCLUSIONS: In this 5 ± 1 year retrospective assessment, survival and healing rates after root canal treatment with Thermafil root fillings were comparable to those previously reported for conventional root filling techniques.

Knowledge and practice of, and attitudes toward, pulp therapy in deciduous teeth among pediatric dentists in India.

AIM: The aim of the present study was to assess the knowledge and practice of, and attitudes toward, pulp therapy in deciduous dentition among pediatric dentists. METHODS: A cross-sectional, observational survey was conducted using a closed-ended, multiple-choice questionnaire evaluating the knowledge and practice of, and attitudes toward, pulp therapy in deciduous dentition, which was formulated and sent to 360 pediatric dentists across India. Descriptive statistics were done, followed by χ2 -test to test the association between years of experience and the questionnaire items. RESULTS: A total of 3.5% of pediatric dentists performed their treatment using a rubber dam in all cases; 30% preferred to use local anesthesia prior to indirect pulp therapy (IPT). Traditional indirect pulp capping was preferred to IPT, and only 48% of them believed in not removing it completely. Pulpotomy was preferred over IPT (70%) when there was a probability of pulp exposure following complete caries excavation. Calcium hydroxide, along with iodoform, was the material of choice for the obturation of primary teeth (73.5%). A stainless steel crown was placed after pulp therapy in the primary tooth (86.3%). Most dentists believed requested immediate and 3-month follow up. CONCLUSION: The survey helps in assessing whether our views or approaches are in line with recent trends.

Effect of photodynamic therapy and non-thermal plasma on root canal filling: analysis of adhesion and sealer penetration.

OBJECTIVE: The aim of this study was to evaluate the effect of photodynamic therapy (PDT) and non-thermal plasma (NTP) on adhesion and sealer penetration in root canals. MATERIAL AND METHODS: Sixty single-rooted premolars were used. The teeth were prepared using a crown-down technique. NaOCl and EDTA were used for irrigation and smear layer removal, respectively. The root canals were divided into three groups: control, PDT, and NTP. After treatments, the roots were filled using gutta-percha and either AH Plus (AHP) or MTA Fillapex (MTAF) sealers. Samples were sectioned at 4, 8, and 12 mm from the apex (1-mm slices)and analyzed by the push-out bond strength test (adhesion) and confocal laser scanning microscopy (sealer penetration). Data were statistically evaluated using Kruskal-Wallis, Dunn's, and Spearman's tests. RESULTS: Regarding AHP, bond strength was similar in the NTP group and in the control group, but significantly lower in the PDT group. As to MTAF, both therapies showed lower values than the control group. In the confocal analysis of AHP, maximum and mean penetration, and penetrated area were statistically higher in the control group than in the PDT and NTP groups. Penetrated perimeter was similar among groups. Regarding MTAF, all parameters yielded better results in the NTP than in the control group. The PDT and control groups showed similar results except for penetrated area. CONCLUSION: PDT and plasma therapy affected the adhesion and sealer penetration of root canals filled with AH Plus and MTA Fillapex and there is no positive correlation between adhesion and sealer penetration.

Evaluación de la penetración de cementos obturadores de canales mediante microscopía electrónica de barrido / Evaluation of the penetration of root canal filling cements through scanning electron microscopy

Antecedentes: la literatura odontológica demuestra que los tratamientos endodónticos fallidos, comúnmente son debidos a la persistencia de los microorganismos. Una característica importante de los cementos obturadores de canales es su habilidad para penetrar en los túbulos dentinarios, logrando así un sellado impermeable entre las paredes dentinarias y el material de obturación central, reduciendo las filtraciones potenciales y aumentando la resistencia a la fractura. Objetivo: Evaluar mediante microscopía electrónica de barrido (MEB) la penetración de MTA Fillapex, cemento de Grossman (CG) y top seal a lo largo del conducto radicular. Materiales y métodos: Estudio experimental in vitro, en 36 dientes premolares humanos divididos aleatoriamente en 3 grupos, (n= 12), los cuales fueron preparados con técnica endodóntica Step Back. Cada grupo se dividió en 2 subgrupos utilizando como irrigante NaOCl al 2,5%, al igual que NaOCl al 2,5% + EDTA al 17%. Los canales fueron obturados con técnica de condensación lateral, seccionados longitudinalmente para observar mediante microscopia electrónica de barrido a nivel de los tercios cervical, medio y apical, la penetración del cemento al interior de los túbulos dentinarios. Se realizó análisis estadístico con SPSS v 22 IBM con p< 0,05 y las pruebas Kruskal-Wallis y Mann-Whitney. Resultados: Mediante la prueba Kruskal-Wallis, los cementos de Grossman y top seal al utilizar NaOCl + EDTA presentaron valores de p= 0,025 y p= 0,002 en los tercios medio y apical respectivamente. La prueba de Mann Whitney mostró un valor p= 0,031 en el tercio apical para el cemento MTA Fillapex al utilizar NaOCl. Los valores de la mediana fueron MTA Fillapex tercio medio= 2,0000, tercio apical= 1,0000; top seal tercios medio y apical= 4,0000; cemento de Grossman tercios medio y apical= 4,0000. Al ser igual el valor de la mediana entre los cementos top seal y Grossman se utilizaron los valores de la varianza con un resultado estadísticamente significativo para el cemento de Grossman= 0,276 en el tercio medio y top seal= 0,176 en el tercio apical. La prueba de Mann Whitney arrojó un valor p= 0,031 en el tercio apical para el cemento MTA Fillapex. Con un valor de mediana de NaOCl= 3,0000, NaOCl + EDTA= 1,0000. Conclusiones: Al comparar los cementos obturadores MTA Fillapex, top seal y cemento de Grossman utilizando como irrigante NaOCl + EDTA se observó mayor penetración del cemento de Grossman. A nivel del tercio apical se observó mayor penetración con el cemento top seal. El cemento obturador MTA Fillapex presentó mayor penetración a nivel del tercio apical al utilizar como irrigante NaOC (AU)

Background: the literature has shown that failed endodontic treatments are commonly due to the persistence of microorganisms. One important characteristic of root canal filling cements is their ability to penetrate the dentinal tubules, achieving an impermeable sealing between the dentinal walls and the central filling material, reducing potential filtrations and increasing the resistance to fracture. Objective: To evaluate through scanning electron microscopy (SEM) the penetration of MTA Fillapex, Grossman sealer and top seal all along the root canal. Methods: In vitro experimental study, in 36 human teeth randomly divided into 3 groups, (n= 12), which were prepared with the Step Back endodontic technique. Each group was divided into 2 subgroups using NaOCl 2.5%, and NaOCl 2.5% + EDTA 17% as irrigating solutions. The root canals were sealed using the lateral condensation technique, longitudinally sectioned to observe through scanning electron microscopy the cervical, medium and apical thirds, the penetration of the cement inside the dentinal tubules. The statistical analysis was performed with SPSS v22 IBM with p < 0.05 and the Kruskal-Wallis and Mann-Whitney tests. Results: through the Kruskal- Wallis test the Grossman sealer and top seal when using NaOCl + EDTA showed values of p= 0.025 and p= 0.002 in the medium and apical thirds respectively. The Mann-Whitney test showed a value of p= 0.031 in the apical third for the MTA Fillapex when using NaOCl. The median values were MTA Fillapex medium third= 2.000, apical third= 1.000; top seal medium and apical thirds= 4.000. Since the median values between the top seal and Grossman sealer were the same, the values from the variance were used, with a statistically significant result for the Grossman sealer= 0.276 in the medium third and top seal = 0.176 in the apical third. The Mann-Whitney test showed a value p= 0.031 in the apical third for the MTA Fillapex. With a median value of NaOCl= 3.000, NaOCl + EDTA= 1.000. Conclusions: When comparing the filling cements MTA Fillapex, top seal and Grossman sealer using NaOCl + EDTA as an irrigating solution, more penetration from the Grossman sealer was observed in medium third. At the apical third, more penetration from the top seal sealer was observed. The MTA Fillapex cement showed the greatest penetration at the apical third when using NaOCl as an irrigating solution (AU)

Effect of photodynamic therapy and non-thermal plasma on root canal filling: analysis of adhesion and sealer penetration

Abstract Objective The aim of this study was to evaluate the effect of photodynamic therapy (PDT) and non-thermal plasma (NTP) on adhesion and sealer penetration in root canals. Material and Methods Sixty single-rooted premolars were used. The teeth were prepared using a crown-down technique. NaOCl and EDTA were used for irrigation and smear layer removal, respectively. The root canals were divided into three groups: control, PDT, and NTP. After treatments, the roots were filled using gutta-percha and either AH Plus (AHP) or MTA Fillapex (MTAF) sealers. Samples were sectioned at 4, 8, and 12 mm from the apex (1-mm slices)and analyzed by the push-out bond strength test (adhesion) and confocal laser scanning microscopy (sealer penetration). Data were statistically evaluated using Kruskal-Wallis, Dunn's, and Spearman's tests. Results Regarding AHP, bond strength was similar in the NTP group and in the control group, but significantly lower in the PDT group. As to MTAF, both therapies showed lower values than the control group. In the confocal analysis of AHP, maximum and mean penetration, and penetrated area were statistically higher in the control group than in the PDT and NTP groups. Penetrated perimeter was similar among groups. Regarding MTAF, all parameters yielded better results in the NTP than in the control group. The PDT and control groups showed similar results except for penetrated area. Conclusion PDT and plasma therapy affected the adhesion and sealer penetration of root canals filled with AH Plus and MTA Fillapex and there is no positive correlation between adhesion and sealer penetration.

Efeito de três protocolos de irrigação final na remoção da smear layer do terço médio de dentes endodonticamente tratados: uma análise qualitativa / Effect of three final irrigation protocols on the smear layer removal from the middle third of endodontically treated teeth: a qualitative analysis

Objetivo: avaliar, por meio de microscopia eletrônica de varredura (MEV), a capacidade de desobliteração dos túbulos dentinários de dentes endodonticamente tratados, utilizando- se diferentes soluções quelantes. Métodos: os condutos radiculares de caninos permanentes foram irrigados com hipoclorito de sódio (NaOCl) a 2,5% (substituído a cada instrumento) e obturados. Após a desinfecção e obturação desses dentes, realizou-se a remoção do material obturador, com brocas largo, e utilizou-se as seguintes soluções auxiliares, com irrigação ultrassônica passiva (PUI) por 1 minuto: álcool 70% (controle); ácido cítrico a 10%; EDTA a 17%; e quitosana a 0,2%. As raízes foram seccionadas longitudinalmente em duas partes e as amostras foram levadas para análise em microscópio eletrônico de varredura, para obtenção de fotomicrografias para a avaliação qualitativa. Resultados: as soluções de EDTA a 17% e ácido cítrico a 10% removeram a smear layer de forma semelhante entre si. A solução de quitosana a 0,2% removeu a smear layer parcialmente, apresentando menor eficácia na desobliteração dos túbulos dentinários do que as soluções de EDTA a 17% e ácido cítrico a 10%. Conclusão: houve uma maior remoção de smear layer e desobliteração quando da utilização do EDTA a 17%, seguido do ácido cítrico a 10%, da quitosana a 0,2% e do álcool 70%.

Assessment of Coronal Leakage of Temporary Restorations in Root Canal-treated Teeth: An in vitro Study.

INTRODUCTION: Coronal leakage is one of the constant concerns in routine dental practice. It is one of the factors responsible for the failure of root canal therapy. Permanent restorations should be given as soon as possible after the completion of root canal therapy. If unavoidable, provisional restoration should be given in such a way that it maximally reduced the leakage of microorganisms and fluids from the external environment into the canal space. Hence, we evaluated the effect of saliva on the coronal leakage of temporary restorations. MATERIALS AND METHODS: Biomechanical preparation of the root canals of 204 fresh mandibular first premolar teeth was done using endodontic files with intermittent irrigation of sodium hypochlorite solution and ethylenediaminetetraacetic acid. Alternate irrigation with normal saline was done periodically. After preparation, drying of the canals was done using paper points followed by sealing of the apical foramen. For the assessment of the microleakage, Siqueira et al apparatus and method was used. All the specimens were divided into four groups based on the provisional restorative material used. All the groups were further divided into three subgroups based on the presence and absence of intracanal medicaments. Verissimo et al's criteria were used to check the turbidity at 1-, 2-, 3-, and 4-week interval respectively. All the results were analyzed by Statistical Package for the Social Sciences (SPSS) software. Chi-square test was used to measure the level of significance, and p < 0.05 was considered to be significant. RESULTS: In group I, all the subgroups' specimens showed significant difference at 1 week's time. Only the subgroup with no intracanal medicaments in Cavit-containing provisional restoration showed nonsignificant alterations. Statistically significant alterations were seen at 1, 2, and 3 weeks' interval in all the subgroups except for one with intracanal medicaments. CONCLUSION: All the temporary restorative materials were not able to prevent microleakage after 1 week's time, with worst bacterial resistance shown by Ketac Molar and ionomer restorative material. Future studies are advocated for better prognosis of root canal therapy.

Effect of different gutta-percha solvents on the microtensile bond strength of various adhesive systems to pulp chamber dentin.

OBJECTIVES: The aim of this study was to evaluate the effect of different endodontic solvents on the microtensile bond strength (µTBS) of various adhesives to pulp chamber dentin. MATERIAL AND METHODS: A total of 120 human third molars were selected. Canals were prepared with the ProTaper Universal system and obturated. The access cavities were then restored with resin composite. After 1 week, a retreatment procedure was applied as follows: control, no solvent was applied to the pulp chamber and experimental groups, three different solvents (chloroform, eucalyptol, and orange oil) were applied to the pulp chamber for 2 min. The canal filling was removed and calcium hydroxide (Ca[OH]2) was placed into the canals. After 7 days, the Ca(OH)2 was removed from the canals and the canals were re-obturated. Teeth were then divided into three subgroups according to the adhesive used. The samples were restored with a nanohybrid resin composite using three different adhesives: Clearfil SE Bond (CSE), Adper Easy One (AEO), and Single Bond 2 (SB2). The samples were aged with thermocycling. Teeth were sectioned, and a total of 20 dentin sticks were obtained for each subgroup. µTBS testing was then performed. The debonded surfaces were evaluated using scanning electron microscopy (SEM) analysis. Data were analyzed using two-way ANOVA and Tukey's post hoc tests. RESULTS: Chloroform showed statistically lower mean µTBS values (14 ± 7.2 MPa) than control group did (19.2 ± 6.1 MPa) (p < 0.05). Orange oil (18.1 ± 6.3 MPa) and eucalyptol (16.9 ± 6.8 MPa) did not reduce the mean µTBS statistically (p > 0.05). Chloroform showed significantly lower bond strength for all adhesives (p < 0.05). Whereas orange oil did not reduce the mean µTBS values of all adhesive systems significantly (p > 0.05), eucalyptol reduced the µTBS values of all the groups, but the results were only statistically significant for SB2 (p < 0.05). CSE showed statistically higher bond strength (20.4 ± 6.8 MPa) than AEO (14.6 ± 5.3 MPa) and SB2 (16.3 ± 7.2 MPa) did (p < 0.05). There were no statistical differences between AEO and SB2 (p > 0.05). According to the SEM analysis of the debonded surfaces, adhesive failures were the most common type in all the groups, followed by mixed failures. CONCLUSIONS: While chloroform reduced the mean bond strength of the adhesive resins, orange oil did not affect the bond strength of the adhesives. The effect of eucalyptol on bond strength depended on the type of adhesive system. CLINICAL RELEVANCE: This study shows that endodontic solvents could affect the microtensile bond strength of adhesives to pulp chamber dentin.