Design, metallurgy, mechanical properties, and shaping ability of 3 heat-treated reciprocating systems: a multimethod investigation.

OBJECTIVE: This study aimed to compare 3 reciprocating systems regarding design, metallurgy, mechanical properties, and shaping ability. MATERIALS AND METHODS: New Reciproc Blue R25, WaveOne Gold Primary, and REX 25 instruments (n=41 per group) were analyzed regarding design, metallurgy, and mechanical performance, while shaping ability (untouched canal walls, volume of removed dentin, and hard tissue debris) was tested in 36 anatomically matched root canals of mandibular molars. Results were compared using one-way ANOVA post hoc Tukey and Kruskal-Wallis tests with a significant level set at 5%. RESULTS: All instruments showed symmetrical cross sections with asymmetrical blades, no radial lands, no major defects, and an almost equiatomic nickel and titanium ratio. The highest R-phase start temperatures were observed with WaveOne Gold (46.1°C) and REX (44.8°C), while Reciproc Blue had the lowest R-phase start (34.5°C) and finish (20°C) temperatures. WaveOne Gold had the lowest time to fracture (169 s) and the highest maximum load (301.6 gf) (P <0.05). The maximum torque of Reciproc Blue (2.2 N.cm) and WaveOne Gold (2.1 N.cm) were similar (P >0.05), but lower than REX (2.6 N.cm) (P <0.05). No statistical differences were observed among instruments in the angle of rotation (P >0.05) and in the shaping ability in both mesial and distal canals (P >0.05). CONCLUSION: Although the overall design, temperature transition phases and mechanical behavior parameters were different among tested instruments, they were similar in terms of shaping ability. CLINICAL RELEVANCE: All tested heat-treated NiTi reciprocating systems showed similar shaping ability, without clinically significant errors.

Does the type of endodontic access influence in the cyclic fatigue resistance of reciprocating instruments?

INTRODUCTION: The aim of the present study was to compare the cyclic fatigue resistance of Reciproc R25 (R25) and Reciproc Blue R25 (R25B) instruments, after simulated clinical use in traditional (TradAC) and ultraconservative (UltraAC) endodontic access cavities. METHODS: Forty mandibular molars were randomly assigned into the following groups, according to the type of access and instrument to be used: TradAC and R25, TradAC and R25B, UltraAC and R25, and UltraAC and R25B. Teeth were accessed accordingly, and the root canals were prepared using "RECIPROC ALL" kinematics. The cyclic fatigue resistance of the forty used instruments was obtained measuring the time to fracture in an artificial stainless-steel canal. Ten brand new R25 and R25B were used as control groups. The fracture surfaces and the side cutting edges of the instruments were examined with a scanning electron microscope. Data were statistically analyzed using one-way ANOVA and post hoc Tukey tests with a significance level of P < 0.05. RESULTS: R25B instruments showed significantly higher cyclic fatigue resistance than R25, regardless of the access cavity type (P < 0.05). No differences were observed in the cyclic fatigue resistance between instruments without simulated clinical use and used in TradAC (P > 0.05). R25 and R25B used in UltraAC showed significantly lower cyclic fatigue resistance compared with the instruments used in TradAC and without simulated clinical use (P < 0.05). CONCLUSIONS: R25B files showed improved cyclic fatigue resistance than R25. The use of R25B and R25 files in mandibular molars with UltraACs decreased their cyclic fatigue resistance, compared with TradAC. CLINICAL RELEVANCE: The use of Reciproc and Reciproc Blue files in mandibular molars with ultra-conservative endodontic access cavities reduced their cyclic fatigue resistance. Clinicians should be aware about the reduced cyclic fatigue resistance of these files when used in mandibular molars with UltraAC, due to the synergistic effect of access angulation and severe curvature induced in the endodontic files.

The impact of using a pneumatic contra-angle device on the lifespan of M-Wire- and Blue-treated instruments.

OBJECTIVES: To evaluate the cyclic fatigue resistance of Reciproc M-Wire R25 (VDW, Munich, Germany) and Reciproc R25 Blue instruments (VDW) driven by Direct® (VDW) contra-angle connected to an ordinary an air-driven motor or an electric motor and compare the results with those obtained by the Reciproc M-Wire R25 or Reciproc Blue R25 instruments driven by an electric torque-controlled motor using "RECIPROC ALL" preset program. MATERIALS AND METHODS: Thirty Reciproc M-Wire R25 (25/0.08v) and 30 Reciproc Blue R25 (25/0.08v) instruments were used. Cyclic fatigue resistance was tested measuring the time to fracture and the number of cycles to fracture in an artificial stainless-steel canal with a 60° angle and a 5-mm radius of curvature. The Reciproc M-Wire and Reciproc Blue instruments were activated with a 6:1 reduction handpiece powered by a torque-controlled motor using "RECIPROC ALL" preset program, with Reciproc Direct® contra-angle powered by an ordinary air-driven motor or with Direct® contra-angle powered by an electric motor (n = 10). The fracture surface of all fragments was examined with a scanning electron microscope. The results were statistically analyzed using Student's t test and one-way ANOVA at a significance level of P < 0.05. RESULTS: Cyclic fatigue life and number of cycles to fracture were significantly higher for Reciproc Blue instruments than for Reciproc M-Wire instruments regardless of the activation mode (P < 0.05). Instruments driven by Direct® contra-angle powered by an electric or by an ordinary air-driven motor revealed significantly longer cyclic fatigue life and number of cycles to fracture than instruments driven by an electric torque-controlled motor using "RECIPROC ALL" preset program (P < 0.05). CONCLUSIONS: Reciproc Blue instruments showed improved performance regarding fatigue resistance when compared to Reciproc M-Wire instruments. Instruments driven by Reciproc Direct® contra-angle showed higher cyclic fatigue life and number of cycles to fracture than instruments driven by an electric torque-controlled motor. CLINICAL RELEVANCE: Recently, Reciproc Direct®, the world's first contra-angle handpiece with integrated reciprocating motion, has been launched in endodontic market. The present study showed improved cyclic fatigue life of endodontic instruments when activated by Reciproc Direct®.

Cyclic fatigue using severely curved canals and torsional resistance of thermally treated reciprocating instruments.

OBJECTIVES: To evaluate the cyclic fatigue using severely curved canals and torsional resistance of ProDesign R (Easy Equipamentos Odontológicos, Belo Horizonte, MG, Brazil), Reciproc Blue (VDW, Munich, Germany), and WaveOne Gold (Dentsply Maillefer, Ballaigues, Switzerland) reciprocating instruments MATERIALS AND METHODS: Twenty instruments of the ProDesign R (25/0.06) system, 20 instruments of the Reciproc Blue (25/0.08v) system, and 20 instrument of the WaveOne Gold (25/0.07v) system were used. Cyclic fatigue resistance was tested measuring the time to fracture and the number of cycles to fracture in an artificial stainless steel severely curved canal with 80° angle and a 3-mm radius of curvature (n = 10). Torque and angle of rotation at failure of new instruments (n = 10) were measured according to ISO 3630-1. The fracture surfaces of all fragments were examined with a scanning electron microscope. Results were statistically analyzed using one-way ANOVA and Tukey's test at a significance level of p < 0.05. RESULTS: ProDesign R instruments showed a significantly longer cyclic fatigue life than the other tested instruments (p < 0.05). Reciproc Blue showed longer cyclic life than WaveOne Gold (p < 0.05). Reciproc Blue showed the higher torsional strength, followed by WaveOne Gold and ProDesign R instruments (p < 0.05). Moreover, Reciproc Blue showed significantly higher angular rotation to fracture than ProDesign R (p < 0.05). WaveOne Gold showed intermediary results regarding angular rotation to fracture with no differences when compared to Reciproc Blue or ProDesign R instruments (p < 0.05). CONCLUSIONS: ProDesign R presented the highest cyclic fatigue resistance in severely curved canals when compared with Reciproc Blue and WaveOne Gold. However, Reciproc Blue showed the higher torsional strength overall and higher angular rotation to fracture when compared to ProDesign R. CLINICAL RELEVANCE: Despite the numerous advantages of reciprocating instruments, these instruments still have some risk of fracture during its use, especially in severely curved canals. The present study evaluated the cyclic fatigue and torsional resistance of thermally treated reciprocating instruments.

Correlation Between Proinflammatory Cytokine Expression and Clinical Data in Apical Granuloma.

INTRODUCTION: This study was intended to evaluate the expression of inflammatory cytokines commonly secreted by CD4+ T cells (IL-2, IL-5, IL-17, TGF-ß, TNF-α, and IFN-γ) in apical granulomas and correlate with the clinical conditions and time elapsed since root canal treatment. METHODS: Eighteen biopsy specimens obtained by periradicular surgery of teeth with post-treatment apical periodontitis and diagnosed as apical granuloma were available from the oral pathology laboratory. Silanized slides containing paraffin sections were used for immunohistochemical reactions. Images were analyzed by using an optical microscopy and each slide was subdivided into 5 fields at high magnification. RESULTS: IFN-γ and TGF-ß were the cytokines with the highest expression levels. There were statistically significant differences when comparing IL-2 and IFN-γ (P < .05), and IL-2 and TGF-ß (P < .05). Comparison between the detected cytokines and clinical data and time of treatment demonstrated significant correlation (P < .05) between lower expression of IL-2 and the presence of painful symptoms, absence of sinus tract, and treatments performed more than 4 years before. It was also possible to observe a significant correlation between lower expression of IL-5 and treatments performed less than 4 years before (P < .05). CONCLUSION: IFN-γ and TGF-ß were highly expressed in apical granulomas. However, only IL-2 and IL-5 levels were associated with clinical data and time since previous root canal treatment.

A Multimethod Assessment of a New Customized Heat-Treated Nickel-Titanium Rotary File System.

This study aimed to compare three endodontic rotary systems. The new Genius Proflex (25/0.04), Vortex Blue (25/0.04), and TruNatomy (26/0.04v) instruments (n = 41 per group) were analyzed regarding design, metallurgy, and mechanical performance, while shaping ability (untouched canal walls, volume of removed dentin and hard tissue debris) was tested in 36 anatomically matched root canals of mandibular molars. The results were compared using one-way ANOVA, post hoc Tukey, and Kruskal−Wallis tests, with a significance level set at 5%. All instruments showed symmetrical cross-sections, with asymmetrical blades, no radial lands, no major defects, and almost equiatomic nickel−titanium ratios. Differences were noted in the number of blades, helical angles, cross-sectional design, and tip geometry. The Genius Proflex and the TruNatomy instruments had the highest and lowest R-phase start and finish temperatures, as well as the highest and lowest time and cycles to fracture (p < 0.05), respectively. The TruNatomy had the highest flexibility (p < 0.05), while no differences were observed between the Genius Proflex and the Vortex Blue (p > 0.05). No differences among tested systems were observed regarding the maximum torque, angle of rotation prior to fracture, and shaping ability (p > 0.05). The instruments showed similarities and differences in their design, metallurgy, and mechanical properties. However, their shaping ability was similar, without any clinically significant errors. Understanding these characteristics may help clinicians to make decisions regarding which instrument to choose for a particular clinical situation.

Marginal gaps and voids of three root-end filling materials: A microcomputed tomographic study.

A root-end filling material is required to fill the root-end cavity without gaps or voids, to prevent root canal reinfection and to provide periapical healing. Thus, this study evaluated the volume of marginal gaps and voids of three root-end filling materials using microcomputed tomography (micro-CT). Thirty maxillary incisors were prepared and filled with gutta-percha and endodontic sealer. The specimens were scanned using micro-CT and distributed into three groups (n = 10): White MTA, MTA Repair HP, and Bio-C Repair. The root tips were resected at 90° to the longitudinal axis and the cavity (3 mm depth) was prepared with an ultrasonic tip. The materials were handled, and the cavities were filled. The specimens were rescanned and the percentual volume of gaps and voids were analyzed. The data were analyzed using Kruskal-Wallis and Dunn tests (p < .05). No statistical difference was found in the percentage of gaps among the tested materials (p > .05). White MTA presented less voids than Bio-C and MTA Repair HP (p < .05). The materials presented a similar percentual volume of gaps and White MTA presented less voids than other tested materials.

Effects of clinical use of NiTi reciprocating instruments on cyclic and torsional resistance, and on roughness.

The aim of the present study was to evaluate the cyclic fatigue, torsional resistance and surface roughness of Reciproc R25 instruments in four different situations, namely as new instruments and as instruments tested after clinical preparation of one, two or three maxillary molars with four root canals. The total time required to perform each root canal preparation was recorded. Cyclic fatigue resistance was determined by the time to fracture using a customized testing device (n = 10 per group). The torsional test evaluated the torque and angle of rotation to failure according to ISO 3630-1 (n = 10 per group). The roughness of the working parts of new and used instruments was evaluated with a profilometer (n = 5 per group). Statistical analysis was performed using one-way ANOVA and Tukey's test. The level of significance was set at 5%. No fractures or deformations were observed after clinical use. Higher preparation time was needed during the third use of the instruments for all root canals (p < 0.05). There were no significant differences among the groups in regard to either cyclic fatigue or torsional resistance (p > 0.05). Regarding the roughness measurements, groove depth was higher on new and one- versus two- or three-maxillary-molar-prepared instruments (p < 0.05). It can be concluded that the clinical use of Reciproc instruments increased preparation time and decreased surface roughness. However, clinical use did not affect the cyclic fatigue or torsional resistance of the Reciproc instruments.

Cyclic Fatigue and Torsional Resistance of Four Martensite-Based Nickel Titanium Reciprocating Instruments.

OBJECTIVE: To evaluate cyclic fatigue and torsional resistance of Reciproc Blue R25 (VDW, Munich, Germany), WaveOne Gold Primary (Dentsply Maillefer, Ballaigues, Switzerland), ProDesign R (Easy Equipamentos Odontológicos, Belo Horizonte, Brazil), and X1 Blue File (MK Life, Porto Alegre, Brazil) nickel titanium (NiTi) martensite reciprocating instruments. METHODS: In each group, ten instruments were tested for cyclic fatigue resistance using a stainless-steel artificial canal (curvature angle of 80° and radius of 3 mm) and ten instruments for torsional failure according to ISO 3630-1 standard. The surface of the fractured instruments was examined under scanning electron microscopy (SEM) at ×250 magnification. The results were compared statistically with one-way ANOVA and post hoc Tukey tests and the alpha-type error was set at 5%. RESULTS: X1 blue file and ProDesign Rinstruments showed highest time to fracture than Reciproc Blue and Wave One Gold (P<0.05). However, no differences were found between X1 Blue File and ProDesign R (P>0.05). In addition, Reciproc Blue demonstrated highest time to fracture than WaveOne Gold (P<0.05). The lowest torsional resistance (1.0±0.2 N.cm) and angle of rotation (412º±46) was observed in the ProDesign R group (P<0.05). SEM analyses of fractured surfaces showed a crack initiation area and overload fast fracture zone after cyclic fatigue test, and concentric abrasion marks with microvoids at the centre of rotation after torsional failure experiment. CONCLUSION: Overall, X1 Blue File and ProDesign R showed higher cyclic fatigue resistance than Reciproc Blue and WaveOne Gold instruments, while ProDesign R had the lowest torsional resistance and angular rotation values to fracture. SEM analysis of all instruments demonstrated typical failures features in both cyclic fatigue and torsional failure tests.

Cytotoxicity, antibacterial and physicochemical properties of a new epoxy resin-based endodontic sealer containing calcium hydroxide.

BACKGROUND: This study evaluated the cytotoxicity, antibacterial and physicochemical properties of a new epoxy resin-based endodontic sealer containing calcium-hydroxide Sealer Plus. AH Plus was used as a reference for comparison. MATERIAL AND METHODS: Cytotoxicity evaluation was performed according to ISO-10993-5 specifications using MTT assay to check the 3T3 cells viability at 1- to 4-week periods. Antibacterial activity was evaluated using a direct contact test against Enterococcus faecalis. Radiopacity, solubility and flow evaluations were performed according to ISO-6876/2012 specifications. Setting time was assessed following the ANSI/ADA-standard-n.57. The pH level was measured at 3,24,48,72, and 168 hours. Data were statistically analyzed using t-test. The significance level adopted was P<0.05. RESULTS: AH Plus and Sealer Plus showed cytotoxic effects after 24 hours and 1 week of manipulation and become noncytotoxic after 2 weeks. No differences were observed in the cytotoxicity of both tested sealers (P>0.05). Direct contact results revealed that both freshly prepared sealers has antibacterial effects against Enterococcus faecalis. However, after 7 days both sealers had lost much of their antibacterial effects. Although AH Plus presented higher radiopacity and flow than Sealer Plus (P<0.05), both sealers showed minimum required values. No differences were observed in the solubility of both sealers (P>0.05). AH Plus showed a higher setting time when compared to Sealer Plus (P<0.05). AH Plus and Sealer Plus showed a neutral pH during all tested periods (P<0.05). CONCLUSIONS: It can be concluded that Sealer Plus showed suitable properties to be used as an endodontic sealer, comparable with those obtained by AH Plus. Key words:Cytotoxicity, root canal filling materials, root canal obturation.

The Apical Root Canal System of Teeth with Posttreatment Apical Periodontitis: Correlating Microbiologic, Tomographic, and Histopathologic Findings.

INTRODUCTION: This study evaluated the microbiological conditions of the apical root canal system of teeth with posttreatment apical periodontitis and correlated them with observations from cone-beam computed tomographic (CBCT) imaging, micro-computed tomographic (micro-CT) imaging, and histopathology. METHODS: Root apices were obtained from 36 root canal-treated teeth subjected to periradicular surgery. CBCT examination was available before surgery. The apical root specimens were scanned in a micro-CT device and then cryopulverized. The powder was subjected to DNA extraction for real-time polymerase chain reaction quantification of total bacteria, Streptococcus species, members of the phylum Actinobacteria, and Enterococcus faecalis. Microbiological findings were evaluated for associations with CBCT, micro-CT, and histopathologic data. An association between lesion size and the proportion of unfilled apical canal system volume was also assessed. RESULTS: All cryopulverized specimens were positive for total bacteria. Actinobacteria and streptococci occurred in 35 and 33 specimens, respectively, and were usually dominant in the community. Actinobacteria counts were 2.23 times higher in granulomas than in cysts. Streptococci were significantly more present in small lesion cases. E. faecalis was detected in only 7 samples, always as a dominant community member. The association of total bacteria, streptococci, and Actinobacteria counts with the unfilled canal volume was significant in the univariate analyses but not confirmed in the adjusted analyses. Large lesions were significantly associated with a higher volume of unfilled apical canals. CONCLUSIONS: Bacterial infection occurred in all root apices, with high prevalence and dominance of Actinobacteria and streptococci. The volume of the unfilled apical canal system was significantly associated with the lesion size and possibly with bacterial counts. Findings illustrate the need to thoroughly disinfect and fill the apical root canal of infected teeth during endodontic therapy.

Pro-inflammatory and anti-inflammatory cytokine expression in post-treatment apical periodontitis.

OBJECTIVE: This study evaluated the expression of pro-inflammatory (IL-1ß, IL-6, IFN-γ and TNF-α) and anti-inflammatory (IL-4 and TGF-ß) cytokines in apical periodontitis lesions. Correlations between these cytokines and clinical and cone-beam computed tomographic (CBCT) data were also assessed. MATERIAL AND METHODS: Apical periodontitis lesions' data were obtained from 27 patients subjected to periradicular surgery. Specimens were processed for histopathologic and immunohistochemical analysis. Sections were evaluated according to the amount of positive staining for each antibody. Expression levels of the target mediators were compared with clinical and CBCT data. RESULTS: Twenty lesions were diagnosed as granuloma and 7 as cyst. In granulomas, IL-4 expression was significantly higher than IL-6 (p=0.001) and TNF-α (p=0.001). There was a significant relationship between high levels of TNF-α and lesions <5 mm (p=0.017). In cysts, IL-6 expression was significant lower than IL-4 (p=0.001) and IFN-γ (p=0.004). There was a significant relationship between high levels of TGF-ß and endodontic treatment performed ≤4 years before (p=0.045). In general, IL-4 was the most expressed mediator in both cysts and granulomas. CONCLUSIONS: There was a balance between the expression of pro-inflammatory and anti-inflammatory cytokines associated with the chronic periradicular inflammatory process. TNF-α and TGF-ß were related to some clinical and CBCT data.

Molecular Analysis of the Antibacterial Effects of Photodynamic Therapy in Endodontic Surgery: A Case Series.

In this case series, bacterial reduction promoted by antimicrobial photodynamic therapy (PDT) used during endodontic surgery was evaluated. Cases were also followed up, and the surgical outcome was reported. The study consisted of 19 teeth with posttreatment apical periodontitis that were consecutively treated by endodontic surgery. After apicoectomy, the root end was treated with PDT using methylene blue as the photosensitizer. Bacteriologic samples were taken from both the cut root surface and the root-end cavity before and after PDT. Samples were analyzed for the total bacterial and Streptococcus group counts using quantitative real-time polymerase chain reaction. EndoSequence BC-RRM Putty (Brasseler, Savannah, GA) was used as the root-end filling. Patients were followed up, and the surgical outcome was evaluated. The reduction in bacterial counts after the PDT approach was analyzed using the nonparametric Wilcoxon signed rank test. PDT significantly reduced the total bacterial and streptococcal counts in both root-end cavities and resected root surfaces (P < .05). The success rate for 15 teeth that were available for recall after 12 to 21 months was 93% under a loose evaluation criterion and 73% under a rigid one. Used during endodontic surgery, PDT significantly enhanced disinfection of the cut surface area and root-end cavity. Cases treated with PDT showed a high healing rate.

Torsional Fatigue Resistance of Blue-treated Reciprocating Instruments.

INTRODUCTION: The aim of the present study was to evaluate the influence of blue thermal treatment on the torsional resistance behavior of M-Wire Reciproc files (VDW, Munich, Germany). METHODS: Ten M-Wire Reciproc R25 (25/0.08v) and 10 Reciproc Blue R25 (25/0.08v, VDW) instruments were used. The torque and angle of rotation at failure of new instruments (n = 10) were measured according to ISO 3630-1. Three millimeters of each instrument tip was clamped to a small load cell by a lever arm linked to the torsion axis. The fracture surface of all fragments was examined with a scanning electron microscope. Results were statistically analyzed using the Student t test at a significance level of P < .05. RESULTS: The maximum torsional strength of M-Wire Reciproc was higher than Reciproc Blue instruments (P < .05). Reciproc Blue instruments showed significantly higher angular rotation to fracture than M-Wire Reciproc instruments (P < .05). Scanning electron microscopy of the fracture surface showed similar and typical features of torsional failure for the 2 types of instruments, including concentric abrasion marks and the fibrous dimple marks at the center of rotation. CONCLUSIONS: Reciproc Blue instruments showed a higher angle of rotation to fracture but a lower torque to failure than M-Wire Reciproc instruments.

Cyclic and Torsional Fatigue Resistance of XP-endo Shaper and TRUShape Instruments.

INTRODUCTION: The purpose of this study was to evaluate the cyclic and torsional fatigue resistance of the XP-endo Shaper (FKG Dentaire, La Chaux-de-Fonds, Switzerland) and TRUShape (Dentsply Tulsa Dental Specialties, Tulsa, OK) instruments. METHODS: Twenty XP-endo Shaper (30/0.01) instruments and 20 TRUShape (30/0.06v) instruments were used. Cyclic fatigue resistance was tested by measuring the number of cycles and time to fracture in an artificial stainless steel canal with a 60° angle and a 5-mm radius of curvature (n = 10). The torque and angle of rotation at failure of new instruments (n = 10) were measured according to ISO 3630-1. The fracture surface of all fragments was examined with a scanning electron microscope. Results were statistically analyzed using the Student t test at a significance level of P < .05. RESULTS: The XP-endo Shaper instruments showed a significantly longer number of cycles to fracture and time to failure in seconds than the TRUShape instruments (P < .05). The XP-endo Shaper also presented a lower maximum torque load (P < .05) but a significantly higher angular rotation to fracture than TRUShape (P < .05). CONCLUSIONS: The XP-endo Shaper instruments showed a higher cyclic fatigue resistance and angle of rotation to fracture but lower torque to failure than TRUShape instruments.

Mechanical Properties of Anatomic Finishing Files: XP-Endo Finisher and XP-Clean.

The aim of the present study was to evaluate the cyclic fatigue of two anatomic finishing files: XP-Endo Finisher and XP-Clean. Roughness pattern and the micro-hardness of the files were also assessed. Instruments were subjected to cyclic fatigue resistance measuring the time to fracture in an artificial stainless-steel canal with a 60° angle and a 5-mm radius of curvature. The fracture surface of all fragments was examined with a scanning electron microscope. The roughness of the working parts was quantified by using a profilometer and the micro-hardness test was carried out using a Vickers hardness tester. Results were statistically analyzed using a student´s t-test at a significance level of P < 0.05. Weibull analysis was also performed. XP-Endo Finisher presented significantly longer cyclic fatigue life than XP-Clean instruments (P<0.05). XP-Endo Finisher was able to withstand 1000% more cycles to fracture when compared to XP-Clean instruments. SEM visual inspection of the fracture surfaces revealed fractographic characteristics of ductile fracture in all tested instruments; wide-ranging forms of dimples were identified and no plastic deformation in the helical shaft of the fractured instruments was observed. When mean life was compared XP-Endo Finisher lasted longer than XP-Clean with a probability of 99.9%. XP-Endo Finisher instruments also exhibited significantly lower roughness than XP-Clean instruments (P<0.05). No differences in the micro-hardness was observed between the files (P>0.05). It can be concluded that XP-Endo Finisher instruments showed improved performance when compared with XP-Clean instruments, demonstrating higher cyclic fatigue resistance and lower roughness.

Influence of surgical decompression on the expression of inflammatory and tissue repair biomarkers in periapical cysts.

OBJECTIVE: The biologic effects of surgical decompression on the epithelium and connective tissues of periapical cysts are not fully understood. The aim of this study was to evaluate the expression of tissue repair and inflammatory biomarkers in periapical cysts before and after surgical decompression. STUDY DESIGN: Nine specimens of periapical cysts treated with decompression before undergoing complete enucleation were immunohistochemically analyzed to investigate the expression of interleukin-1ß, tumor necrosis factor-α, transforming growth factor-ß1, matrix metalloproteinase-9, Ki-67, and epidermal growth factor receptor. Expression of the biomarkers was classified as positive, focal, or negative. Ki-67 immunoexpression was calculated as a cell proliferation index. The expression of the biomarkers was compared in the specimens from decompression and from the final surgical procedure. RESULTS: Computed tomography demonstrated that volume was reduced in all cysts after decompression. There were no differences in the immunoexpression of the proinflammatory and tissue repair biomarkers when comparing the specimens obtained before and after the decompression. CONCLUSIONS: Surgical decompression was efficient in reducing the volume of periapical cysts before complete enucleation. When comparing the specimens obtained from surgical decompression and from complete surgical removal, the immunohistochemical analysis did not show a decrease in proinflammatory biomarkers; neither did it show an increase in tissue repair biomarkers.

Human Exoproteome in Acute Apical Abscesses.

INTRODUCTION: An acute apical abscess is a severe response of the host to massive invasion of the periapical tissues by bacteria from infected root canals. Although many studies have investigated the microbiota involved in the process, information on the host factors released during abscess formation is scarce. The purpose of this study was to describe the human exoproteome in samples from acute apical abscesses. METHODS: Fourteen pus samples were obtained by aspiration from patients with an acute apical abscess. Samples were subjected to protein digestion, and the tryptic peptides were analyzed using a mass spectrometer and ion trap instrument. The human proteins identified in this analysis were classified into different functional categories. RESULTS: A total of 303 proteins were identified. Most of these proteins were involved in cellular and metabolic processes. Immune system proteins were also very frequent and included immunoglobulins, S100 proteins, complement proteins, and heat shock proteins. Polymorphonuclear neutrophil proteins were also commonly detected, including myeloperoxidases, defensins, elastases, and gelatinases. Iron-sequestering proteins including transferrin and lactoferrin/lactotransferrin were found in many samples. CONCLUSIONS: The human exoproteome included a wide variety of proteins related to cellular processes, metabolism, and immune response. Proteins involved in different mechanisms against infection, tissue damage, and protection against tissue damage were identified. Knowledge of the presence and function of these proteins using proteomics provides an insight into the complex host-pathogen relationship, the host antimicrobial strategies to fight infections, and the disease pathogenesis.

Transportation Assessment in Simulated Curved Canals after preparation with Twisted File Adaptive and BT-Race instruments.

BACKGROUND: This study compared the incidence of deviation along curved canals after preparation with two nickel-titanium (NiTi) rotary systems, Twisted File Adaptive and BT-RaCe. MATERIAL AND METHODS: Forty resin training blocks with curved canals were filled with ink and divided into two groups according to the instrumentation technique. Preinstrumentation images were acquired by using a stereomicroscope. The canals were up to an instrument #35/0.04. Postinstrumentation images were captured using the same conditions, and the images were superimposed. The amount of resin removed was measured at 8 different points, beginning at the apical terminus of the canal. Differences in the mesial and distal aspects were measured to evaluate the occurrence of deviation. The Student's-t test was used for comparison of the intragroup deviation. Intergroup analysis was performed by using one-way ANOVA for each level. For multiple comparisons, the Bonferroni test was used and a cutoff for significance was set at 5%. RESULTS: Intragroup analysis showed that both instrumentation techniques promoted some deviation at all levels. BT-RaCe showed significantly lower deviation at 0 and 4-mm levels than Group Twisted File Adaptive (p<0.05). On the other hand BT-RaCe showed worse performance at level 6. CONCLUSIONS: The results of this study demonstrated that none of the NiTi tested systems was able to instrument curved canals simulated in resin blocks without some deviation during the preparation. There is still need for improvement in the instruments manufacturing aiming the better performance of endodontic files in curved root canals. Key words:BT-RaCe, Curved root canals, Deviation, Twisted File Adaptive.

Microbiome in the Apical Root Canal System of Teeth with Post-Treatment Apical Periodontitis.

INTRODUCTION: Bacteria present in the apical root canal system are directly involved with the pathogenesis of post-treatment apical periodontitis. This study used a next-generation sequencing approach to identify the bacterial taxa occurring in cryopulverized apical root samples from root canal-treated teeth with post-treatment disease. METHODS: Apical root specimens obtained during periradicular surgery of ten adequately treated teeth with persistent apical periodontitis were cryogenically ground. DNA was extracted from the powder and the microbiome was characterized on the basis of the V4 hypervariable region of the 16S rRNA gene by using paired-end sequencing on Illumina MiSeq device. RESULTS: All samples were positive for the presence of bacterial DNA. Bacterial taxa were mapped to 11 phyla and 103 genera composed by 538 distinct operational taxonomic units (OTUs) at 3% of dissimilarity. Over 85% of the sequences belonged to 4 phyla: Proteobacteria, Firmicutes, Fusobacteria and Actinobacteria. In general, these 4 phyla accounted for approximately 80% of the distinct OTUs found in the apical root samples. Proteobacteria was the most abundant phylum in 6/10 samples. Fourteen genera had representatives identified in all cases. Overall, the genera Fusobacterium and Pseudomonas were the most dominant. Enterococcus was found in 4 cases, always in relatively low abundance. CONCLUSIONS: This study showed a highly complex bacterial community in the apical root canal system of adequately treated teeth with persistent apical periodontitis. This suggests that this disease is characterized by multispecies bacterial communities and has a heterogeneous etiology, because the community composition largely varied from case to case.