Comparison between isolated and associated with codeine acetaminophen in pain control of acute apical abscess: a randomized clinical trial.

OBJECTIVES: The study aimed to compare the acetaminophen administration efficacy or its combination with codeine for pain control in acute apical abscesses cases. MATERIALS AND METHODS: Thirty-nine patients who sought emergency treatment in the Faculty of Dentistry of the Federal University of Rio Grande do Sul were included, all of them with acute apical abscess diagnosis. These patients were divided into two groups: acetaminophen group-prescription of acetaminophen (1000 mg) and acetaminophen-codeine group-prescription of acetaminophen (1000 mg) + codeine (30 mg), both with oral intake every 6 h for 3 days. The pain scores were recorded by the patients on their own at 6, 12, 24, 48, and 72 h after finishing clinical assistance, by filling a pain evolution journal, containing a visual analogue scale (VAS). Student t test was conducted to investigate different mean ages between groups 1 and 2. A comparison of weight and means of initial pain scores between groups was carried out using the Mann-Whitney U test. Chi-square test was performed to compare gender, affected tooth, education, initial swelling, and frequency of adverse effect between test and control groups. Mann-Whitney U test was applied to compare groups in the same period. Friedman's test was used to compare results from the same group over time. RESULTS: Both groups showed score reduction over time (P < 0.05). Paracetamol-codeine group showed significant pain score reduction at 48 h registers when compared to baseline and at 6 h scores (P < 0.05). Further, pain scores at 72 h were significantly lower, when compared to the baseline, at 6 h, and at 12 h scores (P < 0.05). Acetaminophen group showed significant pain score reduction observed at 72 h, when compared to the baseline and at 6 h scores (P < 0.05). There were no significant differences in pain score reduction over time between groups (P > 0.05). There was no difference between the groups regarding the frequency of adverse reactions (P > 0.05). CONCLUSION: Both medications were effective for pain control in acute apical abscess cases. The findings might have inferred in pain control of acute apical abscess associated pain in patients who used an antibiotic drug. External validity of the findings for acute apical abscess cases with no need for an antibiotic prescription is uncertain. CLINICAL RELEVANCE: This paper suggests acetaminophen 1000 mg can be used for pain control in the treatment of acute apical abscess associated with systemic manifestation.

Influence of cervical preflaring and root canal preparation on the fracture resistance of endodontically treated teeth.

BACKGROUND: Evaluate the fracture resistance of endodontically treated teeth after cervical preflaring and root canal preparation and to assess the volume of the root canal and the amount of remaining root dentin before and after cervical preflaring. METHODS: Forty-four mandibular incisors were selected using micro-CT scanning and distributed into 4 groups (n = 11) according to the instrument used for cervical preflaring: control group - no cervical preflaring; Gates Glidden - burs size #2 and #3; WXN - 25.07 Navigator instrument; and Easy - 25.08 ProDesign S instrument. Coronal opening was performed, and the canals were prepared with Wave One Gold Primary and filled with an epoxy-resin based sealer and gutta-percha cones. Micro-CT scans were performed before and after root canal instrumentation. All images were reconstructed and assessed for the thickness of mesial and distal root dentin at 3 mm and 5 mm from the cement -enamel junction and for the volume of cervical portion of the canal after preparation. Fracture resistance test was performed applying compressive loads at a crosshead speed of 0.5 mm/min, applied on the palatal aspect of specimens at 135° along the long axis of the tooth. The data were analyzed using ANOVA and Tukey's test (P = .05). RESULTS: Cervical preflaring and canal preparation reduced the dentin thickness (P < .05) and increased the canal volume (P < .05) in all groups at 3 mm an 5 mm. Cervical preflaring with Gates Gliden burs reduced the fracture resistance of endodontically treated teeth (P < .05). CONCLUSIONS: All instruments reduced the dentin thickness and increased the canal volume in the cervical at 3 mm and 5 mm. Gates Glidden reduced fracture resistance of mandibular incisors submitted to cervical preflaring, whereas NiTi instruments did not. CLINICAL RELEVANCE: Cervical preflaring assumes particular importance previously to the root canal preparation because it minimizes the occurrence of operative accidents, and permits more accurate determination of working length and the apical diameter.

Factors affecting the color stability and staining of esthetic restorations.

This study aimed to assess the color stability of two composite resins, unprotected or protected with a hydrosoluble gel (oxygen inhibitor) during final polymerization, when subjected to different staining solutions and daily tooth brushing simulation. Nanohybrid composite (IPS Empress Direct) or nanofilled composite (Filtek Z350) were used to produce round samples that were either unprotected or protected with a hydrosoluble gel before the final cycle of polymerization. For 5 days, the samples were immersed for 1 h/day in four different staining solutions: distilled water (control), coffee, soft drink, and red wine. Once a day, the samples were also subjected to mechanical brushing with soft-bristled brushes for 30 min. The combination of experimental conditions produced 16 groups (n = 10). Color changes (ΔE) were evaluated at baseline and after mechanical brushing cycles for 1, 3, and 5 days. Data were analyzed by linear regression models. Protection with hydrosoluble gel was able to significantly reduce the color change only on the first day (p = 0.001). The type of composite resin did not significantly affect the color change over the days. Wine affected composite resin color change only on the first day (p = 0.002). Over time, color stability of composite resins did not improve with the protection of a hydrosoluble gel before the final polymerization.

Effect of ethanol on the antimicrobial properties of chlorhexidine over oral biofilm.

The aim of this study was to evaluate the effect of 95% ethanol irrigation, with 5 or 10 min of action, on the antibacterial properties of 2% chlorhexidine (CHX), on oral biofilm, evaluated with confocal laser scanning microscopy (CLSM). Oral biofilm development was induced in 80 sterilized bovine dentin blocks, distributed in two groups (5 or 10 min) and 4 subgroups, according to time and the solution used: Saline (SALINE5, SALINE10); Saline followed by CHX (SALINE/CHX5, SALINE/CHX10); Ethanol (ETHANOL5, ETHANOL10), Ethanol followed by CHX (ETHANOL/CHX5, ETHANOL/CHX10). The surface of the block was dyed with Live/Dead® BacLight. Images from different areas were analyzed by BioImage L program. The total biovolum (µm³), biovolum of live cells (green), percentage of live cells of the thickness of the biofilm visualized in CLSM and on surface biofilm were evaluated. Total biovolum and biovolum of living cells showed similar results among the different groups (p > .05). The percentage of living cells in total thickness of the biofilm also was similar among the groups (p > .05), except ETHANOL5, SALINE/CHX10, ETHANOL10, and ETHANOL/CHX10 that showed lower percentage than SALINE5 (p < .05). The ETHANOL10 and ETHANOL/CHX10 also showed lower percentage of living cells than ETHANOL/CHX5 and SALINE10 (p < .05). In relation to biofilm surface, SALINE/CHX5, SALINE/CHX10, ETHANOL5, ETHANOL10, ETHANOL/CHX5, and ETHANOL/CHX10 showed a lower percentage of living cells percentage than SALINE5 and SALINE10 groups (p < .05). Therefore, ethanol has no effect on antimicrobial properties of 2% chlorhexidine, prior when used as endodontic irrigating solution.

NiTi loss on the dentinal walls and instrument deformation during root canal preparation.

The purpose of this study was to quantify the presence of nickel (Ni) and titanium (Ti) on dentin walls of prepared root canals using Endosequence (ES) and Wave One (WO) systems, the deformation, and fracture of these instruments. Thirty extracted human premolar teeth were selected and prepared with WO, ES, and manually (control group-CG). Each instrument was used in four root canals. The root canals were irrigated with 2.5% sodium hypochlorite solution. After preparation, roots were sectioned longitudinally and the apical third was analyzed by scanning electron microscopy with X-ray microanalysis (SEM-EDS). The percentage of Ni and Ti found on dentin walls was compared using Kruskal-Wallis test and post hoc Dunn. The instruments deformation and fracture was evaluate by SEM before and after use. Spiral distortion, fractures, and surface wear were compared using Mann-Whitney test. The level of significance was set at 5%. Ni and Ti were found on the dentin walls of the apical root canal for ES and WO systems (p > .05). No distortion in the spirals and no instrument fracture were observed. Regarding to surface wear, most of the instruments scored as moderate wear (p > .05). This study concluded the WO and ES presented Ni and Ti loss. In addition, the preparation of four root canals did not caused irreversible deformation in WO and ES instruments.

Microbiological analysis of absorbent paper points employed by undergraduate students from a dental school in south of Brazil

Aim: The aim of this study was identify contamination on absorbent paper points used by students of Dental Clinic III of the Faculty of Dentistry of Federal University of Rio Grande do Sul in the semester 2015/1, in order to warn students and professionals of the area on the importance to sterilize these materials. Material and Methods: In a clinical environment, 180 absorbent paper points we collected (80 of them from the first series and 80 from the second one), from 40 students. After the collection, each one was singly immersed in a microtube containing 1.5 ml of the BHI (Brain Heart Infusion) culture. Positive control was composed by one paper point contaminated by saliva, and negative control was composed by a closed microtube, only with BHI. The microtubes were incubated at 37ºC in bacteriological incubator during 14 days. The microtubes that presented turbidity were considered positive, and those which did not present turbidity were considered negative. Results: The results were analyzed by the Fisher Exact Test, which demonstrated that paper points from the second series presented higher agreement contamination between the paper points collected from each box, when compared to the analyzed boxes from the first series (p=0.03). All the samples observed presented growth of Bacillus spp in the microorganism identification. Conclusions: It is possible conclude that absorbing paper points, when exposed to clinical environment suffer contamination, and the autoclave sterilization is necessary before the use, regardless the commercial brand, in order to ensure the aseptic chain maintenance.