Factors influencing the outcome of nonsurgical root canal treatment and retreatment: A retrospective study.

This study assessed the influence of diverse variables on the outcome of nonsurgical root canal treatment/retreatment. In general, 304 teeth from 218 patients were treated/retreated and the outcome evaluated by the periapical index (PAI). Teeth with apical periodontitis lesions that have not completely healed were classified as success or failure based on lenient and rigid criteria, respectively. Findings were evaluated using a logistic regression analysis. The overall success rates were 74% and 82% using the PAI-rigid and lenient success criteria, respectively. Specifically for treatment, the success rates were 73% (rigid) and 82% (lenient), while for retreatment they were 78% (rigid) and 83% (lenient). The treatment outcome was negatively affected by overextension, presence of preoperative lesion, lesion size >10 mm, and higher number of treatment visits (with no intracanal medication). Regarding retreatment, the chance of success was greater for teeth with adequate coronal restorations.

Disinfection and Shaping of Vertucci Class II Root Canals after Preparation with Two Instrument Systems and Supplementary Ultrasonic Activation of Sodium Hypochlorite.

INTRODUCTION: This study compared disinfection and shaping after root canal preparation with either XP-endo Shaper or TruNatomy instrument systems, supplemented by ultrasonic activation of sodium hypochlorite (NaOCl) with either stainless-steel (SS) or nickel-titanium (NiTi) inserts. METHODS: Mesial roots from mandibular molars with Vertucci class II configuration were divided into 2 groups (n = 24) based on anatomically paired micro-computed tomography (micro-CT) analyses. Pre and postpreparation micro-CT scans were obtained to evaluate the shaping performance. The canals were contaminated with a mixed bacterial culture for 30 days and then subjected to preparation with either XP-endo Shaper or TruNatomy instruments using NaOCl irrigation. Supplementary ultrasonic activation of NaOCl was conducted using either an SS (TruNatomy group) or NiTi (XP-endo Shaper group) insert. Bacteriological samples were taken from the canals before preparation (S1), after preparation (S2), and after the supplementary approach (S3). Bacterial reduction was evaluated using a quantitative real-time polymerase chain reaction. RESULTS: Preparation with both instrument systems significantly reduced bacterial counts (P < .01). After preparation, 36% (TruNatomy) and 35% (XP-endo Shaper) were negative for bacteria. These values increased to 59% and 65% after ultrasonic activation with the SS and NiTi inserts, respectively. The quantitative data in S2 showed that XP-endo Shaper promoted a significantly higher bacterial reduction than TruNatomy (P < .05). No significant intragroup differences were observed after ultrasonic activation (P > .05), probably because the SS insert promoted a significantly higher S2-to-S3 reduction than the NiTi insert (P < .01). Micro-CT analysis revealed no significant differences in the unprepared areas between the groups (P > .05). CONCLUSIONS: The XP-endo Shaper caused a significantly higher bacterial reduction than TruNatomy in Vertucci class II canals. Better antibacterial results after ultrasonic activation were observed for the SS ultrasonic inserts than for the NiTi inserts.

Effects of Calcium Hydroxide Paste in Different Vehicles on Bacterial Reduction during Treatment of Teeth with Apical Periodontitis.

INTRODUCTION: This clinical study evaluated the antibacterial effects of calcium hydroxide associated with different vehicles during the treatment of infected teeth with apical periodontitis. METHODS: Bacteriologic samples were taken from 90 necrotic root canals of teeth with apical periodontitis before (S1) and after preparation with a rotary nickel-titanium instrument system and 2.5% sodium hypochlorite irrigation (S2). The teeth were distributed in 3 groups according to the intracanal medication used, which consisted of a calcium hydroxide paste in glycerin, camphorated paramonochlorophenol/glycerin (CHPG), or 2% chlorhexidine for 1 week, and then another sample was taken (S3). The frequency of bacteria-positive cases and the reduction of bacterial counts were evaluated by quantitative real-time polymerase chain reaction. RESULTS: Substantial intracanal bacterial reduction was observed after preparation in the 3 groups (P < .001). After calcium hydroxide paste in glycerin medication, the number of bacteria-positive cases decreased from 20/29 (69%) to 17/29 (59%); however, the mean bacterial counts increased 8.4% from S2 to S3. Medication with CHPG reduced the number of bacteria-positive cases from 17/29 (59%) to 15/29 (52%), with a significant mean S2-S3 reduction of 71% (P < .05). In the chlorhexidine group, the number of bacteria-positive cases decreased from 21/30 (70%) to 17/30 (57%) after medication, with a mean S2-S3 reduction of 55%, which, however, was not statistically significant (P > .05). Intergroup comparisons showed no significant differences (P > .05). CONCLUSION: Comparison between the 3 calcium hydroxide pastes showed no significant differences in antibacterial effectiveness in the main root canal. However, only the CHPG paste showed a significant reduction in bacterial counts when postpreparation and postmedication samples were compared.

Antibiotic indication in endodontics by Colombian dentists with different levels of training: a survey / Indicação dos antibióticos em Endodontia por dentistas colombianos com diferentes níveis de formação: uma pesquisa por questionário

ABSTRACT Aim: This study investigated how Colombian dentists with different academic levels indicate antibiotics with therapeutic purposes in endodontics. Materials and method: A cross-sectional survey was conducted among 559 dentists in the form of an online questionnaire. Results: Three hundred and twenty questionnaires were answered (57.2%). There were significant differences among respondents. For irreversible pulpitis, 140 dentists (43.7%) said they prescribe antibiotics (57.5% of general practitioners, 20.1% of specialists and 38.9% of those with Master's and/or PhD degrees), while for symptomatic apical periodontitis, 183 (57.2%) did so (74.1% of general practitioners, 28.4% of specialists and 50.0% of those with Master's and/or PhD degrees) (p < 0.05). Amoxicillin was the most frequently prescribed antibiotic, and its association with clavulanic acid was the most often cited for acute periradicular abscess with systemic involvement. Conclusions: The greatest misunderstandings in prescribing antibiotics occurred among general practitioners. Considering all clinical conditions that do not require antibiotics, 60% of general practitioners and 34% of specialists, on average, indicated antibiotics.

RESUMO Objetivo: Este estudo investigou como dentistas colombianos com diferentes níveis acadêmicos indicaram antibióticos com fins terapêuticos em Endodontia. Materiais e método: Realizou-se um levantamento transversal com 559 dentistas. Foi enviado um questionário online. Resultados: Foram respondidos 320 questionários (57,2%). Houve diferenças significativas entre os profissionais com diferentes níveis de formação. Para pulpite irreversível, 140 (43,7%) dentistas afirmaram indicar antibióticos (57,5% clínicos gerais, 20,1% especialistas e 38,9% com mestrado e/ou doutorado), enquanto para periodontite apical sintomática, 183 (57,2%) prescrevem estes medicamentos (74,1% clínicos, 28,4% especialistas e 50,0% com mestrado e doutorado) (p < 0,05). A amoxicilina foi a mais indicada entre os profissionais, e sua associação com ácido clavulânico foi a mais referida para abscesso perirradicular agudo com acometimento sistêmico. Conclusões: Os maiores equívocos na prescrição de antibióticos ocorreram com os clínicos gerais. Considerando todas as condições clínicas que não requerem antibióticos, 60% dos clínicos gerais e 34% dos especialistas, em média, indicaram estes medicamentos.

Comparative Evaluation of Homeopathic Therapy in the Treatment of Chronic Periodontitis.

CONTEXT AND OBJECTIVE: Periodontitis and type 2 diabetes (T2D) are chronic diseases generally treated with conventional therapies alone. The aim of this study was to compare the effects of homeopathy as an adjunct to conventional periodontal therapy in individuals with periodontitis and T2D. DESIGN: 85 individuals, age between 35 and 70 years, of both genders, participated in this randomized study; 70 patients were from the Institute of Endocrinology and Diabetes of Rio de Janeiro, Brazil. They were divided into 2 groups: G1, individuals with periodontitis without systemic conditions; and G-2, individuals with periodontitis and T2D. Both groups received homeopathic treatment and were evaluated in clinical and laboratory examinations. The medication used was chosen based on the similarity principle: Berberis 6CH, Mercurius Solubilis/Belladona /Hepar Sulfur and a Pyrogenium 200CH biotherapic. Medications were prescribed in diluted low ultra-diluted concentration doses for all signs and symptoms, while biotherapics were used for chronic stimulation. SETTING: The study was performed in Brazil by university research professors of homeopathy and periodontics. RESULTS: Both groups showed significant clinical and laboratory improvements during the study from baseline to 1 year with reductions in total cholesterol (total-C), triglycerides, glucose, glycated hemoglobin (A1cHb), uric acid and C-reactive protein (CRP). Statistical and descriptive analyses were performed. For most parameters, G1 performed better than G2 (P < .05). CONCLUSION: Homeopathy as an adjunct to periodontal treatment improves local and systemic clinics and can provide better health conditions for patients with or without T2D.

Antibiotic indication in endodontics by Colombian dentists with different levels of training: a survey.

AIM: This study investigated how Colombian dentists with different academic levels indicate antibiotics with therapeutic purposes in endodontics. MATERIALS AND METHOD: A cross-sectional survey was conducted among 559 dentists in the form of an online questionnaire. RESULTS: Three hundred and twenty questionnaires were answered (57.2%). There were significant differences among respondents. For irreversible pulpitis, 140 dentists (43.7%) said they prescribe antibiotics (57.5% of general practitioners, 20.1% of specialists and 38.9% of those with Master's and/or PhD degrees), while for symptomatic apical periodontitis, 183 (57.2%) did so (74.1% of general practitioners, 28.4% of specialists and 50.0% of those with Master's and/or PhD degrees) (p<0.05). Amoxicillin was the most frequently prescribed antibiotic, and its association with clavulanic acid was the most often cited for acute periradicular abscess with systemic involvement. CONCLUSIONS: The greatest misunderstandings in prescribing antibiotics occurred among general practitioners. Considering all clinical conditions that do not require antibiotics, 60% of general practitioners and 34% of specialists, on average, indicated antibiotics.

OBJETIVO: Este estudo investigou como dentistas colombianos com diferentes níveis acadêmicos indicaram antibióticos com fins terapêuticos em Endodontia. Materiais e método: Realizou-se um levantamento transversal com 559 dentistas. Foi enviado um questionário online. RESULTADOS: Foram respondidos 320 questionários (57,2%). Houve diferenças significativas entre os profissionais com diferentes níveis de formação. Para pulpite irreversível, 140 (43,7%) dentistas afirmaram indicar antibióticos (57,5% clínicos gerais, 20,1% especialistas e 38,9% com mestrado e/ou doutorado), enquanto para periodontite apical sintomática, 183 (57,2%) prescrevem estes medicamentos (74,1% clínicos, 28,4% especialistas e 50,0% com mestrado e doutorado) (p < 0,05). A amoxicilina foi a mais indicada entre os profissionais, e sua associação com ácido clavulânico foi a mais referida para abscesso perirradicular agudo com acometimento sistêmico. Conclusões: Os maiores equívocos na prescrição de antibióticos ocorreram com os clínicos gerais. Considerando todas as condições clínicas que não requerem antibióticos, 60% dos clínicos gerais e 34% dos especialistas, em média, indicaram estes medicamentos.

Disinfection and outcome of root canal treatment using single-file or multifile systems and Ca(OH)2 medication.

This clinical study reports on the antibacterial effects and outcome of endodontic treatment using either a single-file or a multifile system, associated with calcium hydroxide interappointment medication. The root canals of single-rooted teeth with apical periodontitis were treated by using either Reciproc or BioRaCe instrument systems, 2.5% NaOCl irrigation, and calcium hydroxide medication. Bacteriological samples taken before preparation and immediately before obturation were evaluated for total bacterial counts by quantitative real-time polymerase chain reaction (qPCR). Patients were followed up and the treatment outcome was assessed by clinical and radiographic criteria. Decreasing lesions were classified as success in a lenient criterion or failure in a rigid one. Bacteria were detected in all initial samples (47 cases) and were significantly reduced after treatment in both groups (p<0.001). In the Reciproc and BioRaCe groups, 7/25 (28%) and 11/22 (50%) root canals yielded negative qPCR results before obturation, respectively (p>0.05). Quantitative bacterial reduction was similar between groups (p>0.05). The success rate in the BioRaCe group was 95.5% and 77% in the loose and rigid criterion, respectively. In the Reciproc group, corresponding figures were 88% and 76%. Differences in outcome were not significant (p>0.05). No diseased case showed negative qPCR results for bacteria. A difference of >1 Log10 counts was observed between healed and diseased cases. Root canal treatments of teeth with apical periodontitis using a single-file or a multifile system for preparation, associated with NaOCl irrigation and calcium hydroxide interappointment medication, showed similar antibacterial effectiveness and success rate.

Disinfection and outcome of root canal treatment using single-file or multifile systems and Ca(OH)2 medication

Abstract This clinical study reports on the antibacterial effects and outcome of endodontic treatment using either a single-file or a multifile system, associated with calcium hydroxide interappointment medication. The root canals of single-rooted teeth with apical periodontitis were treated by using either Reciproc or BioRaCe instrument systems, 2.5% NaOCl irrigation, and calcium hydroxide medication. Bacteriological samples taken before preparation and immediately before obturation were evaluated for total bacterial counts by quantitative real-time polymerase chain reaction (qPCR). Patients were followed up and the treatment outcome was assessed by clinical and radiographic criteria. Decreasing lesions were classified as success in a lenient criterion or failure in a rigid one. Bacteria were detected in all initial samples (47 cases) and were significantly reduced after treatment in both groups (p<0.001). In the Reciproc and BioRaCe groups, 7/25 (28%) and 11/22 (50%) root canals yielded negative qPCR results before obturation, respectively (p>0.05). Quantitative bacterial reduction was similar between groups (p>0.05). The success rate in the BioRaCe group was 95.5% and 77% in the loose and rigid criterion, respectively. In the Reciproc group, corresponding figures were 88% and 76%. Differences in outcome were not significant (p>0.05). No diseased case showed negative qPCR results for bacteria. A difference of >1 Log10 counts was observed between healed and diseased cases. Root canal treatments of teeth with apical periodontitis using a single-file or a multifile system for preparation, associated with NaOCl irrigation and calcium hydroxide interappointment medication, showed similar antibacterial effectiveness and success rate.

Resumo Este estudo clínico relata os efeitos antibacterianos e o resultado de tratamentos endodônticos usando um sistema de instrumentação de instrumento único ou de múltiplos instrumentos, associado à medicação intracanal com hidróxido de cálcio. Os canais radiculares de 80 dentes unirradiculares com lesão perirradicular foram tratados com os sistemas Reciproc ou BioRaCe, irrigação com NaOCl a 2,5% e medicação com pasta de hidróxido de cálcio por 7 a 10 dias. Amostras bacteriológicas foram colhidas antes do preparo e imediatamente antes da obturação e examinadas quanto à contagem total de bactérias pela reação em cadeia da polimerase em tempo real quantitativa (qPCR). Os pacientes foram acompanhados e o resultado do tratamento foi avaliado por critérios clínicos e radiográficos (índice periapical). Os casos com lesões que diminuíram mas não desapareceram foram classificados como sucesso em um critério leniente ou fracasso em um critério rígido. Quarenta e sete pacientes estavam disponíveis para avaliação bacteriológica e de resultados. Bactérias foram detectadas em todas as amostras iniciais desses casos e foram significativamente reduzidas após o tratamento nos dois grupos (p<0,001). Nos grupos Reciproc e BioRaCe, os canais radiculares apresentaram resultados negativos na qPCR em 7/25 (28%) e 11/22 (50%) casos antes da obturação, respectivamente (p>0,05). A redução bacteriana foi semelhante entre os grupos (p>0,05). O período médio (mediana) de acompanhamento foi de 20,5 (18,5) meses para BioRaCe e 17,4 (18) meses para Reciproc (p>0,05). No grupo BioRaCe, a taxa de sucesso foi de 95,5% e 77% nos critérios leniente e rígido, respectivamente. No grupo Reciproc, os valores correspondentes foram 88% e 76%. As diferenças no resultado não foram estatisticamente significativas (p>0,05). Nenhum caso de doença pós-tratamento mostrou resultados negativos de qPCR para bactérias. Foi observada uma diferença >1 Log10 nas contagens bacterianas entre os casos curados e doentes. O tratamento do canal radicular de dentes com lesão perirradicular utilizando um sistema de instrumento único ou múltiplos no preparo, associado à irrigação com NaOCl e medicação entre consultas com hidróxido de cálcio, mostrou eficácia antibacteriana e taxa de sucesso semelhantes.

Distribution of sodium hypochlorite throughout the mesial root canal system of mandibular molars after adjunctive irrigant activation procedures: a micro-computed tomographic study.

OBJECTIVES: To evaluate and compare irrigant distribution throughout the root canal system of mesial roots of mandibular molars after application of distinct adjunctive irrigant activation procedures. MATERIALS AND METHODS: Fifteen extracted mandibular molars presenting Fan's type II, III, or IV isthmus configurations were selected. The canals were initially enlarged and cleaned. The same specimens were subjected to conventional positive pressure irrigation (PPI) followed by adjunctive irrigation approaches: passive ultrasonic irrigation (PUI), mechanical activation with the XP-endo Finisher instrument, and a control group in which the irrigant remained in the canal with no activation. Retention time for the irrigant was the same for all groups. Sodium hypochlorite mixed with a contrast medium (Omnipaque 300) was used as the irrigant. Before and immediately after the adjunctive irrigation, micro-computed tomographic (micro-CT) scans were taken to evaluate the volume of the entire root canal system that was filled by the irrigant. An exclusive analysis was also done for the isthmus area. RESULTS: Analysis of the entire root canal system showed that the XP-endo Finisher instrument promoted better distribution of the irrigant than PUI and the control group (p < 0.01). PUI was not significantly different from the control group (p > 0.05). A separate analysis of the isthmus area showed no significant difference between the adjunctive irrigation methods and the control (p > 0.05). CONCLUSIONS: The XP-endo Finisher instrument promoted better distribution of irrigant throughout the root canal system, especially in the apical canal segment, when compared to PUI. However, the tested approaches did not differ as to the ability to drive irrigants into the isthmus area. CLINICAL RELEVANCE: This study highlighted that the XP-endo Finisher instrument presented a better performance to distribute irrigant throughout the root canal system, especially in the apical canal segment compared to positive pressure irrigation and PUI.

Root Canal Disinfection by Single- and Multiple-instrument Systems: Effects of Sodium Hypochlorite Volume, Concentration, and Retention Time.

INTRODUCTION: This ex vivo study evaluated the intracanal bacterial reduction promoted by chemomechanical preparation using a single-file technique varying the volume, concentration, and retention time of sodium hypochlorite (NaOCl) irrigation in comparison with a multifile system. METHODS: Palatal roots from extracted maxillary first molars were selected and anatomically matched based on microcomputed tomographic analysis for group distribution. The canals were contaminated with a fresh mixed bacterial culture grown in anaerobiosis and recently obtained from a tooth with apical periodontitis. Specimens were divided into 4 groups of 24 each according to the following preparation protocols: REC-6LOW (Reciproc R50 instrument [VDW, Munich, Germany], 6% NaOCl, low irrigant volume), REC-2.5LOW (R50, 2.5% NaOCl, low irrigant volume), REC-2.5HI (R50, 2.5% NaOCl, high irrigant volume), and BR-2.5HI (BioRaCe [FKG Dentaire, LaChaux-de-Fonds, Switzerland], 2.5% NaOCl, high irrigant volume). The total time of preparation was recorded. Intracanal bacteriologic samples were taken before and after preparation; DNA was extracted and subjected to quantitative polymerase chain reaction. RESULTS: Bacteria were detected in 22 initial samples from the REC-2.5LOW group and in 23 from the other groups. Intragroup analysis showed that all tested preparation protocols were highly effective in significantly reducing the intracanal bacterial counts (P < .001). Intergroup comparison of bacterial reduction levels revealed a statistically significant difference between BR-2.5HI and REC-2.5LOW (P < .05). Counts of bacteria were 2.5 times significantly higher in REC-2.5LOW compared with BR-2.5HI. No other significant differences were found in quantitative findings (P > .05). CONCLUSIONS: The concerted effects of multiple instruments, the high volume of irrigation, and the long retention time of NaOCl irrigant had a positive influence on intracanal disinfection during chemomechanical preparation.

C-shaped canals in first and second mandibular molars from Brazilian individuals: A prevalence study using cone-beam computed tomography.

INTRODUCTION: The study aimed to evaluate, through in vivo tomographic analysis, the prevalence of C-shaped canals in mandibular first and second molars of Brazilian individuals, analyzing its frequency by thirds of the roots, and in contralateral teeth. METHODS: Images of 801 mandibular molars (379 first molars and 422 second molars) from 334 Brazilian individuals (142 men and 192 women) were identified through 1544 cone beam computed tomography (CBCT) exams, obtained from a private oral radiologic clinic. The cross-sectional configurations were analyzed to determine the frequency of C-shaped canals at three different axial levels and classified in categories by three experienced endodontists independently. RESULTS: The incidence of C-shaped canals was 181 (23%). Considering the type of tooth, 91 (24.01%) were identified in the first molars, and 90 (21.32%) were found in the second molars. The incidence was significantly higher in female individuals (P < 0.05) for both first and second molars. The most common C-shaped canal configurations were: C1 (89.01% for first molars and 90% second molars), followed by C2 (8.79% for first molars and 6.66% for second molars) and C4 (2.19% for the first molars and 3.33% for the second molars). Bilateral C-shaped canals were significantly higher than unilateral for both first and second molars (P < 0.01). CONCLUSIONS: The prevalence of C-shaped canals in mandibular molars of the Brazilian individuals was higher than previously reported for both mandibular first (24.01%) and second molars (21.32%). The incidence was significantly higher in female individuals and the coronal portion of the roots. The classic C-shaped format "C1" was the most frequent anatomical configuration. Furthermore, the prevalence of bilateral C-shaped canals was higher for the first molar (61.70%) and lower for the second molar (38.29%).

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.

Factors associated with dental fractures in Brazilian individuals.

AIM: The aim of the present study was to assess the association of sex, age, group of teeth, and type of accident (exposure) with dental fractures (outcome: enamel-dentine fracture without [EDF] or with pulp exposure [EDPF] and root fracture RF]). METHODS: In total, 1046 patients were selected. Logistic binary regression was used. RESULTS: The findings showed that EDF has less change of affecting individuals ≤9 years of age than ≥40 years of age (odds ratio [OR]: 0.58, 95% confidence interval [CI]: 0.35-0.95). Violence (OR: 3.07, 95% CI: 1.77-5.31), traffic accidents (OR: 1.50, 95% CI: 1.05-2.13), and sporting accidents (OR: 1.70, 95% CI: 1.19-2.44)] were associated with EDF. Regarding EDPF, the mandibular lateral incisors had a 10 times higher chance of being injured than canines and posterior teeth (OR: 10.43, 95% CI: 1.74-62.4). Those aged ≤9 years (OR: 0.21, 95% CI: 0.07-0.58) and 10-19 years (OR: 0.38, 95% CI: 0.17-0.88) had a significantly lower chance of being affected by RF. CONCLUSION: EDF and RF are associated with individuals ≥40 years of age; violence and traffic and sporting accidents are also associated with EDF, and mandibular incisors have a greater chance of being affected by EDPF.

Histobacteriologic Conditions of the Apical Root Canal System and Periapical Tissues in Teeth Associated with Sinus Tracts.

INTRODUCTION: This histobacteriologic study described the pattern of intraradicular and extraradicular infections in teeth with sinus tracts and chronic apical abscesses. METHODS: The material comprised biopsy specimens from 24 (8 untreated and 16 treated) roots of teeth associated with apical periodontitis and a sinus tract. Specimens were obtained by periradicular surgery or extraction and were processed for histobacteriologic and histopathologic methods. RESULTS: Bacteria were found in the apical root canal system of all specimens, in the main root canal (22 teeth) and within ramifications (17 teeth). Four cases showed no extraradicular infection. Extraradicular bacteria occurred as a biofilm attached to the outer root surface in 17 teeth (5 untreated and 12 treated teeth), as actinomycotic colonies in 2 lesions, and as planktonic cells in 2 lesions. Extraradicular calculus formation (mineralized biofilm) was evident in 10 teeth. CONCLUSIONS: Teeth with chronic apical abscesses and sinus tracts showed a very complex infectious pattern in the apical root canal system and periapical lesion, with a predominance of biofilms.

Effects of aging, gender, and hypogonadism on mandibular bone density.

AIM: The aim of the present study was to evaluate how aging, sex, and hypogonadism influence mandibular bone density with and without the benefits of hormone treatment. METHODS: Three-month old Wistar rats were randomly assigned to three experimental groups, with eights animals per group: controls, castrated (orchiectomized [ORX], ovariectomized [OVX]) and castrated with hormonal treatment (ORX + testosterone, OVX + estradiol benzoate). Females were previously evaluated by vaginal cytology. The corporal mass was verified weekly, and after three experimental periods (90, 120, and 150 days), the animals were killed. Blood was collected, and bones underwent densitometric and biomechanical analyses. RESULTS: After castration, the male rats demonstrated low gain in body weight compared to females (P < .05). Male and female castrated animals presented serum concentrations of sex steroid hormones lower than the control group (P < .05). Bone mineral density and biomechanical properties of the L4 vertebrae and femur were reduced earlier in females than in males (P < .05). However, mandibles were affected only in the male rats at the most chronic experimental period. CONCLUSION: Hypogonadism promotes alterations in the mandible over chronic periods, especially in males, and these alterations could be minimized by hormone treatment.

What is the role of Staphylococcus aureus and herpes virus infections in the pathogenesis of atopic dermatitis?

Atopic dermatitis (AD) is a chronic, relapsing disease. Genetic, environmental and immunological factors are involved in its pathophysiology. Individuals with AD have an increased predisposition to colonization and/or infection of the skin by various pathogens, especially Staphylococcus aureus and herpes simplex virus. The composition of their skin microbiome is also different, and changes during flares. The disease severity can be related to the degree of colonization by S. aureus. In addition, the presence of this bacterial species can predispose the host to more severe and disseminated viral infections. This article reviews the role of S. aureus and herpes virus infections and the skin microbiome in the pathogenesis of AD and their importance in the treatment and prevention strategies of this dermatosis.

Cleaning and Shaping Oval Canals with 3 Instrumentation Systems: A Correlative Micro-computed Tomographic and Histologic Study.

INTRODUCTION: The present study evaluated the cleaning and shaping ability of 3 instrumentation systems in oval canals of extracted vital teeth using a correlative analytic approach. METHODS: Oval distal canals from 33 freshly extracted mandibular molars with pulp vitality were scanned by micro-computed tomographic (micro-CT) imaging for sample selection. Specimens matched by anatomic similarities were distributed into 3 experimental groups according to the instrument system to be evaluated: the Self-Adjusting File (SAF; ReDentNOVA, Ra'anana, Israel), TRUShape (Dentsply Sirona, Tulsa, OK), and XP-endo Shaper (FKG Dentaire, La Chaux-de-Fonds, Switzerland). The irrigant was 5.25% sodium hypochlorite heated at 37°C. After rescanning with micro-CT imaging, the unprepared surface areas were identified, measured, and then histologically evaluated for the amount of pulp remnants in each root third. RESULTS: When the apical 4-mm canal segment was evaluated, the SAF exhibited significantly less unprepared areas than the XP-endo Shaper (P < .05), and there were no significant differences for the other comparisons (P > .05). Analysis of the full canal length showed no statistically significant differences between the 3 tested systems (P > .05). Likewise, the tested systems did not differ significantly in cleaning the unprepared walls (P > .05). CONCLUSIONS: There was no significant difference in the amount of unprepared surface areas between the 3 instrument systems, except for the comparison between the SAF and XP-endo Shaper in the apical 4-mm segment. None of them prepared 100% of the root canal walls. The cleaning ability of the 3 systems was similar.

Antibiofilm effects of endodontic sealers containing quaternary ammonium polyethylenimine nanoparticles.

INTRODUCTION: This study evaluated the antibiofilm effects of 2 endodontic sealers incorporated with quaternary ammonium polyethylenimine (QPEI) nanoparticles at a 2% concentration (w/w). METHODS: The materials tested were AH Plus and Pulp Canal Sealer EWT (PCS) in the commercial unmodified form or containing 2% QPEI. Antibiofilm assays were conducted by using direct-contact and membrane-restricted tests for evaluation of bacterial viability in biofilms grown onto membranes or paper disks and the crystal violet microtiter-plate assay to evaluate the effects of sealer extracts on the biofilm biomass. Two Enterococcus faecalis strains (ATCC and an endodontic isolate) were used. RESULTS: Direct contact and membrane-restricted antibiofilm tests revealed that PCS 2% was the only material to promote total killing of E. faecalis ATCC biofilms. All the materials significantly reduced bacterial counts in E. faecalis ATCC biofilms when compared with the positive control in both tests (P < .05). In the direct test against E. faecalis RW35, PCS 2% was significantly more effective than the other materials and was the only one that showed significantly lower counts than the positive control (P < .05). In the crystal violet assay, only AH Plus 2% presented optical density readings significantly lower than the positive control of the ATCC strain (P < .05). No other significant effects on the biofilm biomass of the 2 E. faecalis strains were observed for any of the sealers tested (P > .05). CONCLUSIONS: Addition of QPEI nanoparticles improved the killing ability of PCS against biofilms of both E. faecalis strains and the effects of AH Plus on the biomass of biofilms from the ATCC strain.

Endodontic-related facial paresthesia: systematic review.

Paresthesia is a neurosensitivity disorder caused by injury to the neural tissue. It is characterized by a burning or twinging sensation or by partial loss of local sensitivity. Paresthesia related to endodontic treatment can occur because of extravasation of filling material or the intracanal dressing, as a consequence of periapical surgery or because of periapical infection. A literature review of paresthesia in endodontics was undertaken, with a view to identifying and discussing the most commonly affected nerves, the diagnostic process and the treatment options. Among reported cases, the most commonly affected nerves were those passing through the jaw: the inferior alveolar nerve, the mental nerve and the lingual nerve. To diagnose paresthesia, the endodontist must carry out a complete medical history, panoramic and periapical radiography, and (in some cases) computed tomography, as well as mechanoceptive and nociceptive tests. To date, no specific treatment for endodontic-related paresthesia has been described in the literature, since the problem may be related to a variety of causes.

Polymorphism of the CD14 and TLR4 genes and post-treatment apical periodontitis.

INTRODUCTION: This study investigated the association of CD14 -260C>T and TLR4 +896A>G gene polymorphisms with post-treatment apical periodontitis in Brazilian individuals. METHODS: The study population consisted of 41 patients with post-treatment apical periodontitis and 42 individuals with root canal-treated teeth exhibiting healed/healing periradicular tissues (controls). All teeth had apical periodontitis lesions at the time of treatment, which was completed at least 1 year previously. Saliva was collected from the participants; DNA was extracted and used for CD14 and TLR4 genotyping using the polymerase chain reaction-restriction fragment length polymorphism approach and a real-time polymerase chain reaction TaqMan assay (Applied Biosystems, Foster City, CA), respectively. RESULTS: No specific genotype or allele of the CD14 and TLR4 genes or any combination thereof was positively associated with post-treatment apical periodontitis (P > .05). CONCLUSIONS: Data from the present study suggest that polymorphisms in the CD14 and TLR4 genes do not influence the response to endodontic treatment of teeth with apical periodontitis.