POSTOPERATIVE PAIN INCIDENCE AND INTENSITY FOLLOWING ROOT CANAL OBTURATION WITH BIOCERAMIC AND OTHER SEALERS: A SYSTEMATIC REVIEW WITH META-ANALYSIS

Aims: To investigate whether bioceramicsealers induce a lower incidence and intensity of postoperative pain compared to other sealers. Materials and Methods: Six electronic databases were searched for studies published up to April 2022, following the PICOS strategy: (P) adult patients undergoing root canal treatment or retreatment; (I) root canal filling using bioceramic sealer; (C) root canal filling using other types of sealers; (O) Primary: postoperative pain incidence and/or intensity; Secondary: number of medication intake; (S) randomizedclinical trials. Risk of bias assessment was performed with the revised Cochrane risk of bias tools for randomized trials (RoB 2). Overall certainty of evidence was assessed through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. Results: Ten studies were included. Eight studies had a low risk of bias, and two had some concerns risk. Meta-analyses showed no differences regarding postoperative pain intensity and incidence between bioceramic sealers and AH Plus. Number of medication intake seemed to be associated to the preoperative diagnosis. Zinc oxide-eugenol sealer demonstrated an intense postoperative pain compared to bioceramic sealers and AH Plus. GRADE analysis showed a low certainty of evidence for all outcomes. Conclusions: There seem to be no differences between bioceramic sealers and AH Plus regarding postoperative pain intensity and incidence. Number of medication intake seem to be associated to the preoperative diagnosis. Zinc oxide-eugenol evoked a more pronounced postoperative pain.

Effect of music during endodontic treatment on patients' anxiety: a systematic review of randomized clinical trials.

OBJECTIVES: Endodontic treatment is one of the most fearful procedures among dentistry, and the use of music during the procedure has been evaluated to control patients' anxiety. This systematic review has been conducted to provide a synthesis of the state of knowledge in this field and aimed to answer the following question: "Can music therapy reduce patient's state anxiety during endodontic treatment?". METHODS: A search was performed in six electronic databases (PubMed, Cochrane Library, Scopus, Web of Science, EMBASE, and Open Gray) for articles published until April 2022. The eligibility criteria, based on the PICOS strategy, were as follows: (P) patients undergoing endodontic treatment; (I) exposure to music; (C) no music; (O) patients' anxiety; (S) only randomized clinical trials. The risk of bias was analyzed according to the Cochrane Risk of Bias tool for randomized controlled trials (RoB 2). The strength of evidence from the included studies was assessed using the Grading of Assessment, Development, and Assessment Recommendations (GRADE) tool. RESULTS: Five eligible studies were retrieved. A low to high risk of bias was verified. Descriptive analysis showed an effect in favor of music intervention, with differences among state anxiety, heart rate and blood pressure. CONCLUSIONS: With a very low quality of evidence, dental care professionals may consider playing background music during endodontic treatment since it is a cost-effective and easy alternative to trying to reduce dental anxiety. CLINICAL RELEVANCE: Five studies were included in this systematic review and showed, with a very low quality of evidence, that music may reduce state anxiety levels on patients during root canal treatment.

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.

Eficácia de três protocolos de irrigação final para remoção de raspas dentinárias e material obturador em irregularidades simuladas / Effectiveness of three final irrigation protocols for debris and filling removal from simulated irregularities

Objetivos: Avaliar três protocolos de irrigação final para remoção de detritos e material obturador de istmos simulados. Métodos: Setenta e oito pré-molares foram preparados com o sistema WaveOne Gold 45.05. Os dentes foram seccionados longitudinalmente e um istmo padronizado foi confeccionado no terço apical. Seis raízes foram utilizadas como controle negativo. Os espécimes foram randomizados em dois grupos principais (n=36). Trinta e seis raízes tiveram o istmo preenchido com detritos e as outras trinta e seis raízes foram obturadas com guta-percha e cimento endodôntico, por meio da técnica híbrida de Tagger. Cada grupo foi dividido em três subgrupos (n=12), de acordo com o protocolo de irrigação final: Easy Clean; irrigação ultrassônica passiva (PUI); e XP Clean. A ativação do NaOCl 2,5% pelo Easy Clean foi realizada em três ciclos de vinte segundos; e pelo XP Clean, por um minuto em movimento reciprocante e contínuo, respectivamente. No grupo PUI, o irrigante foi ativado em três períodos de vinte segundos. Resultados: Não foi encontrada associação entre os escores de remoção de detritos e os protocolos de irrigação (p=0,165). Foi observada associação entre os escores de remoção do material obturador e os protocolos de irrigação final (p<0,05). Conclusões: Os protocolos de irrigação final foram efetivos para a remoção de detritos, mas não para remoção de material obturador de istmos no terço apical (AU).

This study aimed to assess three final irrigation protocols on debris and filling removal from simulated irregularities. Methods: Seventy-eight mandibular premolars were prepared with WaveOne Gold system 45.05, splitted longitudinally, and a standardized groove was performed in the apical portion of the canals. Six roots served as negative control. The roots were randomly divided into two main groups (n = 36). The grooves were filled with dentin debris in thirty six roots. The others thirty-six were filled with gutta-percha and endodontic sealer using Tagger hybrid technique. Each main group was then divided into three groups (n = 12) according to the final irrigation protocol: Easy Clean, passive ultrasonic irrigation (PUI), and XP Clean. In Easy Clean 2.5% NaOCl activation was performed for 3 cycles of 20 seconds and XP Clean for one minute under reciprocating and continuous rotary motion and continuous rotary motion, respectively. In the PUI group, the irrigant was activated in three periods of 20 seconds. Results: No association was found among the scores of debris removal and the irrigation protocols (p = .165). An association was observed among the filling material removal scores and irrigation protocols (p< .05). Conclusion: Easy Clean, PUI and XP Clean were effective for dentin debris removal, but did not for filling material from artificial grooves in the apical third (AU).

A New Calcium Silicate-Based Root Canal Dressing: Physical and Chemical Properties, Cytotoxicity and Dentinal Tubule Penetration.

The aims of this study were to evaluate the physical and chemical properties, cytotoxicity and dentinal tubule penetration of a new calcium silicate-based root canal dressing. For pH and calcium ion release evaluation (1, 24, 72 and 168 h) were used a pH meter and colorimetric spectrophotometer, respectively. Radiopacity evaluation followed the ISO 6876:2012. Cytotoxicity was evaluated by the percentage of cell viability using MTT assay. Illustrative images of dentinal tubule penetration were obtained using confocal laser scanning microscopy (CLSM). Data from pH and calcium ion release were statistically analyzed by two-way analysis of variance and Tukey test. Radiopacity was analyzed using the Student t-test. The statistical tests for cytotoxicity results were the one-way analysis of variance and Tukey test. Both materials showed alkaline pH in all experimental times. The pH values for calcium hydroxide paste were higher than bioceramic paste at 1, 24, and 72 h (p<0.05). The calcium ion release of bioceramic was lower than the calcium hydroxide paste only at 24 h (p<0.05). The bioceramic was more radiopaque than the calcium hydroxide paste (p<0.05). Bioceramic paste presented a dose and time-dependent cytotoxic effect after MTT assay. CLSM images showed absence of tubule penetration for both pastes. The new calcium silicate-based canal dressing presented alkaline pH, high calcium release, and acceptable radiopacity. Bio C Temp showed a dose and time-dependent cytotoxic and absence of dentinal tubule penetration.

Evaluation of Physicochemical Properties of New Calcium Silicate-Based Sealer.

This study aimed to evaluate the physicochemical properties of a calcium silicate-based sealer (Sealer Plus BC; MK Life, Porto Alegre, Brazil) compared with an epoxy-resin sealer (AH Plus; Dentsply DeTrey GmbH, Konstanz, Germany). Initial and final setting time was assessed based on ISO 6876:2012 and ASTM C266:03. Calcium ion release and pH were evaluated by filling polyethylene tubes with sealers and then immersing them in 10 mL of deionized water. Following experimental periods of 1, 24, 72 and 168 hours, the samples were measured regarding pH and calcium ion release with a pH meter and a colorimetric spectrophotometer, respectively. The flow was examined based on ISO 6876:2012. Rings of 10 mm in diameter with 1 mm thickness were prepared to analyze the radiopacity (ISO 6876:2012 and ADA n.57) and solubility (ISO 6876:2012). The data were analyzed by variance analysis, Student-T and Tukey tests (p<0.05). The calcium ion release and pH values were significantly higher for the Sealer Plus BC compared with the AH Plus (p<0.05). Lower setting time, flow and radiopacity were observed for the bioceramic sealer than for AH Plus (p<0.05). Sealer Plus BC exhibited higher solubility compared with AH Plus (p<0.05). Sealer Plus BC showed physicochemical properties as setting time, pH, calcium release, flow, and radiopacity following the required standards, but higher solubility than the minimum values required by ISO 6876:2012.

Evaluation of physicochemical properties of new calcium silicate-based sealer

Abstract This study aimed to evaluate the physicochemical properties of a calcium silicate-based sealer (Sealer Plus BC; MK Life, Porto Alegre, Brazil) compared with an epoxy-resin sealer (AH Plus; Dentsply DeTrey GmbH, Konstanz, Germany). Initial and final setting time was assessed based on ISO 6876:2012 and ASTM C266:03. Calcium ion release and pH were evaluated by filling polyethylene tubes with sealers and then immersing them in 10 mL of deionized water. Following experimental periods of 1, 24, 72 and 168 hours, the samples were measured regarding pH and calcium ion release with a pH meter and a colorimetric spectrophotometer, respectively. The flow was examined based on ISO 6876:2012. Rings of 10 mm in diameter with 1 mm thickness were prepared to analyze the radiopacity (ISO 6876:2012 and ADA n.57) and solubility (ISO 6876:2012). The data were analyzed by variance analysis, Student-T and Tukey tests (p<0.05). The calcium ion release and pH values were significantly higher for the Sealer Plus BC compared with the AH Plus (p<0.05). Lower setting time, flow and radiopacity were observed for the bioceramic sealer than for AH Plus (p<0.05). Sealer Plus BC exhibited higher solubility compared with AH Plus (p<0.05). Sealer Plus BC showed physicochemical properties as setting time, pH, calcium release, flow, and radiopacity following the required standards, but higher solubility than the minimum values required by ISO 6876:2012.

Resumo Este estudo teve por objetivo avaliar as propriedades físico-químicas de um cimento à base de silicato de cálcio (Sealer Plus BC MK Life, Porto Alegre, Brasil) e compará-las a um cimento à base de resina epóxica (AH Plus, Dentsply DeTrey GmbH, Konstanz, Alemanha). Tempo de presa inicial e final foram avaliados com base na ISO 6876:2012 e ASTM C266:03. Liberação de íons cálcio e pH foram avaliados após o preenchimento de tubos de polietileno com os cimentos e imersão em 10 mL de água deionizada. Após os tempos experimentais de 1,24,72 e 168 horas, os valores de pH e liberação de íons cálcio foram mensurados utilizando um medidor de pH e um espectofotômetro colorimétrico, respectivamente. Escoamento foi avaliado com base na ISO 6876:2012. Moldes de 10 mm de diâmetro e 1 mm de espessura foram preparados para análise de radiopacidade (ISO 6876:2012 e ADA n.57), solubilidade (ISO 6876:2012). Os dados foram analisados por análise de variância, teste T de Student e teste de Tukey (p<0,05). A liberação de íons cálcio e os valores de pH foram significativamente maiores para o Sealer Plus BC em comparação com o AH Plus (p<0,05). Menores valores de tempo de presa, escoamento e radiopacidade foram observados para o cimento biocerâmico quando comparados com o AH Plus (p<0,05). Sealer Plus BC apresentou propriedades físico-químicas de tempo de presa, pH, liberação de íons cálcio, escoamento, radiopacidade de acordo com as normas exigidas, porém maior solubilidade que aquelas previstas pela ISO 6876:2012.