Impact of low-fusion gutta-percha cones used in variations of the continuous wave condensation technique with filling sealers based on bioceramic compounds on the quality of root canal filling.

To evaluate the impact on the quality of filling with of low-fusion and conventional gutta-percha cones. Thirty-six maxillary canines were prepared and divided into three groups: I-conventional cone with Downpack at 200 °C at 4 mm from the WL; II-low-fusion cone with Downpack at 100 °C up to 4 mm from the WL; III-low-fusion cone with Downpack at 100 °C up to 7 mm from the WL. Temperature variations were measured in thirds on the external surface of the root. The bond strength was evaluated using the push-out test. The adhesive interface was analyzed by scanning electron microscopy. The bond strength and the temperature variation data were analyzed using analysis of variance and the failure type using the chi-square test. The low-fusion cone group with 7 mm Downpack showed higher bond strength (4.2 ± 2.7) compared with conventional cones (2.8 ± 1.6) and low-fusion cones with 4 mm Downpack (2.9 ± 1.6) (p < 0.05), with occurrence of a higher number of adhesive failures to the filling material and mixed failures. Relative to temperature variation, there was less temperature change in the apical third, in the low-fusion cone with Downpack 7 mm (1.0 ± 1.0) (p < 0.05). The use of low-fusion cones allowed the continuous wave condensation technique to be performed at a lower depth of Downpack at 100 °C at 7 mm, with less heating in the apical third, without compromising the quality of filling. Using gutta-percha cones with low fusion, which permits a lower condensation temperature and reduced Downpack depth, maintains the quality of filling, in order to minimize possible damage to the periapical tissues.

Accuracy of Magnetic Resonance Imaging in Clinical Endodontic Applications: A Systematic Review.

INTRODUCTION: The development of dedicated coils and new magnetic resonance imaging (MRI) sequences has led to an increase in image resolution and a reduction in artifacts. Consequently, numerous studies have demonstrated the utility of MRI as a nonionizing alternative to cone-beam computed tomographic imaging. The aim of this systematic review was to evaluate the accuracy of MRI in clinical applications in endodontics. METHODS: A literature search was conducted using PubMed, Embase, Scopus, and Web of Science. The inclusion criteria encompassed studies evaluating MRI applications in endodontics, covering tooth and root canal anatomy, root canal working length, pulp vitality and regeneration, the effect of caries on dental pulp, guided endodontics, periapical lesions, and root cracks/fractures. The selected studies examined both ex vivo and in vivo human teeth using clinical MRI units. Two researchers independently screened the studies, applied the eligibility criteria, and assessed the potential risk of bias using the revised QUADAS-2 tool (Bristol Medical School, University of Bristol, UK). RESULTS: A total of 18 studies were included in this systematic review, demonstrating that the use of MRI has a high diagnostic value in endodontics. In the evaluation of tooth and root canal anatomy, pulp vitality and regeneration, the effect of caries on dental pulp, periapical lesions, and root cracks/fractures, MRI's accuracy is comparable to or even higher than reference standards such as cone-beam computed tomographic imaging, micro-computed tomographic imaging, and histology. CONCLUSIONS: MRI has high potential accuracy for diagnosing various clinical endodontic tasks, except for root canal length, size of caries, and periapical lesion dimensions, which are overestimated in MRI.

Physicochemical properties of calcium silicate cement based endodontic sealers.

AIM: To mensure the physicochemical properties of three ceramic cement endodontic sealers AH Plus Bioceramic, Bio-C Sealer and Bio-C Sealer Ion+ with an epoxy resin sealer, AH Plus. MATERIAL AND METHODS: These properties were measured: hardening time (HT), dimensional change (DC), solubility (SL), flow (FL) and radiopacity (RD). The distilled water obtained from the SL test was analyzed with atomic absorption spectrometry. A sample calculation was made considering n = 5 repetitions for each experimental sealer evaluated. Statistical analysis was performed using one-way ANOVA and post hoc Tukey tests (p < 0.05). RESULTS: For the HT, AH Plus (484 ± 2.76 min) and AH Plus Bioceramic (424 ± 1.23 min) set more slowly than of Bio-C Sealer (370 ± 4.50 min) and Bio-C Sealer Ion+ (380 ± 1.42 min) (p < 0.05). AH Plus Bioceramic (12.56 ± 2.71 %) was more soluble than Bio-C Sealer (6.69 ± 1.67 %), Bio-C Sealer Ion+ (5.67 ± 2.16 %) and AH Plus (0.15 ± 0.01 %) (p < 0.05). AH Plus (0.03 ± 0.01 %) had slight expansion while the cement-based sealers had shrinkage: AH Plus Bioceramic (-1.60 ± 0.63 %) and Bio-C Sealer (-1.38 ± 0.69 %), Bio-C Sealer Ion+ (-5.19 ± 1.23 %) (p < 0.05). Bio-C Sealer Ion+ (59.80 ± 0.86 mm) and Bio-C Sealer (58.60 ± 0.98 mm) had the highest flow compared with AH Plus (56.90 ± 0.56 mm) and AH Plus Bioceramic (49.50 ± 0.63 mm) (p < 0.05). AH Plus (9.17 ± 0.06 mmAl) and AH Plus Bioceramic (8.27 ± 0.84 mmAl) showed radiopacity values when compared with those of Bio-C Sealer (4.90 ± 0.08 mmAl) and Bio-C Sealer Ion+ (4.14 ± 0.05 mmAl) (p > 0.05). CONCLUSION: Ion release is inhered to these cement-based sealers and this result in calcium ion release.

Influence of bioceramic cones on the quality of root canal filling relative to bond strength and adaptation of the adhesive interface.

AIM: To evaluate the bond strength (BS) and analysis of the adhesive interface in root canals filled with bioceramic gutta percha sealers and cones. MATERIAL AND METHODS: Ninety-six maxillary canines were divided into eight groups according to the endodontic sealer (AH Plus, AH Plus Bioceramic, Bio-C Sealer or Bio-C Sealer Ion+ and gutta percha cones (conventional or bioceramic) tested. They were analyzed using the BS test, failure pattern, analysis of the adhesive interface by scanning electron microscopy and confocal laser scanning microscopy. The BS data were compared between groups using the analysis of variance test with the Turkey post-test. The chi-square test was used to assess the type of failure and the non-parametric Mann-Whitney and Kruse-Wallis tests (P < 0.05). RESULTS: Analysis of variance showed higher BS values for the groups of bioceramic gutta percha cones in Bio-C Sealer Ion+ (8.38 ± 4.27), AH Plus Bioceramic (6.19 ± 3.28), Bio-C Sealer (5.70 ± 3.18), AH Plus (4.61 ± 2.11) and for conventional gutta percha cones in AH Plus sealers (4.26 ± 2.35), Bio-C Sealer Ion + (3.63 ± 2.29), Bio-C Sealer (2.94 ± 2.32) and AH Plus Bioceramic (1.19 ± 0.89) (P < 0.05). Relative to the type of failure and adaptation of the types of filling material, a higher percentage of mixed failures was observed (gaps between 1 µm-10 µm) for the group with bioceramic gutta percha cones (P < 0.001). CONCLUSION: The bond between sealers and bioceramic gutta percha cones showed higher bond strength values and greater penetration into the dentin tubules. CLINICAL RELEVANCE: The filling the root canal system with bioceramic sealers should be associated with bioceramic gutta percha cones.

Canal Drying Protocols to Use with Calcium Silicate-based Sealer: Effect on Bond Strength and Adhesive Interface.

INTRODUCTION: The aim of this study was to evaluate the influence on bond strength and interface quality of different canal drying protocols in roots filled with Bio-C Sealer (BCS; Angelus, Londrina, Paraná, Brazil). METHODS: Ninety-six roots of upper canines were prepared with an R50 file (Reciproc; VDW GmbH, Munich, Germany) and irrigated with 2.5% sodium hypochlorite and 17% EDTA under ultrasonic agitation. Roots were divided according to the drying protocol as follows: dry, the White Mac tip (Ultradent, Indaiatuba, SP, Brazil) for 5 seconds followed by aspiration with a capillary tip for 5 seconds and paper points; slightly moist, the White Mac tip followed by capillary aspiration without paper points; wet, the White Mac tip followed by a single paper point. The roots were filled with BCS or AH Plus (AHP; Dentsply Maillefer, Ballaigues, Switzerland) (n = 16) and sectioned for the push-out test after 3 months. Failure modes were assessed, and the interface morphology was analyzed under scanning electron microscopy. After 6 months, the other half of the roots were evaluated. Data were analyzed by analysis of variance/Tukey test at 5%. The chi-square test was used in the failure analysis and the Kruskal-Wallis/Dwass-Steel-Critchlow-Fligner for interface analysis. RESULTS: The AHP-filled roots had the highest bond strength when the canal was dried (P < .05). No difference was found for periods (P > .05). For BCS, the highest bond strength was found in the slightly moist canals (P < .05). A predominance of adhesive failures was observed. The dried canals filled with AHP had the highest percentage of good adaptation, whereas BCS had no difference. CONCLUSIONS: The best drying protocol for AHP is using the White Mac tip followed by capillary tip aspiration and paper points until complete dryness, and for BCS, it is using the White Mac tip followed by capillary aspiration without paper points.

Prevalence and morphological analysis of dens invaginatus in anterior teeth using cone beam computed tomography: A systematic review and meta-analysis.

OBJECTIVES: To evaluate the prevalence and morphological characteristics of DI using CBCT. METHODS: A literature search was performed in PubMed, Embase, Scopus, and Web of Science. Inclusion criteria were randomized clinical trials, cross-sectional studies, and prospective and retrospective cohort studies evaluating the morphological characteristics of DI in anterior teeth using CBCT. Three reviewer authors independently screened the studies, applied the eligibility criteria, assessed the risk of bias, and extracted until September (2022). The risk of bias was evaluated using the Joanna Briggs Institute criteria. Meta-analyses of proportions were used for estimate the prevalence DI according to factors at participant and tooth levels. RESULTS: Six studies were included in the meta-analysis. Among 7373 individuals, a prevalence of 7.45 % of DI was observed (n = 258; τ2 = 0.0096; CI of 4.51-11.3; p < 0.05), with no significant influence of sex. Regarding laterality, unilateral DI showed higher mean prevalence (4.30 %; CI of 2.03-7.33). Among the 382 anterior teeth with DI (0.72 %), the most affected tooth was the upper lateral incisor (5.12 %; n = 329; CI of 2.35-8.86; p < 0.001), type I was the most prevalent (0.59 %; CI of 0.24-1.08) and the presence of open apex and periradicular pathology ranged from 4.3 % to 22.72 % and 3.5-77.92 %, respectively. CONCLUSIONS: The prevalence of individuals with dens invaginatus was 7.45 %, the most affect tooth was the upper lateral incisor with a prevalence of 5.12 % unilaterally and type I was the most prevalent morphology.

Evaluation of the push-out bond strength of an adjustable fiberglass post system to an endodontically treated oval root canal.

To evaluate the push-out bond strength of the adjustable fiberglass post system to dentin. Twenty maxillary canine roots were endodontically treated and divided into two groups (n=10): conventional fiberglass posts (CFPs) and with single adjustable post (SAP) system. Two slices of each third were subjected to the push-out and failure pattern test and the most apical slice was subjected to analysis of the adhesive interface by scanning electron microscopy (SEM). Data were analyzed by the three-way analysis of variance, Tukey, and Friedman tests, and linear regression (α=0.05). The results showed higher push-out bond strength in the initial time interval for SAP (10.3±5.3, p<0.01). After 6 months, there was reduction in push-out bond strength for both (p<0.001). A higher percentage of adhesive and cohesive failures to dentin. After 6 months areas of maladaptation were noted (p=0.000). The SAP is completed to the promissory root canal in relation to alternative CFP.

The impact of provisional intraradicular retainers cementation with temporary methacrylate-based resin in the bond strength of glass fiber posts to root dentin.

Chemical composition of temporary cements interferes in the bond strength and quality of the bond interface of glass fiber posts to root dentin. The aim of the present study was to evaluate the influence of different temporary cements on the bond strength of fiberglass posts and resin cement. Thirty-two maxillary central incisor roots were standardized at 15 mm length. The root canals were prepared with Reciproc R50 and filled with a R50 single cone and AH Plus. Ten mm of filling material was removed with a heated Schilder condenser, leaving 5 mm of apical filling material. The roots were randomly distributed into 4 groups (n = 8). In the control group, the root canal was prepared with a standard drill according to the post diameter (DC #1, FGM, Joinville, Brazil), irrigated with 5 mL of distilled water and immediately received the fiberglass post cemented with self-adhesive resin cement. For the other groups, cores were made with temporary intraradicular retainers cemented with different temporary cements: methacrylate-based resin (Bifix Temp - Voco), calcium hydroxide-based (Provicol - Voco) and zinc oxide-based - eugenol-free (Relyx Temp NE - 3M). After 7 days, mechanical removal of the temporary retainers, preparation, irrigation of the root canal and cementation of the fiberglass post were performed, following the same protocol that had been performed in the control group. The roots were sectioned to obtain 3 slices per root third. The most cervical section of each third was used for the push-out test and failure pattern analysis, while the most apical section was subjected to analysis of the adhesive interface by scanning electron microscopy (SEM). The BS data were compared between groups using the two-way ANOVA and Tukey post-test. The failure pattern results were expressed in percentage and compared between groups using the chi-square test and the material adaptation data at the bond interface were evaluated using the Kruskal-Wallis and Dwass-Steel-Critchlow-Fligner tests. The results showed higher BS in the cervical third, with a higher value in the control group (10.8 ± 0.94) and Bifix Temp group (9.78 ± 0.71), with no statistically significant difference between these groups (P > .05). The middle and apical thirds showed no statistically significant difference (P > .05). As regards the type of failure, a higher percentage of mixed adhesive failures was observed for all groups. Analysis of the adhesive interface by SEM showed that the temporary cement Bifix Temp showed greater adaptation at the bond interface. It was concluded that the methacrylate-based resin temporary cement showed the highest bond strength values and best adaptation to root dentin than the zinc oxide-based and calcium hydroxide-based temporary cements.

Is the quality of root canal filling obtained by cone-beam computed tomography associated with periapical lesions? A systematic review and meta-analysis.

AIM: To evaluate the influence of root canal filling quality on periapical lesion status using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: The bibliographic search was conducted in electronic databases of PubMed, Embase, Scopus, and Web of Science without restrictions related to the year of publication and language. Inclusion criteria were prospective or retrospective cohort studies that followed periapical pathosis for, at least, 1 year. Three reviewers independently evaluated the eligibility for inclusion, extracted data, and assessed the risk of bias. The quality of the studies was based on the Newcastle-Ottawa Scale. This meta-analysis was performed to evaluate the quality of treatment by the homogeneity and apical extension of the filling. RESULTS: Of the 1179 studies initially recovered, six cohort studies were included, out of which four were considered with a low risk of bias. The results showed that the absence of gaps in the filling reduced the chance of unhealed periapical lesions by 2.39 times (RR = 2.39; 95% CI: 1.62-3.53; p < 0.00001; I2 = 55%). An apical filling extension of 0-2 mm below the apex also contributed significantly to the absence of unhealed periapical lesions (RR = 1.49; 95% CI: 1.15-1.94; p = 0.003; I2 = 2%). CONCLUSION: The homogeneity and apical extension of the filling influenced the presence of unhealed periapical lesions in endodontically treated teeth evaluated using CBCT. CLINICAL RELEVANCE: Apical extension of the filling ranging between 0 and 2 mm short of the apical foramen and the homogeneity of the filling without gaps are directly related to the success rate of root canal treatment.

Timing of sugar introduction in diet and early childhood caries: a population-based study in preschoolers / Momento de introdução de açúcar na dieta e cárie na primeira infância: um estudo de base populacional em pré-escolares

Abstract Introduction Sugar ingestion is the most important isolated factor related to dental caries. Contact with sugary foods at an early age may represent a risk to the oral health of preschool children. Objective To evaluate the timing of the introduction of sugar in the diet of preschoolers and its association with early childhood caries. Material and method Cross-sectional population-based study with 888 five-year-old preschoolers from public and private schools. Parents answered a questionnaire on sociodemographic data, eating habits and oral health. The variables timing of sugar introduction (>1 year and ≤1 year) and dental caries experience were dichotomized and data were analyzed using descriptive statistics and Poisson regression (p<0.05). Result The introduction of sugar in the diet occurred during the first twelve months of life for 73.8% of preschoolers. There was no association between the timing of sugar introduction and early childhood caries (p>0.05). The interruption of exclusive breastfeeding and low family income increased the prevalence of preschoolers having early contact with sugar by 32% and 23%, respectively (p<0.05). The prevalence of early childhood caries was 42.3% and was associated with a lower level of maternal education, low income, increased frequency of ingestion of candy and the use of nonfluoridated toothpaste (p<0.05). Conclusion The introduction of sugar in the diet occurred during the first year of life in most preschoolers and there was no association with early childhood caries.

Resumo Introdução A ingestão de açúcar é um importante fator relacionado à cárie dentária. O contato com alimentos açucarados em idade precoce pode representar risco para a saúde bucal de crianças em idade pré-escolar. Objetivo Avaliar o momento de introdução do açúcar na dieta de pré-escolares e sua associação com a cárie na primeira infância. Material e método Estudo transversal de base populacional com 888 pré-escolares de cinco anos de escolas públicas e privadas. Os pais responderam questionário sobre dados sociodemográficos, hábitos alimentares e saúde bucal. As variáveis ​​tempo de introdução do açúcar (> 1 ano e ≤1 ano) e experiência de cárie dentária foram dicotomizadas e os dados foram analisados ​​por meio de estatística descritiva e regressão de Poisson (p <0,05). Resultado A introdução do açúcar na dieta ocorreu nos primeiros doze meses de vida para 73,8% dos pré-escolares. Não houve associação entre o momento de introdução do açúcar e a cárie na primeira infância (p> 0,05). A interrupção do aleitamento materno exclusivo e a baixa renda familiar aumentaram a prevalência de pré-escolares com contato precoce com açúcar em 32% e 23%, respectivamente (p <0,05). A prevalência de cárie na primeira infância foi de 42,3% e esteve associada à menor escolaridade materna, baixa renda, maior frequência de ingestão de doces e uso de dentifrício não fluoretado (p <0,05). Conclusão A introdução de açúcar na dieta ocorreu durante o primeiro ano de vida na maioria dos pré-escolares e não houve associação com cárie na primeira infância.