Diagnóstico, planificación del tratamiento y endodoncia de un primer premolar inferior con dos canales mediante tomografía computarizada 3D: reporte de un caso

El tratamiento endodóntico debe considerar que los dientes presentan una morfología del sistema de canales radiculares con alta variabilidad y complejidad. por lo tanto, el conocimiento acabado de la anatomía radicular y la planificación del procedimiento utilizando sistemas imagenológicos previos a la realización del tratamiento endodóntico, como la tomografía computarizada 3D (CBTC), mejoran el pronóstico, aumentando las probabilidades de éxito. el objetivo de este reporte es mostrar la secuencia de una resolución clínica de un primer premolar inferior (diente 4.4) con una anatomía compleja, utilizando el CBTC tanto en el diagnóstico como en la planificación.

FTIR and SEM analysis applied in tissue engineering for root recovering surgery.

Gingival recession is defined by the displacement of the gingival margin in the apical direction, which overcomes the cementum enamel junction. The etiology of gingival retraction is related to tissue inflammation caused by the accumulation of biofilm, by trauma from brushing action. Aesthetic periodontal surgery aims to return the root coverage to aesthetic harmony, and reduce the risk of periodontal disease and caries. To assist in the root coverage process, the porcine collagen matrix (PCM) has been widely studied. The objectives of this study are to identify the types of collagen that make up the PCM and analyze their morphology. For this, five PCM fragments, 2 mm (thickness) × 2.6 mm (width), were analyzed with the aid of scanning electron microscopy (SEM) and Fourier transform infrared spectroscopy (FTIR). The analysis by SEM showed that the PCM consists of two layers; the surface layer is compact, low porosity, and smooth surface, and a foamed underlying layer has high porosity. Through FTIR we identified that the surface and underlying layers are composed of collagen types I and III, respectively. This biomaterial is conducive to root coverage; it allows adsorption and cell proliferation following the matrix resorption and periodontal tissue neoformation. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 1326-1329, 2017.

The effect of the angle of instrumentation of the Piezoelectric Ultrasonic Scaler on root surfaces.

OBJECTIVES: To evaluate the influence of variations in the working angle of the piezoelectric ultrasonic scaler (PUS) on root surfaces. MATERIAL AND METHODS: Fifty-five uniradicular bovine teeth were used, of which 25 teeth were used for the analysis of the roughness and root wear, while the remaining 30 teeth were used for the analysis of morphology (MRS) and the attachment of blood components (ABC). The teeth were randomly divided into five groups according to the type of treatment (G1-G5: piezoelectric ultrasonic scaler; G6: manual curette) and to the PUS working angle applied (G1: 0°; G2: 30°; G3: 45°; G4: 60°; G5: 90°). For statistical analysis, the data describing the MRS and ABC were analysed by the Kruskal-Wallis and Dunn's tests, and the data describing the roughness and tooth wear were analysed by anova and Tukey's tests at the significance level of 5%. RESULTS: Manual curette (MC) promoted a smoother root surface than the application of the PUS. The PUS used at the angles of 30° and 45° resulted in a high level of ABC that was comparable to that obtained by MC. Additionally, the group in which the PUS was applied at an angle of 45° exhibited less tooth wear than the other groups. CONCLUSIONS: Changes in the working angle of the PUS influenced the characteristics of root surfaces after instrumentation.

Effect of Nd:YAG (1064-nm) and Diode Laser (980-nm) EDTA Agitation on Root Dentin Ultrastructure Properties.

OBJECTIVE: The purpose of this study was to analyze the effects of agitation of 17% ethylenediaminetetraacetic acid (EDTA) with 1064 nm Nd:YAG and 980 nm diode laser on root dentin microhardness and superficial roughness (with confocal laser scanning microscopy [CLSM]). BACKGROUND DATA: Root canal irrigants are used in an attempt to minimize the negative effects of smear layer. MATERIALS AND METHODS: Twenty-five bovine roots were sectioned longitudinally and divided into five groups (n=10 each): (1) deionized water, (2) 17% EDTA, (3) 17% EDTA with 60 sec manual agitation, (4) 17% EDTA with 50 sec diode laser (2 W) agitation, and (5) 17% EDTA with 50 sec Nd:YAG (1.5 W) laser agitation. Microhardness and superficial roughness values were calculated before and after the procedures at the cervical, middle, and apical root thirds. Microhardness was statistically analyzed using two way ANOVA, paired t test, and Tukey's tests (α=0.05). Roughness was statistically analyzed using Kruskal-Wallis, paired t test, and Student-Newman-Keuls tests (α=0.05%). RESULTS: Statistically significant differences in microhardness and roughness were observed between the deionized water group and others. EDTA with 1064 nm Nd:YAG or 980 nm diode laser presented the lowest microhardness and the highest roughness values and was significantly different from EDTA with manual agitation and EDTA only (p<0.05). However, there were no differences in microhardness or dentin roughness between the root thirds (p>0.05). CLSM analysis showed that the control samples exhibited smoother surfaces than that of the EDTA groups. CONCLUSIONS: Nd:YAG 1064 nm and 980-nm diode laser EDTA agitation caused greater reduction in microhardness and increased roughness of root dentin than EDTA only or EDTA with manual agitation.

Comparative Analysis of Root Dentin Morphology and Structure of Human Versus Bovine Primary Teeth.

This study evaluated the structural and morphological differences between human and bovine primary root canals. Primary human maxillary central incisors (H) (n=9) and primary bovine incisors (B) (n=9) were selected. The roots were sectioned in the vestibular-lingual direction, planed and delimited in cervical, middle, and apical thirds. Tubule density (number of tubules per mm2) and diameter were analyzed by scanning electron microscopy (1,000 and 5,000×) using Image J 1.47 software. Data were submitted to two-way repeated measures ANOVA and Tukey tests (α=0.05). The highest tubule density was observed for B (28.527±1.717 mm2) compared with H (15.931±0.170 mm2) (p<0.01). Regarding root thirds, the cervical third presented a greater tubule density (26.417±11.654 mm2) than the apical third (17.999±5.873 mm2). The diameter of the dentin tubules was not different for cervical (3.50±0.08 µm), middle (3.45±0.30 µm) and apical thirds (3.42±0.33 µm) and substrate (H-3.29±0.14 µm; B-3.63±0.06 µm). It could be concluded that: (1) the radicular dentin structure of human and bovine primary teeth and root thirds differ in terms of the tubule density; (2) the radicular dentin morphology of human and bovine primary teeth and root thirds are similar in terms of the diameter of the dentin tubules.

A microscopic analysis of the effects of root surface scaling with different power parameters of Er,Cr:YSGG laser.

The aim of this study was to evaluate the effects of different power parameters of an Erbium, Cromium: Yttrium, Scandium, Gallium, Garnet laser (Er,Cr:YSGG laser) on the morphology, attachment of blood components (ABC), roughness, and wear on irradiated root surfaces. Sixty-five incisive bovine teeth were used in this study, 35 of which were used for the analysis of root surface morphology and ABC. The remaining 30 teeth were used for roughness and root wear analysis. The samples were randomly allocated into seven groups: G1: Er,Cr:YSGG laser, 0.5 W; G2: Er,Cr:YSGG laser, 1.0 W; G3: Er,Cr:YSGG laser, 1.5 W; G4: Er,Cr:YSGG laser, 2.0 W; G5: Er,Cr:YSGG laser, 2.5 W; G6: Er,Cr:YSGG laser, 3.0 W; G7: scaling and root planning (SRP) with manual curettes. The root surfaces irradiated by Er,Cr:YSGG at 1.0 W and scaling with manual curettes presented the highest degrees of ABC. The samples irradiated by the Er,Cr:YSGG laser were rougher than the samples treated by the manual curette, and increasing the laser power parameters caused more root wear and greater roughness on the root surface. The Er,Cr:YSGG laser is safe to use for periodontal treatment, but it is not appropriate to use irradiation greater than 1.0 W for this purpose.

The smear layer created by scaling and root planing is physiologically eliminated in a biphasic process.

Mechanical instrumentation of the root surface causes the formation of a smear layer, which is a physical barrier that can affect periodontal regeneration. Although different procedures have been proposed to remove the smear layer, there is no information concerning how long the smear layer persists on root surfaces after instrumentation in vivo. This study assessed the presence of the smear layer on root surfaces over a 28-day period after subgingival instrumentation with hand instruments. Fifty human teeth that were referred for extraction because of advanced periodontal disease were scaled and root planed (SRP) by a single experienced operator. Ten teeth were randomly assigned to be extracted 7, 14, 21, and 28 days after SRP. Another 10 teeth were extracted immediately after instrumentation (Day 0, control group). The subgingival area of the instrumented roots was evaluated with scanning electron microscopy. Representative photomicrographs were assessed by a blinded and calibrated examiner according to a scoring system. A rapid and significant (p < 0.05, Z test) initial reduction in the amount of smear layer was observed at 7 days, and a further significant (p < 0.05) decrease was observed 28 days after SRP. Interestingly, even 28 days after SRP, the smear layer was still present on root surfaces. This study showed that the physiological elimination of the smear layer occurred in a biphasic manner: a rapid initial reduction was observed 7 days after instrumentation, which was followed by a slow process leading to a significant decrease 28 days after instrumentation.

The smear layer created by scaling and root planing is physiologically eliminated in a biphasic process

Mechanical instrumentation of the root surface causes the formation of a smear layer, which is a physical barrier that can affect periodontal regeneration. Although different procedures have been proposed to remove the smear layer, there is no information concerning how long the smear layer persists on root surfaces after instrumentation in vivo. This study assessed the presence of the smear layer on root surfaces over a 28-day period after subgingival instrumentation with hand instruments. Fifty human teeth that were referred for extraction because of advanced periodontal disease were scaled and root planed (SRP) by a single experienced operator. Ten teeth were randomly assigned to be extracted 7, 14, 21, and 28 days after SRP. Another 10 teeth were extracted immediately after instrumentation (Day 0, control group). The subgingival area of the instrumented roots was evaluated with scanning electron microscopy. Representative photomicrographs were assessed by a blinded and calibrated examiner according to a scoring system. A rapid and significant (p < 0.05, Z test) initial reduction in the amount of smear layer was observed at 7 days, and a further significant (p < 0.05) decrease was observed 28 days after SRP. Interestingly, even 28 days after SRP, the smear layer was still present on root surfaces. This study showed that the physiological elimination of the smear layer occurred in a biphasic manner: a rapid initial reduction was observed 7 days after instrumentation, which was followed by a slow process leading to a significant decrease 28 days after instrumentation.

Effect of super-oxidized water, sodium hypochlorite and EDTA on dentin microhardness.

The present study aimed to evaluate the influence of the following irrigating solutions on the microhardness of root canal dentin: 2% sodium hypochlorite (2NaOCl), 5% sodium hypochlorite (5NaOCl), super-oxidized water (400 ppm Sterilox - Sx) and 17% EDTA (E). Eighty roots from bovine incisors were randomly divided into 8 groups (n=10): 2NaOCl, 5NaOCl, Sx, and 2NaOCl + E, 5NaOCl + E, Sx + E (associated with E as final irrigant for 5 min), E solely and distilled water (dH2O) as the negative control. Root canal preparation was performed by hand instruments, using one of the irrigation protocols for 30 min. Then, 5 mm of the cervical root third were cut out from each sample and subjected to the Vickers microhardness test, at two points, one at approximately 500-1000 µm from the root canal lumen (distance 1), and the other at approximately 500-1000 µm from the external root surface (distance 2). Data were analyzed by Wilcoxon and Kruskal-Wallis tests at 5% significance level. Microhardness values at distance 1 were significantly lower than those at distance 2 for all groups, except 5NaOCl and 5NaOCl + E groups (p>0.05). EDTA showed the lowest microhardness values. However, no statistically significant difference was detected among groups at distance 1 and EDTA was significantly different only from Sx at distance 2. In conclusion, all tested solutions showed lower microhardness at the most superficial root canal dentin layer compared to the one found near the external root surface, except 5NaOCl and 5NaOCl + E; EDTA promoted lower microhardness values in comparison to Sterilox at this site.

Effect of surface treatment on the bond strength between yttria partially stabilized zirconia ceramics and resin cement.

STATEMENT OF PROBLEM: No consensus has been reached on the best bonding protocol between a zirconia ceramic surface and the tooth structure. PURPOSE: The purpose of this study was to evaluate the extrusion shear strength between yttria partially stabilized zirconia ceramics and resin cement (Panavia F) after different surface treatments. MATERIAL AND METHODS: The surface treatments evaluated (n=7) included the following: G1-control group (no surface treatment); G2-treated with MDP primer (Alloy Primer); G3-treated with 40% hydrofluoric acid (210 seconds); and G4-treated with 40% hydrofluoric acid (210 seconds) followed by MDP primer. The specimens were bonded to 2.5-mm-thick disks of bovine root dentin, and the extrusion shear tests were performed after they had been stored for 24 hours in distilled water at 37°C. The surface modifications were assessed on 2 specimens that were selected from each group by scanning electron microscopy. Data were analyzed with 1-way ANOVA and the Tukey-Kramer honestly significant difference test (α=.05). RESULTS: G4 (mean 2.84, standard deviation [SD] 0.43 MPa) presented significantly higher (P<.001) extrusion shear strength when compared with the other groups in the study (G1: mean, 1.57; SD 0.28 MPa; G2: mean 1.46, SD 0.28 MPa; G4: mean 1.16, SD 0.41 MPa). No significant differences were found among the other groups in the study. CONCLUSIONS: Yttria partially stabilized zirconia ceramics can be treated with 40% hydrofluoric acid for 210 seconds to increase the bond strength with the resin cement.

MicroCT analysis of a retrieved root restored with a bonded fiber-reinforced composite dowel: a pilot study.

PURPOSE: This evaluation aimed to (1) validate micro-computed tomography (microCT) findings using scanning electron microscopy (SEM) imaging, and (2) quantify the volume of voids and the bonded surface area resulting from fiber-reinforced composite (FRC) dowel cementation technique using microCT scanning technology/3D reconstructing software. MATERIALS AND METHODS: A fiberglass dowel was cemented in a condemned maxillary lateral incisor prior to its extraction. A microCT scan was performed of the extracted tooth creating a large volume of data in DICOM format. This set of images was imported to image-processing software to inspect the internal architecture of structures. RESULTS: The outer surface and the spatial relationship of dentin, FRC dowel, cement layer, and voids were reconstructed. Three-dimensional spatial architecture of structures and volumetric analysis revealed that 9.89% of the resin cement was composed of voids and that the bonded area between root dentin and cement was 60.63% larger than that between cement and FRC dowel. CONCLUSIONS: SEM imaging demonstrated the presence of voids similarly observed using microCT technology (aim 1). MicroCT technology was able to nondestructively measure the volume of voids within the cement layer and the bonded surface area at the root/cement/FRC interfaces (aim 2). CLINICAL SIGNIFICANCE: The interfaces at the root dentin/cement/dowel represent a timely and relevant topic where several efforts have been conducted in the past few years to understand their inherent features. MicroCT technology combined with 3D reconstruction allows for not only inspecting the internal arrangement rendered by fiberglass adhesively bonded to root dentin, but also estimating the volume of voids and contacted bond area between the dentin and cement layer.

Ultrastructural evaluation of the hybrid layer after cementation of fiber posts using adhesive systems with different curing modes.

This in vitro study evaluated the adhesive interface of intraradicular fiber glass posts and root dentin using scanning electron microscopy (SEM). Forty-eight single-rooted premolars were randomly divided into 6 groups consisting of chemical, dual, or light cured adhesive systems combined with either chemical or dual cure resin cements. Scanning electron microscopic analysis showed the best results for continuity, density and morphology of the hybrid layer and resin tags for the combination of a self-cure adhesive with self-cure cement resin, followed by a dual-cure adhesive with self-cure cement resin, and finally a light-cure adhesive with self-cure cement. For the dual-cure resin cement, the same relation may be observed. The apical third was the most critical region for evaluated the criteria for all combinations of materials (Kruskal-Wallis and Friedman tests; p<0.001). Generally, the simplification of steps in the adhesive system and the polymerization reaction of resin adhesives and cements produced a direct effect on the quality of the adhesive post/dentin substrate interface.

Analysis of the interface and bond strength of resin-based endodontic cements to root dentin.

This study evaluated by scanning electron microscopy the interface between root dentin and resin cements, with or without additional application of a dual-cured one-step self-etching dentin adhesive. In addition, the push-out bond strength of these materials to dentin was evaluated. Root canals of 50 maxillary human canines were subjected to biomechanical preparation and randomly assigned into five groups (n = 10) according to the obturation employed: I. AH Plus/gutta-percha; II. Endo-REZ/gutta-percha; III. Epiphany SE/Resilon; IV. Endo-REZ/gutta-percha + adhesive; and V. Epiphany SE/Resilon + adhesive. After obturation, two cross sections of 1.0 mm of each third of the root were obtained and analyzed by SEM and push-out. Data were analyzed by Kruskal-Wallis, Two-way ANOVA and Tukey's HSD tests (α = 5%). Significant differences occurred between scores for gap parameters and tags; greater tag formation resulted for Epiphany SE (P < 0.05). There were also significant differences between groups for the bond strength. AH Plus (1.24 ± 0.70) showed higher values (P < 0.05) compared to groups II (0,17 ± 0.19), III (0.10 ± 0.06), IV (0.09 ± 0.08), and V (0.06 ± 0.03), which were statistically similar (P > 0.05). There was no significant difference between the root thirds (P > 0.05). It was concluded that the use of a self-etching adhesive system did not improve the adhesion of resin-based sealers to dentin and that AH Plus showed better bond strength when compared to other cements.

Ultrastructural evaluation of the hybrid layer after cementation of fiber posts using adhesive systems with different curing modes

This in vitro study evaluated the adhesive interface of intraradicular fiber glass posts and root dentin using scanning electron microscopy (SEM). Forty-eight single-rooted premolars were randomly divided into 6 groups consisting of chemical, dual, or light cured adhesive systems combined with either chemical or dual cure resin cements. Scanning electron microscopic analysis showed the best results for continuity, density and morphology of the hybrid layer and resin tags for the combination of a self-cure adhesive with self-cure cement resin, followed by a dual-cure adhesive with self-cure cement resin, and finally a light-cure adhesive with self-cure cement. For the dual-cure resin cement, the same relation may be observed. The apical third was the most critical region for evaluated the criteria for all combinations of materials (Kruskal-Wallis and Friedman tests; p<0.001). Generally, the simplification of steps in the adhesive system and the polymerization reaction of resin adhesives and cements produced a direct effect on the quality of the adhesive post/dentin substrate interface.

Este estudo in vitro avaliou as interfaces adesivas de pinos intra-radiculares de fibra de vidro e a dentina radicular utilizando microscópio eletrônico de varredura (MEV). Quarenta e oito pré-molares unirradiculares foram divididos ao acaso em seis grupos, compostos por sistemas adesivos de cura química, dual ou fotopolimerizável, associado com cimentos resinosos de polimerização química ou dual. As análises microscópicas mostraram a maior continuidade, densidade e morfologia da camada híbrida e prolongamentos resinosos para a associação entre adesivos e cimentos auto-polimerizáveis seguido pelo grupo do adesivo de dupla polimerização e cimento de resina auto-polimerizável, e finalmente pelo adesivo fotopolimerizável e cimento de resina auto-polimerizável . Para os cimentos resinosos de dupla polimerização a mesma relação pode ser observada. O terço apical mostrou ser o substrato mais crítico em relação aos critérios avaliados para todas as associações entre os materiais usados(testes de Kruskal-Wallis e Friedman p<0,001). De maneira geral, a simplificação dos passos do sistema adesivo e a reação de polimerização dos adesivos e cimentos resinosos produzem efeitos diretos na qualidade da interface adesivo pino/dentina.

Influence of dental exposure to oral environment on smear layer removal and collagen exhibition after using different conditioning agents.

Although in vitro studies have shown encouraging results for root surface conditioning with demineralizing agents, in vivo studies have failed to show its benefits in periodontal healing. This can be attributed to several factors, among which, the hypermineralization of dental surface. Therefore, this in vitro study compared, using scanning electron microscopy (SEM), the effect of root surface conditioning with different conditioners (1% and 25% citric acid, 24% EDTA and 50 mg/mL tetracycline hydrochloride) in impacted teeth and in teeth that had their roots exposed to the oral environment. One trained examiner assessed the SEM micrographs using a root surface modification index. There was a tendency of more root surface modification in the group of impacted teeth, suggesting that the degree of root mineralization influences its chemical demineralization.

Comparison among four commonly used demineralizing agents for root conditioning: a scanning electron microscopy.

UNLABELLED: Dental roots that have been exposed to the oral cavity and periodontal pocket environment present superficial changes, which can prevent connective tissue reattachment. Demineralizing agents have been used as an adjunct to the periodontal treatment aiming at restoring the biocompatibility of roots. OBJECTIVE: This study compared four commonly used demineralizing agents for their capacity of removing smear layer and opening dentin tubules. METHODS: Fifty fragments of human dental roots previously exposed to periodontal disease were scaled and randomly divided into the following groups of treatment: 1) CA: demineralization with citric acid for 3 min; 2) TC-HCl: demineralization with tetracycline-HCl for 3 min; 3) EDTA: demineralization with EDTA for 3 min; 4) PA: demineralization with 37% phosphoric acid for 3 min; 5) CONTROL: rubbing of saline solution for 3 min. Scanning electron microscopy was used to check for the presence of residual smear layer and for measuring the number and area of exposed dentin tubules. RESULTS: Smear layer was present in 100% of the specimens from the groups PA and control; in 80% from EDTA group; in 33.3% from TC-HCl group and 0% from CA group. The mean numbers of exposed dentin tubules in a standardized area were: TC-HCl=43.8±25.2; CA=39.3±37; PA=12.1±16.3; EDTA=4.4±7.5 and CONTROL=2.3±5.7. The comparison showed significant differences between the following pairs of groups: TC-HCl and CONTROL; TC-HCl and EDTA; CA and CONTROL; and CA and EDTA. The mean percentages of area occupied by exposed dentin tubules were: CA=0.12±0.17%; TC-HCl=0.08±0.06%; PA=0.03±0.05%; EDTA=0.01±0.01% and CONTROL=0±0%. The CA group differed significantly from the others except for the TC-HCl group. CONCLUSION: There was a decreasing ability for smear layer removal and dentin tubule widening as follows: AC>TC-HCl>PA>EDTA. This information can be of value as an extra parameter for choosing one of them for root conditioning.

Comparison among four commonly used demineralizing agents for root conditioning: a scanning electron microscopy

Dental roots that have been exposed to the oral cavity and periodontal pocket environment present superficial changes, which can prevent connective tissue reattachment. Demineralizing agents have been used as an adjunct to the periodontal treatment aiming at restoring the biocompatibility of roots. OBJECTIVE: This study compared four commonly used demineralizing agents for their capacity of removing smear layer and opening dentin tubules. METHODS: Fifty fragments of human dental roots previously exposed to periodontal disease were scaled and randomly divided into the following groups of treatment: 1) CA: demineralization with citric acid for 3 min; 2) TC-HCl: demineralization with tetracycline-HCl for 3 min; 3) EDTA: demineralization with EDTA for 3 min; 4) PA: demineralization with 37 percent phosphoric acid for 3 min; 5) Control: rubbing of saline solution for 3 min. Scanning electron microscopy was used to check for the presence of residual smear layer and for measuring the number and area of exposed dentin tubules. RESULTS: Smear layer was present in 100 percent of the specimens from the groups PA and control; in 80 percent from EDTA group; in 33.3 percent from TC-HCl group and 0 percent from CA group. The mean numbers of exposed dentin tubules in a standardized area were: TC-HCl=43.8±25.2; CA=39.3±37; PA=12.1±16.3; EDTA=4.4±7.5 and Control=2.3±5.7. The comparison showed significant differences between the following pairs of groups: TC-HCl and Control; TC-HCl and EDTA; CA and Control; and CA and EDTA. The mean percentages of area occupied by exposed dentin tubules were: CA=0.12±0.17 percent; TC-HCl=0.08±0.06 percent; PA=0.03±0.05 percent; EDTA=0.01±0.01 percent and Control=0±0 percent. The CA group differed significantly from the others except for the TC-HCl group. CONCLUSION: There was a decreasing ability for smear layer removal and dentin tubule widening as follows: AC>TC-HCl>PA>EDTA. This information can be of value as an extra parameter for choosing one of them for root conditioning.

Effect of instrumentation using curettes, piezoelectric ultrasonic scaler and Er,Cr:YSGG laser on the morphology and adhesion of blood components on root surfaces: a SEM study.

This study used scanning electron microscopy (SEM) to evaluate the morphology and adhesion of blood components on root surfaces instrumented by curettes, piezoelectric ultrasonic scaler and Er,Cr:YSGG laser. One hundred samples from 25 teeth were divided into 5 groups: 1) Curettes; 2) Piezoelectric ultrasonic scaler; 3) Curettes plus piezoelectric ultrasonic scaler; 4) Er,Cr:YSGG laser; 5) Curettes plus Er,Cr:YSGG laser. Ten samples from each group were used for analysis of root morphology and the other 10 were used for analysis of adhesion of blood components on root surface. The results were analyzed statistically by the Kruskall-Wallis and Mann-Whitney tests with a significance level of 5%. The group treated with curettes showed smoother surfaces when compared to the groups were instrumented with piezoelectric ultrasonic scaler and the Er,Cr:YSGG laser. The surfaces instrumented with piezoelectric ultrasonic scaler and Er,Cr:YSGG laser, alone or in combination with hand scaling and root planing, did not differ significantly (p>0.05) among themselves. No statistically significant differences (p>0.05) among groups were found as to the adhesion of blood components on root surface. Ultrasonic instrumentation and Er,Cr:YSGG irradiation produced rougher root surfaces than the use of curettes, but there were no differences among treatments with respect to the adhesion of blood components.

Ultramorphology of the root surface subsequent to hand-ultrasonic simultaneous instrumentation during non-surgical periodontal treatments: an in vitro study.

OBJECTIVE: The purpose of this study was to investigate the ultramorphology of the root surfaces induced by mechanical instrumentation performed using conventional curettes or piezoelectric scalers when used single-handedly or with a combined technique. MATERIAL AND METHODS: Thirty single-rooted teeth were selected and divided into 3 groups: Group A, instrumentation with curettes; Group B instrumentation with titanium nitride coated periodontal tip mounted in a piezoelectric handpiece; Group C, combined technique with curette/ultrasonic piezoelectric instrumentation. The specimens were processed and analyzed using confocal and scanning electron microscopy. Differences between the different groups of instrumentation were determined using Pearson's χ2 with significance predetermined at α=0.001. RESULTS: Periodontal scaling and root planing performed with curettes, ultrasonic or combined instrumentation induced several morphological changes on the root surface. The curettes produced a compact and thick multilayered smear layer, while the morphology of the root surfaces after ultrasonic scaler treatment appeared irregular with few grooves and a thin smear layer. The combination of curette/ultrasonic instrumentation showed exposed root dentin tubules with a surface morphology characterized by the presence of very few grooves and slender remnants of smear layer which only partially covered the root dentin. In some cases, it was also possible to observe areas with exposed collagen fibrils. CONCLUSIONS: The curette-ultrasonic simultaneous instrumentation may combine the beneficial effects of each instrument in a single technique creating a root surface relatively free from the physical barrier of smear layer and dentin tubules orifices partial occlusion.

Quantitative 3D profilometry and SEM analysis of the adaptation of root-end filling materials placed under an optical microscope.

AIM: To evaluate by 3D profilometry and scanning electron microscopy (SEM), the marginal adaptation of mineral trioxide aggregate (MTA) and Sealer 26 placed in root-end cavities with direct vision or under an optical microscope. METHODOLOGY: The root ends of 52 root filled canine teeth were filled with MTA or Sealer 26 under direct vision or optical microscope (n=13). In each group, eight specimens were analysed by profilometry for measurement of the area and depth of gaps. In the other five specimens, gap area was measured using SEM to verify marginal adaptation and surface characteristic. Data were analysed by parametric (anova and Tukey) and non-parametric (Kruskal-Wallis and Dunn) tests. RESULTS: The assessment of the adaptation of both materials to dentine was not influenced by the mode of visualization, which was confirmed by both profilometry and SEM observations. The voids measured with profilometry for Sealer 26 under direct vision were significantly wider and deeper than those for MTA under direct vision (P<0.05). In SEM, significantly larger gap areas were observed with Sealer 26 (P<0.05). CONCLUSION: Root-end cavities filled with MTA had smaller gaps and better marginal adaptation than Sealer 26.