Marginal gaps and voids using two warm compaction techniques and different sealers: a micro-CT study.

OBJECTIVE: To assess the percentage of marginal gaps and voids in oval-shaped canals obturated by using two warm compaction techniques with a Bio-C sealer and AH Plus Jet. MATERIALS AND METHODS: Forty canines with oval canals were scanned by microcomputed tomography (micro-CT), and root canal preparation was performed with an XP-endo Shaper system and irrigated with 5.25% sodium hypochlorite. Then, the specimens were paired into four groups (n=10) according to the root canal filling technique and endodontic sealer: Bio-C sealer and continuous wave of condensation, Bio-C sealer and Tagger's hybrid, AH Plus Jet and continuous wave of condensation, and AH Plus Jet and Tagger's hybrid. After root canal filling, a new scan was performed. The percentage of marginal gaps and voids was calculated with the ImageJ software, and the data were analyzed statistically using two-way ANOVA and Tukey tests, with a significance level of 5%. RESULTS: The percentage of marginal gaps was significantly lower in the Bio-C sealer than in AH Plus Jet (p=0.021) regardless of the technique. However, no difference was found in the percentage of voids between root canal filling techniques and the endodontic sealer (p>0.05). CONCLUSION: Both sealers and techniques demonstrated good quality of root canal filling. However, the use of the Bio-C sealer enhanced the filling ability by reducing marginal gaps, regardless of the root canal filling technique. CLINICAL RELEVANCE: This study highlights the better performance of the Bio-C sealer in the quality of the root canal filling, reducing marginal gaps when compared to AH Plus Jet independent of the technique.

Is the clinical performance of internal conical connection better than internal non-conical connection for implant-supported restorations? A systematic review with meta-analysis of randomized controlled trials.

PURPOSE: To evaluate bone loss, prosthodontics and biological complications, and implant survival rates of internal conical connections (ICC) compared with internal non-conical connection (INCC) implants. METHODS: The systematic review was registered on PROSPERO (CRD42021237170). Meta-analysis was performed using standardized mean difference (SMD) for bone loss and risk ratio (RR) for implant survival and complication rates. Risk of bias analysis was evaluated using RoB 2.0, whereas the GRADE tool was used to evaluate the certainty of evidence. A systematic search of the PubMed, Web of Science, Embase, Cochrane, and ProQuest databases was performed independently by two reviewers for articles published up to March 2022. The search criteria had no language or publication date restrictions. Handsearching analysis was performed in the reference list of potential articles. RESULTS: Twelve randomized clinical trials, including 678 patients and 1006 implants (ICC [n = 476]; INCC [n = 530]), were included. Meta-analysis revealed that ICC demonstrated a lower risk for marginal bone loss (SMD: -0.80 mm; p = 0.004) and prosthodontics complications (RR: 0.16; p = 0.01) than INCC. However, both internal connections demonstrated no significant difference in implant survival rates (RR: 0.54; p = 0.10) and biological complications (RR: 0.90; p = 0.82). The overall risk of bias revealed some concerns and a low risk of bias for most of the included studies. However, the certainty of evidence of outcomes was considered low to moderate. CONCLUSION: ICC may be considered a more favorable treatment option than INCC owing to greater preservation of peri-implant bone tissue and a lower probability of prosthodontics complications. However, well-conducted studies with long-term follow-up are warranted.

The thermoplastic techniques or single-cone technique on the quality of root canal filling with tricalcium silicate-based sealer: An integrative review.

Background: The filling of the root canal system (RCS) is an important step in endodontic treatment and aims to obtain a three-dimensional sealing of the root canal spaces to prevent bacterial contamination. For this, the selection of an appropriate sealer must be performed synchronously with the choice of the root canal filling technique. This study aims, through an integrative review, to evaluate the quality of root canal filling by comparing thermoplastic and single-cone (SC) techniques. Material and Methods: The Medline/PubMed, Scopus, Web of Science and Virtual Health Library (VHL) databases were used to find articles published until November 2021. The eligibility criteria comprised articles that evaluating the quality of root canal filling comparing thermoplastic techniques with the SC technique using tricalcium silicate-based sealer. Studies that evaluated primary teeth, endodontic retreatment or perforations, different outcomes, and studies that considered artificial teeth or different sealer and material for obturation of different techniques were excluded. For articles that were not available for access, an additional contact with authors were considered. A total of 1699 articles were found. After duplicate removal, the title and abstract of 828 articles were screened. Sixteen articles were considered for full-text analysis, but only ten articles met the eligibility criteria. Data extracted from the studies were discussed and tabulated to allow the comparison of desired factors. Results: Concerning the formation of gaps/voids, the thermoplastic techniques showed better results than the SC technique in 3 articles. On the other hand, 2 articles reported no statistical difference between the tested techniques. In addition, about the penetration of tricalcium silicate-based sealer in the dentinal tubules, of the 5 articles selected, in 4 there was no significant difference between the tested techniques and only one study showed better penetration of the sealer when using thermoplastic techniques. Conclusions: The thermoplastic technique was better in most selected studies regarding gaps and voids, but regarding the penetration of the sealer into the tubules, both techniques were effective. Key words:Root canal filling, thermoplastic techniques, tricalcium silicate.

The response of Mesenchymal Stem Cells to endodontic materials.

An endodontic material must be minimally harmful to stem cells since they are essential, thanks to their capacity for cell proliferation, self-renewal, and differentiation. For this reason, in this in vitro study, the cell viability and the expression of genes involved in cell plasticity and differentiation were investigated in stem cells recovered from human dental pulp (hDPSCs) that were in contact with four endodontic materials (Endofill, MTA, Pulp Canal Sealer, and Sealer 26). The viability of HDPSCs was assessed by MTT and trypan blue exclusion assays. PCR evaluated cellular plasticity by determining the CD34, CD45, Nestin, CD105, Nanog, and OCT4 expressions. The effect on cell differentiation was determined by RT-PCR expression of the RUNX2, ALP, OC/BGLAP, and DMP1 genes. The data were analyzed using ANOVA with Bonferroni correction (p <0.05). Pulp Canal Sealer and Endofill decreased cell viability after 48 hours (p <0.001). MTA and Sealer 26 did not disrupt cell viability (p> 0.05). When cultivated in the presence of MTA and Sealer 26, hDPSCs expressed Nestin, CD105, NANOG, and OCT-4 and did not express CD34 and CD45. MTA and Sealer 26 interfered with DMP1, OC/BGLAP and RUNX2 expressions (p <0.05) but did not change ALP gene expression (p> 0.05). MTA and Sealer 26 showed biological compatibility in the presence of hDPSCs.

The response of Mesenchymal Stem Cells to endodontic materials

Abstract An endodontic material must be minimally harmful to stem cells since they are essential, thanks to their capacity for cell proliferation, self-renewal, and differentiation. For this reason, in this in vitro study, the cell viability and the expression of genes involved in cell plasticity and differentiation were investigated in stem cells recovered from human dental pulp (hDPSCs) that were in contact with four endodontic materials (Endofill, MTA, Pulp Canal Sealer, and Sealer 26). The viability of HDPSCs was assessed by MTT and trypan blue exclusion assays. PCR evaluated cellular plasticity by determining the CD34, CD45, Nestin, CD105, Nanog, and OCT4 expressions. The effect on cell differentiation was determined by RT-PCR expression of the RUNX2, ALP, OC/BGLAP, and DMP1 genes. The data were analyzed using ANOVA with Bonferroni correction (p <0.05). Pulp Canal Sealer and Endofill decreased cell viability after 48 hours (p <0.001). MTA and Sealer 26 did not disrupt cell viability (p> 0.05). When cultivated in the presence of MTA and Sealer 26, hDPSCs expressed Nestin, CD105, NANOG, and OCT-4 and did not express CD34 and CD45. MTA and Sealer 26 interfered with DMP1, OC/BGLAP and RUNX2 expressions (p <0.05) but did not change ALP gene expression (p> 0.05). MTA and Sealer 26 showed biological compatibility in the presence of hDPSCs.

Resumo Um material endodôntico deve ser minimamente prejudicial às células-tronco, uma vez que essas células são extremamente importantes, devido à sua capacidade de proliferação, autorrenovação e diferenciação celular. Por esse motivo, a viabilidade celular e a expressão de genes envolvidos na plasticidade e diferenciação celular foram investigadas em células-tronco recuperadas de polpa dentária humana (HDPSCs) que estiveram em contato com quatro materiais endodônticos (Endofill, MTA, Pulp Canal Sealer e Sealer 26). A viabilidade das HDPSCs foi avaliada pelos ensaios MTT e de exclusão de azul de tripano. A plasticidade celular foi avaliada pela determinação das expressões dos genes CD34, CD45, Nestin, CD105, Nanog e OCT4 por PCR. O efeito na diferenciação celular foi determinado pela expressão dos genes RUNX2, ALP, OC/BGLAP e DMP1 por RT-PCR. Os dados foram analisados por ANOVA com correção de Bonferroni (p <0,05). Em comparação com o controle, Pulp Canal Sealer e Endofill diminuíram a viabilidade celular após 48 horas (p <0,001). MTA e Sealer 26 não interromperam a viabilidade celular (p> 0,05). Quando cultivado na presença de MTA e Sealer 26, as HDPSCs expressaram Nestin, CD105, NANOG e OCT-4 e não expressaram CD34 e CD45. MTA e Sealer 26 interferiram nas expressões de DMP1, OC / BGLAP e RUNX2 (p <0,05), mas não alteraram a expressão do gene ALP (p> 0,05). Sendo assim, MTA e Sealer 26 demonstraram compatibilidade biológica na presença de HDPSCs.

Is a fiber post better than a metal post for the restoration of endodontically treated teeth? A systematic review and meta-analysis.

OBJECTIVE: To evaluate systematically the evidence about the failure rates of endodontically treated teeth (ETT) restored with intraradicular metal posts (MPs) or fiber posts (FPs). DATA: The review protocol was registered on PROSPERO (CRD42020189792). Eligibility criteria included randomized clinical trials (RCT) and prospective clinical trials (PCT) that compared the failures between FP and MP restorations for ETT. Meta-analyses were conducted for failure rates using fixed- and random-effects models. Subgroup and funnel plot analyses were performed. SOURCES: Four electronic databases (MEDLINE/PubMed, Web of Science, Scopus, and Cochrane Library), manual, and grey literature were screened by two researchers independently for articles published until November 2020 without language or time restrictions. For the analysis of the risk of bias, the Cochrane collaboration tool and ROBINS-I were used. The certainty of the evidence was evaluated using GRADE. STUDY SELECTION: Ten studies were included. A total of 704 participants with a mean age of 42.7 years with a total of 844 ETT were restored using 453 FPs and 391 MPs. The FPs presented similar failures to that with MPs (P=0.39; risk ratio [RR]:0.82; 95% confidence interval [CI]: 0.52 to 1.29). Subgroup analysis showed no significant differences between the FPs and MPs for the anterior region (P=0.60; RR:0.88; [CI]: 0.54 to 1.42), posterior region (P=0.52; RR:1.18; [CI]: 0.71 to 1.98), root fracture (P=0.44; RR:0.78; [CI]: 0.41 to 1.49), and debonding (P=0.56; RR:1.27; [CI]: 0.57 to 2.80). Additionally, FP showed similar failures compared with those of cast (P=0.36; RR:0.63; [CI]: 0.23 to 1.72) and prefabricated MPs (P=0.68; RR:0.90; [CI]: 0.54 to 1.50). The RCT and PCT studies revealed a low risk of bias for most of the domains. However, the certainty of evidence was considered low. CONCLUSION: No evidence of difference was observed for failure rates between FPs, and MPs, independent of region and different MPs used in ETT. However, further well-conducted clinical studies with high-quality evidence are encouraged. CLINICAL SIGNIFICANCE: Our results indicate that both retainer posts can be considered an adequate alternative in restoring ETT. Therefore, the choice of post (fiber or metal) could be based on dentist preference or individual characteristics of the patient as the failure rates for different posts are similar.

Shaping ability and apical debris extrusion after root canal preparation with rotary or reciprocating instruments: a micro-CT study.

OBJECTIVES: The aim of this study was to evaluate the shaping ability of the TruShape and Reciproc Blue systems and the apical extrusion of debris after root canal instrumentation. The ProTaper Universal system was used as a reference for comparison. MATERIALS AND METHODS: Thirty-three mandibular premolars with a single canal were scanned using micro-computed tomography and were matched into 3 groups (n = 11) according to the instrumentation system: TruShape, Reciproc Blue and ProTaper Universal. The teeth were accessed and mounted in an apparatus with agarose gel, which simulated apical resistance provided by the periapical tissue and enabled the collection of apically extruded debris. During root canal preparation, 2.5% sodium hypochlorite was used as an irrigant. The samples were scanned again after instrumentation. The percentage of unprepared area, removed dentin, and volume of apically extruded debris were analyzed. The data were analyzed using 1-way analysis of variance and the Tukey test for multiple comparisons at a 5% significance level. RESULTS: No significant differences in the percentage of unprepared area were observed among the systems (p > 0.05). ProTaper Universal presented a higher percentage of dentin removal than the TruShape and Reciproc Blue systems (p < 0.05). The systems produced similar volumes of apically extruded debris (p > 0.05). CONCLUSIONS: All systems caused apically extruded debris, without any significant differences among them. TruShape, Reciproc Blue, and ProTaper Universal presented similar percentages of unprepared area after root canal instrumentation; however, ProTaper Universal was associated with higher dentin removal than the other systems.

O uso da tomografia computadorizada de feixe cônico no diagnóstico e no gerenciamento de insucesso endodôntico: relato de caso clínico / The use of cone beam computed tomography in the diagnosis and management of endodontic failure: clinical case report

Objetivo: descrever um caso clínico em que a tomografia computadorizada de feixe cônico (TCFC) foi utilizada para auxiliar no diagnóstico e no melhor gerenciamento de retratamento endodôntico. Relato de caso: uma paciente compareceu à clínica com queixa de uma fístula na região dos molares superiores do lado direito há aproximadamente dois meses. Radiograficamente, observou-se lesão periapical do elemento 17. Após a confirmação da necessidade do retratamento, a paciente relatou já ter feito duas intervenções endodônticas nesse elemento. Assim, optou-se por solicitar um exame de TCFC, para melhores diagnóstico e planejamento do caso. Ao avaliar a TCFC, verificou-se presença de lesão periapical extensa, presença de espaços vazios no canal mesiovestibular (MV) e palatino (P), cone de guta percha além do ápice no canal distovestibular (DV) e localização do canal mesiopalatino (MP), que não havia sido manuseado anteriormente, rompimento de cortical óssea vestibular e palatino. Após planejamento, a paciente foi submetida ao retratamento endodôntico. Foi realizada a desobstrução dos canais radiculares com remoção do cone ultrapassando no canal DV, localização do MP e instrumentação completa de todos os canais. O hidróxido de cálcio foi utilizado como medicamento intracanal entre as consultas. Ao observar a regressão da fistula e os canais sem presença de exsudato, realizou-se a obturação do canal radicular. Considerações finais: a TCFC permitiu a visualização de erros operatórios pertinentes ao caso durante os tratamentos endodônticos prévios, o que possibilitou a indicação de um novo tratamento endodôntico e a manutenção do dente na arcada dentária.(AU)

Objective: to describe a clinical case where cone beam computed tomography (CBCT) was used to assist in the diagnosis and better management of endodontic retreatment. Case report: the patient attended the clinic complaining of a fistula in the upper molar region on the right side for approximately two months. Radiographically, the presence of a periapical lesion of element 17 was observed. After confirming the need for retreatment, the patient reported having already undergone two endodontic interventions on this tooth. Thus, it was decided to request a CBCT exam for better diagnosis and case planning. When assessing the CBCT, there was the presence of extensive periapical lesion, presence of empty spaces in the mesiobuccal (MB) and palatal (P) canal, gutta percha cone beyond the apex in the distobuccal (DB) canal and location of the mesiopalatal (MP) canal - which had not been previously handled -, rupture of the cortex vestibular and palatal bone. After planning, the patient underwent endodontic retreatment. Then, all the previous filling material were removed, including the gutta-percha by passing into the DB canal, MP was localized and complete instrumentation of all root canals were done. Calcium hydroxide was used as an intracanal medication between appointments. When the regression of the fistula was observed and canals were without exudate, root canal filling was performed. Final considerations: the CBCT allowed the visualization of operative errors pertinent to the case during previous endodontic treatments, which allowed the indication of a new endodontic treatment and the maintenance of the tooth in the dental arch.(AU)

Missed canals in endodontically treated maxillary molars of a Brazilian subpopulation: prevalence and association with periapical lesion using cone-beam computed tomography.

OBJECTIVES: To evaluate the prevalence of missed canals in endodontically treated maxillary molars through cone-beam computed tomography (CBCT) images and to verify their association with the presence of periapical lesions. MATERIAL AND METHODS: Three oral radiologists evaluated 633 maxillary molars in CBCT exams regarding number of roots, number of root canals, number of missed canals, anatomic identification of missed canals, presence of periapical lesions, and root location of the periapical lesions. Data were statistically analyzed at a 5% significance level. RESULTS: Descriptive statistical analysis showed that among 395 first molars, 218 had at least one missed canal, and 186 (46.5%) had a missed canal and periapical lesion simultaneously. Of these, 72.4% (134) of the missed canals were only mesiobuccal 2 (MB2). Among 238 s molars evaluated, 121 presented at least one missed canal, and 104 (43.6%) had a missed canal and periapical lesion simultaneously. Of these, 81.7% (85) of the missed canals were only MB2. The chi-squared test showed an association between the presence of missed canals and periapical lesions for 1st and 2nd maxillary molars. Teeth that presented a missed canal showed an odds ratio (OR) of 2.57 (p < 0.0001) of being associated with a periapical lesion. Missed canal occurrence was positively related to the number of root canals (z = 13.06, p < 0.0001), meaning when the number of root canals is higher, there is a higher probability of missed canal occurrence. According to the model calculated prediction, for a one-unit increase in the number of canals, the probability of missed canals increases by 4.22%. CONCLUSIONS: It was concluded that MB2 was the most frequently missed canal, associated with the presence of periapical lesions in endodontically treated maxillary molars. CLINICAL RELEVANCE: Professionals' negligence of anatomical root variations has been contributed to the high prevalence of missed canals, leading to failures in endodontic treatment. Their association with periapical lesion occurrence emphasizes the importance of correct detection and instrumentation of these canals.

Shaping ability of two root canal instrumentation systems in oval-shaped canals: A microcomputed tomography study.

The objective was to evaluate the shaping ability of XP-endo Shaper and Mtwo systems in oval-shaped canals preparation by microcomputed tomography (micro-CT) along the entire canal. The volume, surface area and percentage of unprepared area were evaluated by image processing in entire canal and apical third (5 mm). Apical transportation and centring ability were evaluated at 3, 5 and 7 mm from the apex. Forty single-canal oval canines were paired in two groups (n = 20) according to the instrumentation system: XP-endo Shaper and Mtwo. The teeth were scanned by micro-CT before and after instrumentation, using a thermal vat at 37°C. The XP-endo Shaper system was more effective in the instrumentation of oval-shaped canals when compared to Mtwo system, resulting in greater volume increases and lower percentage of unprepared canals walls in apical region. Regarding apical transportation and centring ability, no statistical difference was observed.

The importance of bioceramics and computed tomography in the late clinical management of a horizontal root fracture: A case report.

Root fractures resulting from dental trauma involve dentin, cementum and pulp. The present study aimed to demonstrate the importance of cone-beam computed tomography (CBTC) and bioceramics in the correct planning and intervention of a horizontal root fracture case in tooth 11 with late treatment in an 18-year-old patient. Clinical and radiographic examinations revealed tooth displacement, pain on vertical percussion and images suggestive of a horizontal root fracture. Pulp necrosis was diagnosed and CBTC was requested for treatment planning. Subsequently, endodontic treatment was performed using a bioceramic apical plug. A 2-year follow-up indicated the absence of root resorption and normal periodontal and periapical tissues. It was concluded that endodontic treatment associated with the use of bioceramics and the aid of CBTC is an effective therapeutic option in cases of permanent horizontal root fractures. Key words:Bioceramics, Cone-beam computed tomography, dental Injuries, root fracture.

Capacidade de Adesão de Cimentos Biocerâmicos e Resinosos com a Dentina Radicular: Uma Revisão Integrativa / Adhesion capacity of bioceramic and resin-based root canal sealer to root dentin: an integrative review

Objetivo: comparar a capacidade de adesão do cimento biocerâmico EndoSequence BC e do cimento resinoso AH Plus através de uma revisão integrativa. Material e Métodos: os bancos de dados online Medline/PubMed, Scopus, Web of Science e BVS foram utilizados para a revisão da literatura. Os critérios de elegibilidade incluíram artigos disponíveis na íntegra nas bases de dados pesquisadas, em inglês, e o conteúdo referente à adesão do cimento Endosequence BC sealer em comparação ao AH Plus. Resultados: foram encontrados 45 artigos. Após a remoção duplicada, 22 artigos foram selecionados. Após a leitura dos resumos, textos completos e aplicação dos critérios de inclusão, foram incluídos no total oito artigos. Em relação à capacidade de adesão dos cimentos testados, o AH Plus apresentou melhor adesão do que o cimento BC sealer em três artigos e menor adesão em dois artigos. Força de adesão semelhante foi observada entre os grupos em três estudos. Conclusões: com base nos estudos incluídos, o AH Plus apresenta maior resistência de união quando comparado ao BC Sealer

Aim: To compare the adhesion capacity of the bioceramic EndoSequence BC sealer and the AH Plus sealer through an integrative review. Methodology: The Medline/PubMed, Scopus, Web of Science and VHL online databases were used for the literature review. Eligibility criteria comprised articles available in full on the researched databases, in English, and content addressing Endosequence BC sealer adhesion compared to AH Plus sealer. Results: A total of 45 articles were found. After duplicate removal, 22 articles were selected. After reading the abstracts, full texts and applying the inclusion criteria, eight articles in total were included in the present study. Concerning the adhesion capacity of the tested cements, the AH Plus was reported as presenting better adhesion than the BC sealer in three articles, and less adhesion in two articles. Similar adherence strength was observed between groups in three studies. Conclusions: Based on the included studies, the AH Plus displays greater bond strength when compared to the BC Sealer.

Locating the second mesiobuccal canal in maxillary molars: challenges and solutions.

The second mesiobuccal canal in mesiobuccal roots in maxillary molars is a common finding in root canal treatments. Failure on the location of these canals is associated with a high rate of unsuccessful treatments of maxillary molars. Its prevalence has been assessed in several in vitro and in vivo studies, presenting variations according to the methodology applied, along with the population of interest. While the anatomy of these teeth is well defined in micro-computed tomography studies, the clinical management is a great challenge for the practitioner. The use of a dental operating microscope has rendered a better clinical outcome when considering the location and treatment of this canal. On the other hand, cone-beam computed tomography use is still controversial in the efficacy of MB2 canal location. The association of a dental operating microscope with troughing performed with ultrasonic tips is an essential step in this location. Moreover, sodium fluorescein might be applied for root canal location. Due to the high rate of unsuccessful cases when the MB2 canal is not initially found, several cases are performed aiming to address the cases of missed MB2 canals. Therefore, the clinician should discuss the best possible approach, whether surgical or clinical. This article presents an overview of the importance of the MB2 canal on the outcomes of root canal treatments of maxillary molars. Solutions based in current literature will be presented accordingly.

Associação Brasileira de Odontologia (ABO/GV)

O sucesso do tratamento endodôntico envolve a devida capacidade de limpeza e modelagem dos sistemas de canais radiculares, contudo, não há consenso na literatura sobre os sistemas de lima única Reciproc e WaveOne em termos de formatação do canal. Objetivo: comparar a efetividade na formatação dos canais radiculares utilizando os sistemas Reciproc e WaveOne, no que tange ao transporte e à centralização do preparo. Método: o plano sistemático para a execução desta revisão integrativa consistiu em quatro etapas. Realizou-se um levantamento bibliográfico nas seguintes bases de dados: SciELO, PubMed e Lilacs, com os seguintes descritores: Reciproc e WaveOne, shaping canal, centering canal. Foi feita a leitura dos resumos que constavam nos artigos e documentos selecionados e a seleção daqueles que contemplavam de três a cinco descritores sobre o tema desta pesquisa. Em seguida, foi feita a leitura dos textos na íntegra, seguida pela construção de uma tabela com as informações levantadas nesse processo. Resultados: dos artigos selecionados, sete foram publicados em revistas odontológicas, sendo cinco publicados em revistas de área específica (endodontia) e apenas um foi publicado em uma revista de pesquisa básica de tecnologia. Verificou-se que a maior parte dos estudos foi publicada nos anos 2014 e 2015, a maioria publicada no Brasil e na Coreia. Conclusão: com base nos artigos estudados, não foi possível concluir que há diferença entre os instrumentos avaliados, quanto à centralização e à formatação do preparo após a utilização de Reciproc e WaveOne.

Avaliação comparativa da citotoxicidade dos cimentos MTA Fillapex e AH Plus: revisão integrativa / Comparative evaluation of cytotoxicity of MTA Fillapex and AH Plus cements: an integrative review

Objetivo: O objetivo deste estudo foi realizar uma revisão integrativa comparando a citotoxicidade dos cimentos MTA Fillapex e AH Plus aos tecidos periapicais. Métodos: Foram utilizados artigos na íntegra, nos idiomas português e inglês, publicados durante os períodos de 2010 a 2017, selecionados na base de dados Scielo e Pubmed, utilizando os seguintes descritores: AH Plus, MTA Fillapex e citotoxicidade. Foram excluídos, os trabalhos no idioma não inglês, artigos sem resumo, trabalhos realizados em dentes decíduos e casos clínicos. Resultados: Foram identificados dezenove artigos nas bases de dados, sendo dois artigos no SciELO e dezessete artigos no Pubmed. Após a leitura aprofundada desses artigos, foram excluídos seis artigos por não atenderem aos critérios de inclusão. Dessa forma, a amostra final foi composta por treze artigos científicos, todos de modelos experimentais, publicados em periódicos de procedência internacional, da área odontológica, sendo 50% dos estudos do ano de 2013. Conclusão: Os estudos demonstraram que o MTA Fillapex apresentou maior citotoxicidade aos tecidos periapicais que o cimento AH Plus.(AU)

Aim: This study aimed to perform an integrative review, comparing the cytotoxicity of MTA Fillapex and AH Plus cements to periapical tissues. Methods: Full articles were used in the Portuguese and English languages, published during from 2010 to 2017, selected in the Scielo and Pubmed database, using the following descriptors: AH Plus, MTA Fillapex, and cytotoxicity. Excluded were nonEnglish works, articles without abstracts, work done on primary teeth, and clinical cases. Results: Nineteen articles were identified in the databases, two articles in SciELO and seventeen articles in Pubmed. After the in-depth reading of these articles, six articles were excluded because they did not meet the inclusion criteria. Thus, the final sample consisted of thirteen scientific articles, all of which were experimental models published in international journals in the field of dentistry, with 50% of the studies published in 2013. Conclusion: The studies showed that MTA Fillapex presented greater cytotoxicity to periapical tissues than did the AH Plus cement.(AU)

Evaluation of the dentin changes in teeth subjected to endodontic treatment and photodynamic therapy / Avaliação das alterações morfológicas de dentes submetidos ao tratamento endodôntico e a terapia fotodinâmica

Introduction: Antimicrobial photodynamic therapy (PDT) is an efficient adjuvant technique to promote disinfection of the root canal system. Therefore, it is important to investigate changes to dentin morphology and permeability induced by the use of diode laser on the root dentin. Objective: The purpose of this study was to investigate morphological changes and the percentage of apical leakage after the use of laser. Material and method: Forty single-rooted teeth were instrumented using rotary system and irrigated. Teeth were randomly divided in two groups: G1 - not exposed to PDT (control), and G2 - pretreated with toluidine blue photosensitizer and irradiated with AsGaAl laser diode. Ten teeth in each group were evaluated by SEM for morphological changes. The other ten teeth were filled and stained with Rhodamine B to evaluate the apical leakage. Result: The results showed significant difference between G1 and G2 (p< 0.001 - chi-square), with greater presence of debris in G1 and higher incidence of open dentinal tubules in G2. Erosions and cracks were observed in both groups, with no statistically significant difference (p> 0.001). The apical leakage was significantly higher in G2 than in G1 (p< 0.001 - Student's t-test). Conclusion: It was concluded that the use of low-level laser reduced the smear layer and opened the dentinal tubules. Use of laser increased the permeability of the apical dentin.

Resumo Introdução A PDT antimicrobiana é um eficiente método coadjuvante na desinfecção do sistema de canais radiculares, o que torna importante o estudo sobre a possibilidade de alterações morfológicas e permeabilidade provocadas pelo laser de diodo na estrutura dentinária radicular. Objetivo A proposta deste estudo foi investigar as alterações morfológicas e percentual de infiltração apical radicular após o uso do laser diodo. Material e método Quarenta dentes monorradiculares foram instrumentados pelo sistema rotatório Protaper e irrigados com NaOCl 5,25% e EDTA 17%. Depois, foram divididos aleatoriamente em: G1: não receberam PDT (controle); G2: receberam pré-irradiação com fotossensibilizador azul de toluidina e irradiação com laser diodo de AsGaAl. Em seguida, 10 dentes de cada grupo foram analisados por MEV quanto as alterações morfológicas. Os outros 10 dentes foram obturados e corados por Rodamina B para avaliar o percentual de infiltração apical. Resultado Os resultados mostraram diferença significativa entre G1 e G2 (p< 0,001 - qui-quadrado), verificando maior presença de debris em G1 (controle) e maior ocorrência de túbulos dentinários abertos em G2 (PDT). Erosões e cracks foram observadas em ambos os grupos, sem diferença estatística significativa (p> 0,001). O percentual de infiltração apical foi significativamente maior em G2 que em G1 (p< 0,001 - t student). Conclusão Concluiu-se que a utilização do laser diodo promoveu a redução de smear layer e abertura dos túbulos dentinários, não influenciando na ocorrência de erosão, cracks e carbonização. O laser aumentou a permeabilidade da dentina apical.

Infecção secundária e persistente e sua relação com o fracasso do tratamento endodôntico / The relationship between secondary and persistent infections and failure of endodontic treatments

Objetivo: O objetivo da presente revisão de literatura foi discutir a relação entre a infecção secundária e a infecção persistente e o insucesso endodôntico. Material e Métodos: Foi realizada uma pesquisa bibliográfica abrangendo artigos de revisão e de pesquisa, a partir de buscas em bases de dados SciELO, Periodicos CAPES, PubMed e MedLine utilizando os seguintes descritores: endodontia, periodontite periapical, infecção. Foram incluídos artigos publicados no período de 1990 a 2016 e escritos nas línguas inglesa e portuguesa. Além disso, os artigos foram selecionados após a leitura do seu resumo e a verificação da adequação do mesmo ao conteúdoa dessa revisão. Resultados: A literatura atual parece concordar que a desinfecção inadequada do sistema de canais radiculares e mecanismos de adaptação e resistência microbiana desempenham papel importante no insucesso endodôntico. Porém, a mesma ainda é controversa com relação ao papel do E. faecalis nesses casos de insucesso. Conclusão: Pode-se concluir, dentro das limitações do presente estudo, que o respeito às técnicas endodônticas é fundamental para obter sucesso e que novos estudos, utilizando proteômica, podem contribuir para esclarecer quais os principais micro-organismos envolvidos, bem como seu mecanismo de ação.

Objective: The aim of the present literature review was to discuss the relationship between secondary infections and persistent infections and endodontic treatment failure. Materials and Methods: We conducted a literature search including review articles and original research by searching the SciELO, Periódicos CAPES, PubMed and Medline databases using the following descriptors: endodontics, apical periodontitis, and infection. We included articles that were published between 1990 and 2016, and written in either English or Portuguese. Articles were selected after reading their abstracts and verifying their relevance to the review content. Results: The current literature seems to agree that inadequate disinfection of the root canal system, along with mechanisms of bacterial adaptation and resistance play an important role in endodontic treatment failure. However, there is still controversy regarding the role of Enterococcus faecalis in these failures. Conclusion: From the present study's findings, we can conclude that strict compliance to the proper endodontic techniques is fundamental for treatment success. Additionally, we believe that further studies using proteomic techniques may help fill the gaps regarding the main microorganisms associated with endodontic treatment failure as well as their mechanisms of action.

Avaliação in vitro de infiltração coronária de diferentes cimentos em cavidades complexos / In vitro evaluation of coronal leakage of different sealers in complex cavities

Objetivo: o objetivo do presente estudo foi avaliar in vitro a microin ltração coronária em cavidades complexas seladas com materiais restauradores temporários (MRT). Métodos: as cavidades foram preparadas em 60 pré-molares superiores extraídos de humanos, e os espécimes foram divididos em três grupos, de acordo com o MRT utilizado: G1 = IRM; G2 = Coltosol; G3 = Fill Magic Tempo. Três dentes serviram como controle negativo e não tiveram cavidades preparadas. Antes do selamento das cavidades com o MRT, uma esponja de colágeno foi deixada dentro da câmara pulpar, para avaliação binária da penetração do corante. Dez dentes de cada grupo não foram submetidos à ação de termociclagem e força mecânica oclusal, enquanto outros dez foram submetidos a essas ações. A amostra foi imersa em corante Rodamina B a 0,5% a 37°C, por 7 dias. Resultados: todos os dentes examinados (100%), exceto os controles negativos, apresentaram in ltração pelo corante. Todos os dentes selados com Coltosol (100%) fraturaram após ensaio mecânico, enquanto aqueles com IRM e Fill Magic Tempo mantiveram-se intactos macroscopicamente. A ação ou não das intempéries térmicas e mecânicas não interferiu na penetração do corante nas amostras no presente estudo. Conclusão: nenhum dos materiais testados impediu a in ltração do corante. No entanto, o Coltosol não deve ser indicado para utilização em cavidades complexas onde há incidência de forças mastigatórias, devido ao seu alto índice de fratura.

Autotransplantation of a mandibular third molar: a case report with 5 years of follow-up.

This paper describes the autologous transplantation of a mandibular right third molar to replace the residual roots of the second molar in the same quadrant, preserving function and aesthetics. A 5-year clinical and radiographic follow-up was undertaken. After transplantation, the donor tooth received endodontic treatment and placement of calcium hydroxide, which was periodically replaced every 3 months until the filling of the root canals, totalizing a period of 1-year, when apical closure was confirmed. The tooth was in perfect functional and aesthetic conditions 5 years after beginning of treatment. Autotransplantation is a feasible option for replacing missing teeth when a donor tooth is available. The autotransplantation of a right mandibular third molar with compromised function and aesthetics to replace the residual roots resulting from coronal destruction due to extensive carious lesion of the second molar in the same quadrant was a viable treatment alternative.

Autotransplantation of a Mandibular Third Molar: A Case Report with 5 Years of Follow-up

This paper describes the autologous transplantation of a mandibular right third molar to replace the residual roots of the second molar in the same quadrant, preserving function and aesthetics. A 5-year clinical and radiographic follow-up was undertaken. After transplantation, the donor tooth received endodontic treatment and placement of calcium hydroxide, which was periodically replaced every 3 months until the filling of the root canals, totalizing a period of 1-year, when apical closure was confirmed. The tooth was in perfect functional and aesthetic conditions 5 years after beginning of treatment. Autotransplantation is a feasible option for replacing missing teeth when a donor tooth is available. The autotransplantation of a right mandibular third molar with compromised function and aesthetics to replace the residual roots resulting from coronal destruction due to extensive carious lesion of the second molar in the same quadrant was a viable treatment alternative.

O objetivo deste trabalho foi descrever o transplante autógeno de um terceiro molar inferior direito para substituir as raízes residuais do segundo molar no mesmo quadrante, preservando a função e a estética. Foi realizado acompanhamento clínico e radiográfico por 5 anos. Após o transplante, o dente doador recebeu tratamento endodôntico e colocação de hidróxido de cálcio, o qual foi substituído periodicamente a cada 3 meses, até a obturação dos canais radiculares, totalizando período de 1 ano quando então, o fechamento apical foi confirmado. O dente encontra-se em perfeitas condições funcionais e estéticas após 5 anos do início do tratamento. O autotransplante é uma opção viável para a substituição de dentes perdidos quando um dente doador está disponível. O autotransplante de um terceiro molar inferior direito com comprometimento estético e funcional afim de substituir raízes residuais (resultado de um processo cariogênio extenso) de um segundo molar do mesmo quadrante foi um tratamento alternativo viável.