Effects of estrogen deficiency on the progression of apical periodontitis. A systematic review of preclinical studies.

BACKGROUND: To answer the review's question "Does estrogen deficiency influence on the progression of apical periodontitis?" METHODS: Systematic searches were performed in MEDLINE/PubMed, Cochrane Library, Scopus, Web of Science, EMBASE, and Grey Literature Report databases, without restriction for language or year of publication. The eligibility criteria were based on the PICOS strategy, as follows: (P) animals with estrogen deficiency; (I) induction of apical periodontitis; (C) animals without estrogen deficiency (control group or sham surgery); (O) bidimensional and/or tridimensional measures of apical periodontitis progression; (S) studies in animal models. Risk of bias was performed with SYRCLE Risk of Bias tool. Certainty of evidence was assessed with GRADE. RESULTS: In total, 12 studies were included according to eligibility criteria. All studies (100%) demonstrated that the estrogen deficiency influence the apical periodontitis progression. Most studies performed a histomorphometric analysis evaluating bone loss area (58.3%), radiographic bone loss area (41.7%), bone volume assessment with microcomputed tomography (25%), fluorescence microscopy lesion area in mm2 (16.7%), and radiographic density assessment in one study (8.3%). The most frequent period of analysis was 21 days after lesion induction (75%). GRADE assessment showed a moderate certainty of evidence. DISCUSSION: The included studies demonstrated several limitations regarding randomization, blinding and description of baseline characteristics. All studies showed that an hypoestrogenic condition can favor an increased progression of apical periodontitis. Further clinical studies are necessary to confirm this correlation. CONCLUSIONS: In animal models, the estrogen deficiency significantly impact on the progression of apical periodontitis generating larger lesions comparing to healthy sham animals.

Evaluation of the dentinal tubule penetration of an endodontic bioceramic sealer after three final irrigation protocols

Introduction: This study aimed to evaluate the dentinal tubule penetration of an endodontic bioceramic sealer, Sealer Plus BC, after three final irrigation protocols. Methods: Thirty distobuccal roots of maxillary molars were selected. Root canal preparation was performed up to an #40.06 instrument (X1 Blue) under 2.5% sodium hypochlorite irrigation. Specimens were randomly divided into three groups (n=10), according to the final irrigation protocol: G-NaOCl (2.5% sodium hypochlorite + PUI), G-SS (0.9% saline solution + PUI) and G-H20 (Deionized water + PUI). After final irrigation protocols, all specimens were irrigated with phosphate buffer solution. Root canal obturation was performed using the single cone technique and Sealer Plus BC, stained with a specific fluorophore. Specimens were transversely sectioned and each root third was evaluated in a confocal scanning laser microscopy. Images obtained were analyzed for sealer penetration in the dentinal tubules. Results: Dentinal tubule penetration of Sealer Plus BC was not observed in any root third, regardless of the final irrigation protocol investigated. Conclusions: Sealer Plus BC dentinal tubule penetration was not observed after none of the protocols tested. Dentinal tubule penetrability of Sealer Plus BC may be related to other factors rather than the final irrigation protocol.