Comparison between the rotary (Hyflex EDM®) and manual (k-file) technique for instrumentation of primary molars: a 12-month randomized clinical follow-up study.

OBJECTIVES: Rotational instrumentation is an alternative for the clinical practice of pediatric dentists. However, there are few records in the literature on the clinical and radiographic aspects of treated teeth over time. Compare instrumentation time and filling quality between manual (k-file) and rotary (Hyflex EDM®) files, and clinically and radiographically follow-up the treated teeth for 12 months. Moreover, the characteristics of glass ionomer restorations and their interference in the treatment prognosis over time were evaluated. METHODOLOGY: In total, 40 children with pulp involvement in primary molars received treatment with Hyflex EDM® or manual rotary files, performed by an operator. Clinical and radiographic aspects were observed at different times to determine the effectiveness of each technique. RESULTS: The rotary system reduced instrumentation time when compared to the use of manual files (p≤0.05), but there was no difference in filling quality between the groups (p≥0.05). Moreover, both types of instrumentation were effective for 12 months (p≥0.05), and restoration retention influenced the emergence of periapical lesions (p≤0.05). CONCLUSION: Although rotary files reduce clinical time, the clinical and radiographic aspects of both techniques were similar over 12 months. Moreover, restoration retention has been shown to be related to treatment prognosis.

Comparison between the rotary (Hyflex EDM®) and manual (k-file) technique for instrumentation of primary molars: a 12-month randomized clinical follow-up study

Abstract Rotational instrumentation is an alternative for the clinical practice of pediatric dentists. However, there are few records in the literature on the clinical and radiographic aspects of treated teeth over time. Objectives: Compare instrumentation time and filling quality between manual (k-file) and rotary (Hyflex EDM®) files, and clinically and radiographically follow-up the treated teeth for 12 months. Moreover, the characteristics of glass ionomer restorations and their interference in the treatment prognosis over time were evaluated. Methodology: In total, 40 children with pulp involvement in primary molars received treatment with Hyflex EDM® or manual rotary files, performed by an operator. Clinical and radiographic aspects were observed at different times to determine the effectiveness of each technique. Results: The rotary system reduced instrumentation time when compared to the use of manual files (p≤0.05), but there was no difference in filling quality between the groups (p≥0.05). Moreover, both types of instrumentation were effective for 12 months (p≥0.05), and restoration retention influenced the emergence of periapical lesions (p≤0.05). Conclusion: Although rotary files reduce clinical time, the clinical and radiographic aspects of both techniques were similar over 12 months. Moreover, restoration retention has been shown to be related to treatment prognosis.

Expression of Matrix Metalloproteinases-8 and Myeloperoxidase in Pulp Tissue after Pulpotomy with Calcium Silicate Cements

ABSTRACT Objective: To evaluate the pulp tissue of rat molars after pulpotomies with mineral trioxide aggregate (MTA), BiodentineTM (BDT) and calcium hydroxide (CH) mixed with sterile saline solution (24 hours, 72 hours, 7 days and 15 days), through correlating MPO activity with active neutrophils and MMP8 activity with tissue remodeling. Material and Methods: Thirty-eight Wistar rats were randomly distributed into groups (control, I (MTA gray), II (BDT), and III (CH)) and subdivided according to the study period of 24 hours, 72 hours, 7 days or 15 days after pulpotomy. MMP8 activity was assessed through fluorescence technique, and MPO activity was determined using the MPO assay. Results: A gradual decrease of MPO and MM8 activity occurred in the group MTA over the experimental periods (p<0.05). Groups BDT and CH exhibited an increase in the activity at 7 and 15 days (p<0.05). Conclusion: MTA demonstrated a decrease in the values of MPO e MMP8. BDT and CH showed high neutrophilic and collagenase activity over the experimental periods.

Comparison between calcium hydroxide mixtures and mineral trioxide aggregate in primary teeth pulpotomy: a randomized controlled trial.

OBJECTIVES: To evaluate the effect of calcium hydroxide (CH) associated with two different vehicles as a capping material for pulp tissue in primary molars, compared with mineral trioxide aggregate (MTA). METHODOLOGY: Forty-five primary mandibular molars with dental caries were treated by conventional pulpotomy using one of the following materials: MTA only (MTA group), CH with saline (CH+saline group) and CH with polyethylene glycol (CH+PEG group) (15 teeth/group). Clinical and periapical radiographic examinations of the pulpotomized teeth were performed 3, 6, and 12 months after treatment. Data were tested by chi-squared analysis and a multiple comparison post-test. RESULTS: The MTA group showed both clinical and radiographic treatment success in 14/14 teeth (100%), at all follow-up appointments. By clinical evaluation, no teeth in the CH+saline and CH+PEG groups had signs of mobility, fistula, swelling or inflammation of the surrounding gingival tissue. However, in the CH+saline group, radiographic analysis detected internal resorption in up to 9/15 teeth (67%), and inter-radicular bone resorption and furcation radiolucency in up to 5/15 teeth (36%), from 3 to 12 months of follow-up. In the CH+PEG group, 2/11 teeth (18%) had internal resorption and 1/11 teeth (9%) presented bone resorption and furcation radiolucency at all follow-up appointments. CONCLUSION: CH with PEG performed better than CH with saline as capping material for pulpotomy of primary teeth. However, both combinations yielded clinical and radiographic results inferior to those of MTA alone.

Antimicrobial activity of various brands of children's toothpastes formulated with Triclosan, fluoride and xylitol / Atividade antimicrobiana de dentifrícios infantis formulados com Triclosa, xylitol e fluoreto, disponíveis no mercado

Objective: Evaluate and compare the antimicrobial efficacy of four different commercially available children's toothpastes on bacteria growth inhibition from oral microbiota of young children. Material and Method: The toothpastes tested contained: 1100 ppm sodium fluoride, xylitol and 750 ppm sodium fluoride, xylitol and 500 ppm sodium fluoride, and xylitol and triclosan. Twenty 18 to 36 month-old children were selected. Nonstimulated saliva samples were collected and inoculated on brain heart infusion (BHI) agar. Toothpaste dilutions were applied into the agar wells and incubated at 37 ºC for 24 hours in microaerophilic conditions. Saline and 0.12% chlorhexidine were used as controls. Antimicrobial activity was determined in duplicate by agar-well diffusion technique. Bacterial growth inhibition zones were recorded in mm. Statistical analysis was performed using ANOVA and Tukey's test (p < 0.05). Results: All toothpastes showed antimicrobial activity when compared to negative control (p < 0.05). Toothpaste containing triclosan presented the highest antimicrobial activity followed, in this order, by xylitol and 750 ppm sodium fluoride, chlorhexidine, 1100 ppm sodium fluoride, xylitol and 500 ppm sodium fluoride and saline. Conclusion: Toothpaste containing triclosan and xylitol presented excellent antimicrobial activity, and may be considered a good option for young children. (AU)

Objetivo: Avaliar e comparar a atividade antimicrobiana de 4 dentifrícios infantis, comercialmente disponíveis, com relação à inibição do crescimento da microbiota oral em crianças. Material e Métodos: Os dentifrícios testados continham: 1100 ppm de fluoreto de sódio - xilitol e 750 ppm de fluoreto de sódio - xilitol e 500 ppm de fluoreto de sódio - xilitol e triclosan. Vinte crianças de 18 a 36 meses participaram dessa pesquisa. Amostras de saliva não estimulada foram coletadas e inoculadas em ágar de infusão cérebro-coração (ICC). Dentifrícios diluídos foram aplicados sobre os poços contendo ICC e incubados a 37 ºC por 24 horas em condições microaerofílicas. Solução salina e clorexidina a 0,12% foram usadas como controles. A atividade antimicrobiana foi determinada em duplicata pela técnica de difusão nos poços de ágar. Os halos de inibição do crescimento bacteriano foram registrados em mm. A análise estatística foi realizada usando ANOVA e teste de Tukey (p < 0,05). Resultados: Todos os dentifrícios mostraram atividade antimicrobiana, quando comparados com os controles negativos. O dentifrício contendo triclosan mostrou a maior atividade antimicrobiana, seguido, nessa ordem por dentifrício contendo xilitol e 750 ppm de fluoreto de sódio, clorexidina, dentifrício contendo 1100 ppm de fluoreto de sódio, dentifrício contendo xilitol e 500 ppm de fluoreto de sódio e pela solução salina. Conclusão: O dentifrício contendo triclosan e xylitol apresentou excelente atividade antimicrobiana podendo ser considerado uma vantajosa opção para crianças, contribuindo para o controle das cáries dentárias e reduzindo a ingestão de fluoretos.(AU)

Comparison between calcium hydroxide mixtures and mineral trioxide aggregate in primary teeth pulpotomy: a randomized controlled trial

Abstract Objectives: To evaluate the effect of calcium hydroxide (CH) associated with two different vehicles as a capping material for pulp tissue in primary molars, compared with mineral trioxide aggregate (MTA). Methodology: Forty-five primary mandibular molars with dental caries were treated by conventional pulpotomy using one of the following materials: MTA only (MTA group), CH with saline (CH+saline group) and CH with polyethylene glycol (CH+PEG group) (15 teeth/group). Clinical and periapical radiographic examinations of the pulpotomized teeth were performed 3, 6, and 12 months after treatment. Data were tested by chi-squared analysis and a multiple comparison post-test. Results: The MTA group showed both clinical and radiographic treatment success in 14/14 teeth (100%), at all follow-up appointments. By clinical evaluation, no teeth in the CH+saline and CH+PEG groups had signs of mobility, fistula, swelling or inflammation of the surrounding gingival tissue. However, in the CH+saline group, radiographic analysis detected internal resorption in up to 9/15 teeth (67%), and inter-radicular bone resorption and furcation radiolucency in up to 5/15 teeth (36%), from 3 to 12 months of follow-up. In the CH+PEG group, 2/11 teeth (18%) had internal resorption and 1/11 teeth (9%) presented bone resorption and furcation radiolucency at all follow-up appointments. Conclusion: CH with PEG performed better than CH with saline as capping material for pulpotomy of primary teeth. However, both combinations yielded clinical and radiographic results inferior to those of MTA alone.

Clinical, Radiographic and Histological Evaluation of Primary Teeth Pulpotomy Using MTA And Ferric Sulfate.

The aim of this study was to evaluate the clinical, radiographic and histological outcomes of the dentin-pulp complex from primary molars after pulpotomy with mineral trioxide aggregate (MTA) and 15.5% ferric sulfate (FS). Thirty-one primary molars were randomly allocated into MTA or FS groups. Clinical and radiographic evaluations were recorded at 3-, 6-, 12- and 18-month follow-up. Teeth at the regular exfoliation period were extracted and processed for histological analysis. Clinical and radiographic data were tested by statistical analysis (p≤0.01). Histological outcomes were analyzed descriptively. All of the treated teeth presented clinical success over the experimental periods. Both groups exhibited 100% of radiographic success at 3, 6 and 12 months. At the 18-month follow-up, one tooth from FS group presented inter-radicular radiolucency (p>0.01). Histologically, the treated teeth presented pulp vitality and absence of inflammatory infiltrate into the connective tissue. Only MTA group showed hard tissue barrier surrounded by odontoblasts over the pulp stumps. Both MTA and 15.5% FS are effective for pulpotomies of primary teeth. Although MTA is considered the first-choice material, FS may be a suitable alternative when treatment cost is an issue.

Terapia pulpar em dentes decíduos: possibilidades terapêuticas baseadas em evidências / Pulp therapy in deciduous teeth: therapeutic possibilities based on evidences

Introdução: A pulpotomia em dentes decíduos é uma técnica conservadora de terapia pulpar amplamente utilizada em Odontopediatria, sendo de fundamental importância para evitar a perda prematura desses dentes, quer seja por alterações provocadas pela cárie dentária ou traumatismo dentário. Apesar de ser uma técnica estudada há muitos anos, causa muitas controvérsias e discussões, principalmente em termos de biocompatibilidade dos medicamentos empregados e pelas dificuldades e falhas no diagnóstico da condição pulpar. Objetivo: Por meio de uma revisão sistemática da literatura, no período compreendido entre 2000 e 2011, e com enfoque em estudos clínicos randomizados, revisões sistemáticas e meta-análises, este trabalho teve como objetivo discutir, com base em evidências científicas, alternativas para o tratamento de pulpotomia em dentes decíduos humanos. Conclusão: As evidências científicas fidedignas com o uso de materiais capeadores pulpares e as técnicas de Eletrocirurgia e Laser de Baixa Potência foram escassas. Desta forma, sugere-se a realização de estudos complementares bem delineados estatisticamente para maiores esclarecimentos. As informações geradas em tais experimentos poderão contribuir para um melhor entendimento dos mecanismos da terapia pulpar, podendo gerar o desenvolvimento de protocolos com novas formas terapêuticas, que visam a melhorar a terapia pulpar em dentes decíduos.

Introduction: Pulpotomy of primary teeth has been the treatment of choice in cases of inflammation of the coronal pulp caused by caries or trauma with no involvement of the radicular pulp, thus avoiding the premature loss of the teeth. Not only is the diagnosis of the inflamed dental pulp required for this therapy to succeed, but also the selection of an effective and biocompatible medicament. However, none of the drugs available and recommended for pulpotomy therapy present all the requirements of an ideal pulp capping agent. Objective: Through a systematic literature review, between the years of 2000 and 2011, focusing in randomized clinical trials, systematic reviews and meta-analysis, aiming to analyze and discuss based on alternatives for the treatment of pulpotomy in human deciduous teeth. Conclusion: Scientific evidences showed that the medicaments and techniques influence were few. Thus, further and well-designed studies are suggested for clarification. The information generated in such experiments may contribute to a better understanding of the mechanisms of pulp therapy to new therapeutic approaches aimed at improving pulp therapy in deciduous teeth.

Coroas Procera All-Ceram para reabilitação de dentes com alteração de cor: relato de caso / Procera All-Ceram crowns for replacement discolored teeth: Case report

As coroas totalmente cerâmicas tem se tornado uma solução atrativa para fornecer reabilitação estética e funcional em dentes. O Sistema Procera® é atualmente um serviço restaurador dental que alia bom custo-benefício e alta qualidade. A proposta deste relato de caso foi ilustrar as vantagens deste sistema na reabilitação de dentes anteriores superiores. Uma paciente de 40 anos de idade se apresentou com a seguinte queixa: “desejo de melhorar a estética” dos incisivos centrais superiores com alteração de cor. Os dois incisivos centrais superiores foram preparados e coroas Procera® foram cimentadas. A qualidade do material e o potencial do sistema ajudou a resolver este caso restaurador com total confiança, tempo de trabalho reduzido e ótimo resultado estético

The all-ceramic crowns have become an attractive solution to provide functionaland esthetic rehabilitation on teeth. The Procera® system is currently providing cost-effective and high-quality dental restorative services. The purpose of this case report was to illustrate the advantages of this system for anterior rehabilitation. A 40-year-old patient presented with the chief complaint of “desire to improve esthetics” of discoloured upper central incisors. The two maxillary incisors were prepared and Procera Crowns were cemented. Material quality and the potential of this system helped resolve this restorative case with full confidence, reduced working-time, and optimum esthetic result

In vivo qualitative analysis of the biocompatibility of different cyanoacrylate-based adhesives.

Cyanocrylates have been widely used in the medical and dental fields for several years. In Dentistry, cyanoacrylates have been used for suturing, pulp capping, as retrofilling material in endodontic surgeries, and as cervical plug for pulpless teeth bleaching. The biocompatibility of these adhesives has been the topic of many researches and subcutaneous implantation is an effective methodology for these studies. The present study evaluated the biocompatibility of three different cyanoacrylate-based adhesives. Thirty-six Wistar rats were used, divided into four groups of 9 animals each: A (control)--distilled water, B--cyanoacrylate ester (Super Bonder), C - n-butyl-cyanoacrylate (Histoacryl) and D--alpha-cyanoacrylate (Three Bond). The materials were dispensed in sponges of polyvinyl chloride, the animals were incised and the sponges were inserted in the subcutaneous tissue and sutured. Each group was sub-divided according to the time of sacrifice of the animals: 7, 21 and 45 days. Subjective analysis of the histologic material showed that all groups presented some degree of irritability, but the inflammatory reaction decreased with the experimental time in all groups. Group D showed an inflammatory reaction which was closer to that of the control group and was considered to have good biocompatibility. Groups B and C were similar and presented more aggressive inflammatory reactions when compared to the control group. Based on the results, it was concluded that alpha-cyanoacrylate (Three Bond) was the most biocompatible adhesive because it caused the lowest levels of inflammation.

In vivo qualitative analysis of the biocompatibility of different cyanoacrylate-based adhesives

Cyanocrylates have been widely used in the medical and dental fields for several years. In Dentistry, cyanoacrylates have been used for suturing, pulp capping, as retrofilling material in endodontic surgeries, and as cervical plug for pulpless teeth bleaching. The biocompatibility of these adhesives has been the topic of many researches and subcutaneous implantation is an effective methodology for these studies. The present study evaluated the biocompatibility of three different cyanoacrylate-based adhesives. Thirty-six Wistar rats were used, divided into four groups of 9 animals each: A (control) - distilled water, B - cyanoacrylate ester (Super Bonder), C - n-butyl-cyanoacrylate (Histoacryl) and D - alpha-cyanoacrylate (Three Bond). The materials were dispensed in sponges of polyvinyl chloride, the animals were incised and the sponges were inserted in the subcutaneous tissue and sutured. Each group was sub-divided according to the time of sacrifice of the animals: 7, 21 and 45 days. Subjective analysis of the histologic material showed that all groups presented some degree of irritability, but the inflammatory reaction decreased with the experimental time in all groups. Group D showed an inflammatory reaction which was closer to that of the control group and was considered to have good biocompatibility. Groups B and C were similar and presented more aggressive inflammatory reactions when compared to the control group. Based on the results, it was concluded that alpha-cyanoacrylate (Three Bond) was the most biocompatible adhesive because it caused the lowest levels of inflammation.

Estudo clínico, radiográfico e microscópico dos efeitos do formocresol de Buckley diluído a 1/5, hidróxido de cálcio PA e agregado trióxido mineral (MTA) em pulpotomias de dentes decíduos humanos / Clinical, radiographic and microscopic study on 1: 5 dilution of Buckley's formocresol, calcium hydroxide and trioxide mineral agregate a used for pulpotomies of human primary teeth

O objetivo deste estudo foi comparar a eficácia clínica, radiográfica e microscópica do formocresol (FC) de Buckley diluído a 1/5, hidróxido de cálcio PA (HC) e Agregado Trióxido Mineral (MTA) como agentes capeadores pulpares em dentes decíduos humanos acometidos por cárie extensa. Quarenta e cinco molares decíduos inferiores de 23 crianças com idades entre 5 e 9 anos foram tratados pela técnica convencional de pulpotomia. Os dentes foram aleatoriamente divididos entre os grupos experimentais (HC e MTA) e o grupo controle (FC). Após a remoção da polpa coronária e hemostasia, o tecido pulpar remanescente foi coberto com pasta de MTA ou pó de HC nos grupos experimentais. No grupo controle, uma bolinha de algodão umedecida na solução de FC diluído foi colocada por 5 minutos sobre o remanescente pulpar e então a câmara pulpar preenchida com óxido de zinco e eugenol. Todos os dentes foram restaurados com uma base de óxido de zinco e eugenol reforçado (IRM) e cimento de ionômero de vidro modificado por resina. As avaliações clínicas e radiográficas foram realizadas nos períodos de 3, 6, 12, 18, 24 e 30 meses do pós-operatório. Durante as avaliações, os dentes que se apresentavam no período normal de esfoliação, bem como, dentes considerados fracasso ao tratamento foram extraídos e processados para análise microscópica. Os cortes foram feitos seriadamente, no sentido vestíbulo-lingual e corados pela hematoxilina e eosina. A análise microscópica foi realizada de forma descritiva dos fenômenos mais marcantes ocorridos no tecido pulpar remanescente. Pelos resultados clínicos e radiográficos obtidos foi possível observar uma taxa de sucesso para os grupos FC, HC e MTA de 100%, 35,7% e 100%, respectivamente. Diferença estatisticamente significativa foi observada quanto à presença de reabsorção interna, lesão inter- radicular, mobilidade e fístula para o grupo HC (p < 0,05)...

The aim of this study was to compare the clinical, radiographic and microscopic effectiveness of formocresol (FC), calcium hydroxide (CH) and trioxide mineral aggregate (MTA) as pulp dressing agents in carious primary teeth. Forty-five primary mandibular molars of 23 children between 5 and 9 years old were treated by conventional pulpotomy technique. The teeth were randomly assigned to the experimental (CH and MTA) or control (FC) groups. After coronal pulp removal and hemostasis, remaining pulp tissue was covered with a MTA paste or CH powder in the experimental groups. In the control group, diluted FC was placed over the pulp tissue with a cotton pellet for 5 minutes and removed; the pulp tissue was covered then with zinc oxide-eugenol (ZOE) paste. All the teeth were restored with reinforced zinc oxide-eugenol base and resin modified glass ionomer cement. Clinical and radiographic evaluations were recorded at 3, 6, 12, 18, 24 and 30-month follow-up. During the assessments, the teeth in the regular exfoliation period, as well as those considered as treatment failures were extracted and further processed for microscopic analysis. Serial sections were performed in the bucco-lingual direction and stained with hematoxylin and eosin. Microscopic analysis was performed as a description of the most remarkable phenomena in the remaining pulp tissue. Through clinical and radiographic results, success rates of 100%, 35.7% and 100% for FC, CH and MTA were found, respectively. Statistically significant differences were observed regarding to the presence of internal resorption, inter-radicular bone destruction, mobility and fistula for CH group (p < 0.05). Microscopic analysis revealed the presence of intense inflammatory infiltrate and mineralized tissue deposition, which was irregular throughout the root canal, in the FC group...