Noninvasive Endodontic Periapical Biopsy of a Periapical Fibrous Scar: Case Report.

Postendodontic periapical fibrous scars (PFScs) comprise a type of radiolucent healing that is frequently misinterpreted as a pathological lesion. A combined clinical, radiologic, and histologic correlation is essential for a reliable diagnosis. This report presents a case of a patient with a long-term persistent asymptomatic postendodontic radiolucency that was misdiagnosed as endodontic failure and referred for endodontic retreatment and periapical surgery. To reach a definitive diagnosis, a core bone biopsy needle (CBBn) technique was performed on the area of the radiolucency. The material obtained was processed for histologic analysis and the lesion was determined to be a PFSc. In conclusion, the use of a CBBn before any invasive treatment allowed the clinician to distinguish between PFSc and other persisting pathosis, such as periapical granuloma or cystic lesions.

Pit and fissure depth in the enamel of mandibular third molars: An open gate for microleakage?

The aim of this descriptive ex vivo study was to evaluate qualitatively the depth of pit and fissures (P&F) of the enamel in human mandibular third molars. Fifty (n=50) extracted human mandibular third molars were cleaned and disinfected. All tooth surfaces were coated with nail varnish except for a 1-mm margin around the periphery of the occlusal surface. The teeth were immersed for 48 hours at 37 °C in 1% methylene blue dye solution prepared in artificial saliva. After cleaning, the crowns were separated from the root at the cementoenamel junction and subsequently sectioned longitudinally in buccolingual direction at the location of the central fossa. All sections were examined using a stereoscopic microscope and photographed. The images were downloaded on a computer. The length of penetration of the P&F was recorded using the following scoring system: C1: P&F extended to half of the enamel thickness; C2: P&F extended beyond half of the enamel thickness without reaching the dentine-enamel junction; C3: P&F extended to the dentine-enamel junction. For pits, C1, C2 and C3 were observed in 35, 9 and 6 teeth, respectively, while for fissures, C1, C2 and C3 were observed in 15, 18 and 17 teeth, respectively. The P&F detected in the samples extended to the deepest portions of enamel, quite frequently reaching the enamel-dentine junction. Clinicians should recognize that even if pits and fissures are not clinically obvious, they penetrate deep into the enamel and frequently reach the dentine-enamel junction. Effective treatment is recommended to block access to P&F, thus preventing ingress of bacteria.

Objetivos: El objetivo del presente estudio descriptivo fue evaluar cualitativamente mediante un ensayo ex vivo la profundidad de las fosas y fisuras (F&F) del esmalte en terceros molares inferiores humanos. Materiales y métodos: Cincuenta (n=50) terceros molares inferiores sanos extraídos se lavaron, se descontaminaron y se recubrieron con esmalte para uñas hasta 1 mm menos del área de las F&F. Luego se sumergieron durante 48 horas a 37°C en una solución de azul de metileno al 1% (pH 7,4) preparada con saliva artificial. Posteriormente se lavaron y se separaron las coronas a nivel del límite amelocementario. En cada molar se realizó una sección longitudinal de 1 mm de espesor con orientación vestíbulo-lingual a nivel de la fosa central. Las secciones fueron analizadas con microscopio estereoscópico y fotografiadas. Las imágenes se transfirieron a una computadora. Se determinó cualitativamente la extensión de las F&F en el espesor del esmalte y se las clasificó de acuerdo a 3 categorías. C1: extensión hasta la mitad del espesor del esmalte; C2: extensión que supera la mitad del espesor del esmalte sin afectar el límite amelodentinario; C3: extensión que llega al límite amelodentinario. Resultados: Para las fosas, 35, 9 y 6 especimenes correspondieron a las categorías C1, C2 y C3 respectivamente. Para las fisuras, 15, 18 y 17 especimenes correspondieron a las categorías C1, C2 y C3 respectivamente. Conclusiones: Las fosas y fisuras de la muestra analizada se extienden hasta la zona más profunda del espesor del esmalte. Con cierta frecuencia llegan hasta el límite amelodentinario.

Pit and fissure depth in the enamel of mandibular third molars / Profundidad de fosas y fisuras en el esmalte de terceros molares inferiores

ABSTRACT The aim of this descriptive ex vivo study was to evaluate qualitatively the depth of pit and fissures (P&F) of the enamel in human mandibular third molars. Fifty (n=50) extracted human mandibular third molars were cleaned and disinfected. All tooth surfaces were coated with nail varnish except for a 1-mm margin around the periphery of the occlusal surface. The teeth were immersed for 48 hours at 37 °C in 1% methylene blue dye solution prepared in artificial saliva. After cleaning, the crowns were separated from the root at the cementoenamel junction and subsequently sectioned longitudinally in buccolingual direction at the location of the central fossa. All sections were examined using a stereoscopic microscope and photographed. The images were downloaded on a computer. The length of penetration of the P&F was recorded using the following scoring system: C1: P&F extended to half of the enamel thickness; C2: P&F extended beyond half of the enamel thickness without reaching the dentine-enamel junction; C3: P&F extended to the dentine-enamel junction. For pits, C1, C2 and C3 were observed in 35, 9 and 6 teeth, respectively, while for fissures, C1, C2 and C3 were observed in 15, 18 and 17 teeth, respectively. The P&F detected in the samples extended to the deepest portions of enamel, quite frequently reaching the enamel-dentine junction. Clinicians should recognize that even if pits and fissures are not clinically obvious, they penetrate deep into the enamel and frequently reach the dentine-enamel junction. Effective treatment is recommended to block access to P&F, thus preventing ingress of bacteria.

RESUMEN Objetivos: El objetivo del presente estudio descriptivo fue evaluar cualitativamente mediante un ensayo ex vivo la profundidad de las fosas y fisuras (F&F) del esmalte en terceros molares inferiores humanos. Materiales y métodos: Cincuenta (n=50) terceros molares inferiores sanos extraídos se lavaron, se descontaminaron y se recubrieron con esmalte para uñas hasta 1 mm menos del área de las F&F. Luego se sumergieron durante 48 horas a 37°C en una solución de azul de metileno al 1% (pH 7,4) preparada con saliva artificial. Posteriormente se lavaron y se separaron las coronas a nivel del límite amelocementario. En cada molar se realizó una sección longitudinal de 1 mm de espesor con orientación vestíbulo-lingual a nivel de la fosa central. Las secciones fueron analizadas con microscopio estereoscópico y fotografiadas. Las imágenes se transfirieron a una computadora. Se determinó cualitativamente la extensión de las F&F en el espesor del esmalte y se las clasificó de acuerdo a 3 categorías. C1: extensión hasta la mitad del espesor del esmalte; C2: extensión que supera la mitad del espesor del esmalte sin afectar el límite amelodentinario; C3: extensión que llega al límite amelodentinario. Resultados: Para las fosas, 35, 9 y 6 especimenes correspondieron a las categorías C1, C2 y C3 respectivamente. Para las fisuras, 15, 18 y 17 especimenes correspondieron a las categorías C1, C2 y C3 respectivamente. Conclusiones: Las fosas y fisuras de la muestra analizada se extienden hasta la zona más profunda del espesor del esmalte. Con cierta frecuencia llegan hasta el límite amelodentinario.

Detección y cuantificación de células plasmáticas (plasmocitos) en granulomas periapicales inducidos experimentalmente en ratas / Detection and quantification of plasma cells in experimentally induced rat periapical granulomas

Objetivo: En los granulomas periapicales, los plasmocitos (PL) participan activamente mediante la liberación de inmunoglobulinas. El propósito de este ensayo fue identificar y contar el número de PL en diferentes períodos de tiempo en lesiones periapicales experimentales en ratas. Materiales y métodos: Mediante la exposición al medio oral de la pulpa de los primeros molares inferiores izquierdos, se indujeron granulomas periapicales en ratas a las que previamente se les suministró anestesia. La pulpa de los primeros molares inferiores derechos no fue expuesta, y estos dientes se utilizaron como control. Los animales fueron eutanasiados a los 10, 30 y 60 días de la exposición. Los maxilares inferiores fueron removidos, y los primeros molares, junto con los tejidos circundantes, se procesaron para su estudio histológico. Se obtuvieron secciones semiseriadas, posteriormente coloreadas con verde de metilo-pironina (VMP). Cada tres secciones, las tres siguientes fueron coloreadas con hematoxilina y eosina (H-E). Los controles también fueron coloreados con H-E. Resultados: Todos los especímenes experimentales coloreados con H-E revelaron la presencia de granulomas periapicales. Luego de la exposición pulpar, el número de PL que reaccionó positivamente al VMP se incrementó de manera progresiva desde el día 10 hasta los días 30 y 60. A pesar de que a los 60 días el número de PL fue ligeramente menor que a los 30 días, no hubo diferencias estadísticamente significativas entre estos dos períodos. Los especímenes del grupo control coloreados con H-E mostraron que los tejidos periapicales se encontraban dentro de los parámetros normales en todos los períodos de observación. Conclusiones: Los resultados de este estudio revelaron que el número de plasmocitos VMP positivos se incrementa progresivamente en función del tiempo transcurrido pero se estabiliza al finalizar el experimento. También sugieren que el empleo de la coloración de VMP es un procedimiento adecuado para la identificación y la cuantificación de plasmocitos en los granulomas periapicales inducidos experimentalmente en ratas (AU)

Aim: Plasma cells (PL) release immunoglobulin in periapical lesions. The purpose of this assay was to identify and count the number of plasmocytes observed in periapical lesions in rats. Materials and methods: By exposing the pulp of the lower left first molars to the oral environment, periapical granulomas were induced in rats previously anesthetized. The pulp of right mandibular first molars was not exposed and these teeth were used as negative controls. The animals were euthanized at 10, 30 and 60 days after pup exposure. The mandibles were removed and specimens of the molar teeth along with the surrounding tissues were prepared for histology. Semi serial sections of the left first molar were stained with methyl green pyronine (MGP). Every three sections, the following three sections were stained with hematoxilyn and eosin (H-E). Negative control samples were stained with H-E. Results: All the H-E stained experimental samples revealed the presence of periapical granulomas. After pulp exposure, the number of PL increased from day 10 to 30 and 60. In the 60-day samples the number of PL was slightly less than that of the 30-day samples, with no statistically significant difference. The H-E stained control samples showed normal periapical tissues in all observation periods. Conclusions: The results of this study revealed that the number of VMP positive PL, increased progressively with time but it was stabilized at the end of the experiment. In addition, the results suggest that the use of VMP stain is a suitable procedure for the identification and counting of PL in experimentally induced periapical granulomas in rats (AU)

Comportamiento biológico de dos selladores endodónticos biocerámicos en el tejido óseo de la rata. Un ensayo in vivo / Biological behavior of two bioceramic endodontic sealers in the bone tissue of the rat. In vivo study

Objetivo: Analizar cualitativamente la biocompatibilidad y la capacidad osteogénica de dos selladores endodónticos a base de silicato de calcio: el biocerámico Bio-C Sealer (BIOc) y MTA Densell Sealer (MTAd). Materiales y métodos: En la tibia izquierda de 30 ratas Wistar macho se implantó un tubo de silicona obturado con BIOc. De igual forma, en la tibia derecha de cada una se implantó un tubo de silicona obturado con MTAd. Los animales fueron eutanasiados en grupos de 10 a los 7, 30 y 90 días. Las tibias fueron procesadas para su análisis histológico y analizadas con microscopía óptica. Según lo observado, fueron clasificadas en tres categorías: 1: Presencia de cápsula fibrosa sana y neoformación ósea, sin células inflamatorias; 2: Cápsula fibrosa con o sin células inflamatorias, formación inicial de trabéculas óseas y presencia de células inflamatorias en los tejidos circundantes; 3: Ausencia de cápsula y/o tejido óseo y presencia de numerosas células inflamatorias. Los resultados fueron analizados con las pruebas de McNemar y de Kruskal-Wallis (P<0,05). Resultados: A los 7 días, los tejidos en contacto con BIOc y MTAd reaccionaron según la categoría 3. A los 30 días, todos los casos correspondieron a la categoría 2. A los 90 días, los 10 implantes de BIOc fueron clasificados según la categoría 1. MTAd presentó nueve casos de categoría 1 y un caso de categoría 2. No hubo diferencias significativas entre ambos selladores dentro de cada uno de los períodos de observación (P>0,05), pero sí las hubo cuando se compararon los resultados obtenidos entre períodos de observación (P<0,05). Conclusión: Al finalizar el ensayo, Bio-C Sealer y MTA Densell Sealer se comportaron como materiales biocompatibles y osteogénicos en tibias de rata (AU)

Aim: To analyze the biocompatibility and osteogenic capacity of two silicate-based endodontic sealers, the bioceramic Bio C-Sealer (BIOc) and the MTA-based sealer MTA Densell (MTAd). Materials and methods: Silicone tubes filled with BIOc were implanted in the left tibias of 30 white male Wistar rats (one per tibia). In similar fashion, tubes filled with MTAd were implanted in the right tibias. The animals were euthanized in groups of 10 at 7, 30 and 90 days postoperatively. The tibias were removed, processed for histology and analysed under optical microscopy. The observations were classified in three categories: 1: Presence of a healthy fibrous capsule and newly formed bone trabeculae without inflammatory cells. 2: Fibrous capsule with or without inflammatory cells, initial formation of bone trabeculae and presence of inflammatory cells in the surrounding tissues. 3: Absence of a fibrous capsule and/or bone formation with the presence of numerous inflammatory cells. Data was analyzed by the McNemar and the Kruskal-Wallis test (P<0.05). Results: At 7 days: The tissues in contact with BIOc and MTAd reacted as category 3. At 30 days: All cases were classified as category 2. At 90 days: All BIOc cases were in category 1 while MTAd presented nine cases of category 1 and one case of category 2. There were no significant differences (P>0.05) between both sealants BIOc and MTAd in each period group. However, there were significant differences (P<0.05) when the results between periods were compared. Conclusion: At the end of the experiment both, BIOc and MTAd behaved as biocompatible and osteogenic materials in the rats' tibias (AU)

Influence of a Retentive Shoulder Design to Prevent Early Failure of Three Core Build-Ups.

This study evaluated the influence of a retentive shoulder design to prevent early failure of three resin composite build-ups on molars. Ninety-six intact extracted human maxillary third molars were assigned to two groups (n=48) based on occlusal, buccal cusps only and all cusps reduction. The groups were divided into two subgroups: pin retained and non-pin retained build-ups resulting in four groups (n=24), according the cusps reduction: pin retained/partial, pin retained/complete, non-pin retained/partial, non-pin retained/complete. Occlusal reduction was 3 mm with a semi-lunar retentive shoulder of 3 mm and an axial wall height of 1.5 mm. Groups were restored using a microhybrid, flowable or titanium reinforced resin composite. Modified self-curing acrylic resin provisional crowns were fabricated, cemented with non-eugenol temporary cement and thermal cycled. An instron machine applied tension to the provisional crowns parallel to the long axis of the tooth until dislodgement. A three-way analysis of variance was conducted on the influence of the variables on the retention of the core build-up. Ninety-three build-ups were retained under tensile load, while three core build-ups without pins were dislodged. Three-way analysis of variance showed no statistically significant difference between core build-ups using a retentive shoulder and pin retained core build-ups when tested under tensile load. With the advent of adhesive systems, increased surface area and retentive shoulder design can provide a retentive core foundation to prevent early failures of core build-ups during indirect restoration fabrication which will contribute to the longevity of final restorations.

Bacterial microleakage of a bioactive pit &fissure sealant.

PURPOSE: To compare the sealing properties of three pit and fissure (P&F) sealants, Embrace Wet Bond (EWB), a bioactive P&F sealant Embrace Wet Bond through the addition of modified calcium phosphate (MCP) (EWBMCP) and ClinPro (CLPR). The sealing properties of the materials were tested by means of a bacterial microleakage test. METHODS: 30 extracted intact human third molars were randomly assigned to three groups of 10 (n=10) teeth each. The teeth were cleaned with two passes of air abrasion, followed by rinsing for 20 seconds and then dried with compressed air for another 20 seconds leaving the enamel surface slightly moist. The coronal portion of each tooth was sectioned perpendicular to the long axis at the level of 4 mm below the top of the central fossa of the enamel. A parallel vertical channel 1 mm in diameter was prepared in the central fossa through the entire sample. All samples were sterilized with Gamma radiation. After etching the occlusal surface with 35% phosphoric acid gel followed by rinsing, the sealants were applied. The samples were stored at 37°C in SPB for 3 weeks, thermal cycled for 2,000× (5-55°C) and coated with nail varnish leaving 1 mm uncovered around the P&F material. Samples were then tested for microleakage of E. faecalis culture using a dual chamber leakage model. The broth in the lower chamber was checked daily for turbidity up to 90 days. Statistical significance was determined at P< 0.05. RESULTS: The median survival time for EWBMCP was significantly higher (P< 0.05) than for EWB and CLPR. With respect to bacterial microleakage frequency, EWBMCP and CLPR behaved significantly better than EWB. The bioactive sealant EWBMCP outperformed the other two tested sealants in terms of resistance to bacterial microleakage. Long-term clinical studies are recommended to confirm these in vitro findings. CLINICAL SIGNIFICANCE: Long term resistance to bacterial leakage of occlusal pit and fissure sealants will be beneficial to resisting the development of decay. A recently developed bioactive pit & fissure sealant offers that possibility and it is recommended that the findings are confirmed by clinical studies.

Influence of a retentive shoulder design to prevent early failure of three core build-ups

Abstract This study evaluated the influence of a retentive shoulder design to prevent early failure of three resin composite build-ups on molars. Ninety-six intact extracted human maxillary third molars were assigned to two groups (n=48) based on occlusal, buccal cusps only and all cusps reduction. The groups were divided into two subgroups: pin retained and non-pin retained build-ups resulting in four groups (n=24), according the cusps reduction: pin retained/partial, pin retained/complete, non-pin retained/partial, non-pin retained/complete. Occlusal reduction was 3 mm with a semi-lunar retentive shoulder of 3 mm and an axial wall height of 1.5 mm. Groups were restored using a microhybrid, flowable or titanium reinforced resin composite. Modified self-curing acrylic resin provisional crowns were fabricated, cemented with non-eugenol temporary cement and thermal cycled. An instron machine applied tension to the provisional crowns parallel to the long axis of the tooth until dislodgement. A three-way analysis of variance was conducted on the influence of the variables on the retention of the core build-up. Ninety-three build-ups were retained under tensile load, while three core build-ups without pins were dislodged. Three-way analysis of variance showed no statistically significant difference between core build-ups using a retentive shoulder and pin retained core build-ups when tested under tensile load. With the advent of adhesive systems, increased surface area and retentive shoulder design can provide a retentive core foundation to prevent early failures of core build-ups during indirect restoration fabrication which will contribute to the longevity of final restorations.

Resumo Este estudo avaliou a influência de um preparo retentivo em forma de ombro para prevenir a falha precoce de núcleos de preenchimento realizados em molares com 3 diferentes tipos de resina composta. Noventa e seis terceiros molares superiores hígidos extraídos de humanos, foram divididos em dois grupos (n=48) de acordo com o tipo de redução oclusal: em todas as cúspides (total) ou nas cúspides vestibulares (parcial). Os grupos foram divididos em dois subgrupos: núcleos retidos a pinos e não retidos a pinos, resultando em quatro grupos (n=24): redução oclusal total/retido a pino, redução oclusal parcial/retido a pino, redução oclusal total/não retido a pino, redução oclusal parcial/não retido a pino. A redução oclusal foi de 3 mm com um ombro retentivo semilunar de 3 mm e uma altura de parede axial de 1,5 mm. Os grupos foram restaurados utilizando resina composta microhíbrida, fluível ou reforçada com titânio. Foram confeccionadas coroas provisórias de resina acrílica autopolimerizável modificada, cimentadas com cimento provisório sem eugenol e termocicladas. Uma máquina universal de ensaios foi utilizada para tracionar as coroas provisórias paralelamente ao longo eixo do dente até o seu deslocamento. Análise de variância de 3 fatores foi aplicada para avaliar o efeito dos fatores na retenção do núcleo. Noventa e três núcleos de preenchimento permaneceram retidos sob a carga de tração, enquanto três núcleos de preenchimento sem pinos foram deslocados. A análise de variância não mostrou diferença significante entre os núcleos de preenchimento com desenho retentivo e os núcleos de preenchimento retidos a pinos. Com o advento dos sistemas adesivos, o aumento da área de superfície e o desenho retentivo dos ombros podem fornecer um preparo retentivo para evitar falhas precoces nos núcleos de preenchimento durante a fabricação de restaurações indiretas, o que contribuirá para a longevidade das restaurações finais.

Effect of Ferrule Location with Varying Heights on Fracture Resistance and Failure Mode of Restored Endodontically Treated Maxillary Incisors.

PURPOSE: To investigate the effect of the location of a partial ferrule on 2 walls and the influence of ferrule height variations on remaining walls, fracture resistance, and failure mode of maxillary incisors endodontically treated and restored with fiber posts. MATERIALS AND METHODS: Sixty intact human maxillary central incisors were divided into 6 groups (n = 10): no ferrule (NF), 2-mm ferrule (CF2), absence of lingual wall and 1 proximal wall with remaining walls' height, 1 mm (IF1), 2 mm (IF2), 3 mm (IF3), and 4 mm (IF4). They were restored with a fiberglass post and composite resin core. Complete metal crowns were then cemented on all specimens. Completed specimens were subjected to thermal cycling (6000 cycles, 5°C/55°C) followed by the immediate testing of fracture resistance. After failure, the specimens were sectioned buccolingually and evaluated to identify the mode of failure. The data were analyzed with an ANOVA and the Student-Newman-Keuls multiple comparison tests (α = 0.05). RESULTS: An incomplete ferrule (IF2) with the lingual wall missing and 1 proximal wall had a fracture resistance of 494 ± 137 N, which was significantly less that of a complete ferrule (CF2) (707 ± 162 N, p = 0.002). An increase of 3 to 4 mm in height of the remaining walls had negligible influence on the fracture resistance: 514 ± 117 N (IF3), 557 ± 177 N (IF4). Partial decementation was observed in all specimens of IF3 and IF4, in 9 of IF1 and IF2, in 6 in NF, and in 3 in CF2. Root fractures occurred in 7 specimens, 4 in CF2, 1 in IF1, 1 in IF2, and 1 in IF4. Cracks under the cemento-enamel junction occurred in 4 specimens (NF and IF1), in 5 (IF2 and IF3), and in 6 (CF2 and IF4) and were considered catastrophic failures. CONCLUSIONS: Specimens with a complete ferrule of 2 mm height were more resistant to fracture than specimens with 2 mm height and absence of the lingual wall and 1 proximal wall. A 3 or 4 mm wall height increase was associated with an insignificant increase in fracture resistance and cannot compensate for the absence of the lingual wall and 1 proximal wall.

Endodoncia y operatoria dental 4. Hipersensibilidad dentinaria: ensayo preliminar ex vivo de un modelo experimental para su tratamiento / Endodontics and operative dentistry 4. Dentine hypersensitivity: an ex vivo preliminary assay of an experimental model

Objetivo: Determinar el grado de confiabilidad de un modelo de dentina humana para evaluar la calidad de oclusión de los túbulos dentinarios luego del uso de dos agentes desestabilizantes que contienen oxalato de potasio. Materiales y métodos: Se obtuvieron dos secciones horizontales en forma de discos de dentina de 0,8 mm de espesor de cada uno de 21 terceros molares sanos extraídos por razones periodontales, ortodóncicas o quirúrgicas. El barro dentinario de las superficies coronaria y pulpar de los discos se eliminó con ácido fosfórico al 35% y posterior lavado con suero fisiológico y secado. De cada molar se separó un disco para el grupo 1 (n=20). Los segundos discos de cada molar se destinaron al grupo 2 (n=20). Y los dos discos del molar restante no recibieron tratamiento (controles negativos). El ensayo se realizó en dos etapas. En la primera, las superficies coronarias de los discos del grupo 1 se trataron con Klepp Desensitizer, mientras que en el grupo 2 se empleó BisBlock Desensitizer. Posteriormente, se metalizaron con oro-paladio y se observaron en un microscopio electrónico de barrido. En la segunda etapa, los discos se retiraron del microscopio, se invirtieron de posición, y la superficie pulpal ubicada en posición superior se lavó con suero, se secó, se metalizó y se observó nuevamente con el microscopio. Con el objeto de realizar el análisis químico de los agentes desestabilizantes, se obtuvieron otros dos discos a partir de un molar adicional y se prepararon ambos siguiendo el mismo protocolo que en los discos experimentales. Uno de ellos se trató con Klepp Desensitizer, y el otro, con BisBlock Desensitizer. Finalmente, las superficies pulpares de ambos discos adicionales se metalizaron con carbón y se examinaron mediante un análisis de energía dispersiva de rayos X. Resultados: En la primera etapa del ensayo, la superficie coronaria de los 20 discos de cada grupo se encontraba cubierta por una capa uniforme de cristales precipitados a partir de ambos agentes desestabilizantes. En la segunda etapa, la superficie pulpar de los 20 discos del grupo 1 reveló que todos los túbulos dentinarios estaban totalmente ocluidos por los cristales en nueve (n=9) casos. Lo mismo ocurrió en ocho (n=8) discos del grupo 2. En ambos casos los cristales ocluyeron totalmente los túbulos hasta una profundidad de 0,8 mm. En 11 (n=11) y 12 (n=12) discos de los grupos 1 y 2 respectivamente se observaron túbulos parcialmente ocluidos o bien una combinación de estos con túbulos vacíos. Las diferencias entre grupos no fueron significativas (P>0,05). En los controles negativos todos los túbulos se encontraban vacíos. El análisis de energía dispersiva de rayos X reveló que los cristales precipitados a partir de ambos agentes desestabilizantes dentro de los túbulos contenían importantes concentraciones de calcio y trazas de potasio. Conclusiones: El modelo ensayado parecería ser adecuado para comparar ex vivo la calidad de protección de la superficie dentinaria producida por los agentes desestabilizantes a base de oxalato de potasio (AU)

Influence of remaining coronal tooth structure on fracture resistance and failure mode of restored endodontically treated maxillary incisors.

STATEMENT OF PROBLEM: Limited information is available on the effect of an incomplete ferrule because of the varying residual axial wall heights and the volume of residual tooth structure on the fracture resistance of endodontically treated and restored maxillary incisors. PURPOSE: The purpose of this in vitro investigation was to examine the effect of varying residual axial wall heights, residual coronal tooth structure, and the absence of 1 proximal axial wall on the fracture resistance and failure mode of endodontically treated teeth restored with metal posts. MATERIAL AND METHODS: Sixty intact human maxillary central incisors were divided into 6 groups (n=10): no ferrule (NF), 2-mm complete ferrule (CF2), 2-mm (IF2), 3-mm (IF3), and 4-mm (IF4) incomplete ferrules missing a single interproximal wall, and a control group that had a 6-mm incomplete ferrule (IF6). Cast metal post-and-cores were placed in all experimental specimens except for controls. Control specimens received 1 interproximal cavity preparation extending to the root canal access and a composite resin restoration. Complete metal crowns were then cemented on all specimens. Completed specimens were subjected to thermocycling (6000 cycles, 5°C/55°C) followed by the immediate testing of fracture resistance. Failed specimens were sectioned buccolingually and evaluated to identify the failure mode. The data were analyzed with an analysis of variance (ANOVA) and the Student-Newman-Keuls multiple comparison test (α=.05). RESULTS: An incomplete ferrule (IF2) with 1 interproximal wall missing had significantly reduced fracture resistance (697 N) compared with a complete ferrule (932 N). An increase of 3 to 4 mm of remaining wall height improved fracture resistance, from 844 N (IF3) to 853 N (IF4). Partial decementation was noticed in 8 NF and 5 IF2 specimens. IF3 and IF4 had no decementations. Radicular fractures and cracks (catastrophic failure) were observed in all IF2, IF3, and IF4, 9 CF2, and 6 NF specimens. In 7 specimens without posts (IF6, control), composite resin foundation and/or coronal dentin fracture were observed and the failure was considered repairable. CONCLUSIONS: The results of this in vitro study indicated that specimens with a 2-mm ferrule of uniform height were more resistant to fracture than specimens with a 2-mm ferrule and 1 missing interproximal wall. An increased wall height of 3 or 4 mm was associated with a significant increase in fracture resistance and can compensate for the missing interproximal wall.

Bicompatibilidad de dos materiales bioactivos en el tejido óseo de la rata / Biocompatibility of two bioactive materials in the bone tissue of the rat

Objetivos: Comparar la biocompatibilidad y la actividadosteogénica del material bioactivo experimental Activa PC y de MTA color blanco, por medio de un modelo de implantación en tibia de rata.Materiales y métodos: En las tibias de 20 (n=20) ratas Wistar macho de aproximadamente 350 gramos, seimplantaron tubos de silicona estériles obturados a ras con Activa PC (Pulpdent Corp., Watertown, Estados Unidos) o MTA (Angelus, Londrina, Brasil). Los animales se separaronen dos grupos de 10 (n=10). La eutanasia de uno de los grupos fue realizada a los 15 días, mientras que la del grupo restante se realizó a los 60 días posimplantación. Las tibiasfueron removidas, se fijaron en formol-buffer al 10 por ciento, y se descalcificaron y procesaron para su estudio histológico. La evaluación fue realizada en base a tres categorías, y los resultados se analizaron por medio de la prueba de Wilcoxon y el test no paramétrico de Mann-Whitney, con un nivel de significación de P0,05) entre Activa PC y MTA Angelus en cada uno de los períodos de observación, pero sí las hubo (P<0,05) cuando se compararon los resultados obtenidosa 15 y 60 días. Conclusiones: Activa PC y MTA Angelus se comportaron como materiales biocompatibles en tibias de rata, y su función bioactiva se incrementó significativamente en función del tiempo transcurrido, favoreciendo ambos materialesel proceso de reparación ósea.

Flexural strength and flexural fatigue properties of resin-modified glass ionomers.

OBJECTIVE: To determine the physical properties of several resin-modified glass ionomers (RMGIs) by means of flexural strength and flexural fatigue testing, and to compare them to conventional glass ionomer cements (GICs) and flowable composite resins. METHODS: RMGI samples were fabricated according to ISO 4049 standard. Rectangular specimens were produced using a polytetrafluoroethylene (PTFE) mold with dimensions of 2 x 2 x 25 mm. Flexural strength and flexural fatigue were measured by means of the 3-point bending tests using an Instron universal testing machine at 0.75 mm/min and 0.03 Hz for 100 cycles, respectively. Flexural stress, load, and displacement were recorded for all tests. Data were statistically compared (ANOVA, SNK, p < 0.05). Statistical data analysis for flexural fatigue was achieved through the least frequent events method (failures versus non-failures). The following RMGIs, flowable composites, and GICs were tested: 1) Activa Bioactive-Restorative; 2) Activa Bioactive-Base/Liner; 3) Tetric EvoFlow; 4) Beautifil Flow Plus; 5) Geristore; 6) Fuji Filling LC; 7) Fuji Lining LC; 8) Ketac Nano; 9) Fuji Triage; 10) Ketac Nano; and 11) Vitrebond Plus. RESULTS: The flexural strength of Activa-enhanced RMGIs was statistically significantly greater than all other RMGIs and GICs (p < 0.001). The flexural fatigue of Activa-enhanced RMGIs and flowable composites was significantly greater than all other materials (p < 0.00 1). The flexural fatigue of the Activa-enhanced RMGIs was comparable to the two flowable composites tested. CONCLUSION: The Activa-enhanced RMGIs demonstrated comparable flexural strength and flexural fatigue to flowable composites. Activa-enhanced RMGIs and flowable composites demonstrated flexural strength and flexural fatigue significantly greater than all other tested materials.

Adaptation and penetration of resin-based root canal sealers in root canals irradiated with high-intensity lasers.

This research analyzed the quality of resin-based sealer adaptation after intracanal laser irradiation. Extracted teeth (n = 168) were root canal treated and divided into four groups, according to dentin surface treatment: no laser; Nd:YAG laser (1.5 W, 100 mJ, 15 Hz); diode laser (2.5 W in CW), and Er:YAG laser (1 W, 100 mJ, 10 Hz). The teeth were divided into four subgroups according to the sealer used: AH Plus, EndoREZ, Epiphany, and EpiphanySE. For testing the sealing after root canal obturation, the penetration of silver nitrate solution was measured, whereas to evaluate the adaptation and penetration of the sealer into the dentin, environmental scanning electron microscopy (ESEM) was used. The ESEM images were analyzed using a four-grade criteria score by three evaluators. The inter-examiner agreement was confirmed by Kappa test and the scores statistically compared by the Kruskal-Wallis' test (p < 0.05). Both adaptation and sealer penetration in root canals were not affected by the laser irradiation. Nd:YAG and diode laser decreased the tracer penetration for AH Plus, whereas EndoREZ and EpiphanySE performances were affected by Nd:YAG irradiation (p < 0.05). It can be concluded that intracanal laser irradiation can be used as an adjunct in endodontic treatment; however, the use of hydrophilic resin sealers should be avoided when root canals were irradiated with Nd:YAG laser.

Reacción del tejido óseo de la rata a un material de obturación de conductos radiculares de tercera generación: un ensayo piloto / Reaction of the rat osseous tissue to a third-generation root canal filling material: a pilot assay

Objetivos: analizar la respuesta del tejido óseo de la rata a la implantación de Licon-D (LND). Material y métodos: se implantaron en tibias de 18 ratas, tubos de silicona obturados con LND o pasta lentamente reabsorbible (PLR) utilizada como control positivo. La pared lateral de los tubos (SCN) fue utilizada como control negativo. A los 7, 30 y 90 días post implantación, los implantes y tejidos circundantes fueron fijados en formol al 10 por ciento y procesados para su estudio histológico. Resultados: 7 días: se observó una reacción inflamatoria severa de los tejidos en contacto con LND y PLR, mientras que en contacto con SCN se observó un tejido conectivo sano, con excepción de dos casos. 30 días: la reacción inflamatoria en contacto con LDN se redujo, observándose un proceso de reparación en progreso con trabéculas óseas incipientes. 90 días: en contacto con LDN se observó una cápsula fibrosa y reparación ósea. Para PLR se observó a los 30 días un tejido fibroso que rodeaba un foco de tejido granulomatoso, mientras que los SCN se encontraban rodeados por una cápsula constituida por tejido fibroso sano. 90 días: en contacto con PLR, se observó una cápsula fibrosa y trabéculas óseas incipientes. En contacto con SCN, los tejidos circudantes se encontraban normales en todos los casos. Conclusiones: a pesar que LND y PLR produjeron una reacción inflamatoria inicial severa, luego de 90 días, ambos materiales fueron bien tolerados por el tejido óseo de la rata. Se observó una reparación completa en contacto con LND y un proceso de reparación en progreso en contacto con PLR.

Interrupted orthodontic force results in less root resorption than continuous force in human premolars as measured by microcomputed tomography.

INTRODUCTION: Root resorption is an undesirable but very frequently occurring sequel of orthodontic treatment. The aim of this study was to compare root resorption caused by either continuous (CF) or interrupted (IF) orthodontic force. MATERIAL AND METHODS: The study was performed on human subjects on 30 first upper and lower premolars scheduled for extraction for orthodontic reasons. During four weeks before extraction 12 teeth were subjected to either CF or IF. The force was generated by a segmental titanium-molybdenum alloy cantilever spring that was activated in buccal direction. Initially a force of 60 CentiNewton was used in both CF and IF groups, the force in the former, however, was reactivated every week for 4 weeks. There was no reactivation of force in the IF group after initial application. A morphometric analysis of root resorption was performed by microcomputed tomography and the extent of tooth movement was measured on stone casts. Furthermore, a Tartarate-Resistant Acidic Phosphatase activity (TRAP), the marker enzyme of osteoclasts and cementoclasts, was determined by histochemical method. The Mann-Whitney U test was used to compare the difference in measured parameters between treatment and control tooth groups. RESULTS: The number of resorption craters was significantly higher and their average volume almost twice as large in the CF compared to the IF group (p < 0.05). However, the distance of tooth displacement was similar for both groups. Cementoclasts were detected with the TRAP technique on the surface of two teeth only; both were subjected to continuous force. CONCLUSIONS: The use of IF leads to less destruction of root structure as opposed to continuous force while the same tooth movement was achieved.

Capacidad de sellado de tres agentes cementantes para restauraciones coronarias indirectas / Sealing ability of three luting agents used for cementation of indirect coronal restorations

Objetivo: comparar ex vivo, por medio de un modelo de filtración bacteriana, la capacidad de sellado de un ionómero vítreo modificado con resinas, de un ionómero vítreo convencional y de un cemento de fosfato de cinc, utilizados para la cementación de coronas coladas (AU). Materiales y métodos: un total de 30 premolares humanos sanos, extraídos, fueron preparados de forma estandarizada para recibir una corona metálica con terminación en chamfer sobre dentina. Se realizaron impresiones, se vaciaron en densita tipo IV, se enceraron y se colaron en aleación de oro tipo III. Luego fueron separadas al azar en tres grupos de 10 (n=10) especímenes cada uno. Las coronas del grupo 1 fueron cementadas con Rely-X Luting Plus (3M/ESPE); y las del grupo 2, con Ketac-Cem (3m/ESPE); y las del grupo 3 (control), con el cemento de fosfato de cinc Harvard Cement (Harvard Debtal International GmbH, Hoppengarten, Alemania). Todos los especímenes fueron termociclados. Posteriormente, la superficie metálica oclusal fue reducida 1 mm hasta exponer la dentina, y las muestras se esterilizaron en autoclave. El proceso de filtración se realizó por medio de un sistema de doble cámara con medio de cultivo. El medio de la cámara superior se inoculó con E. faecalis y el sistema fue incubado durante 60 días. En la cámara inferior, la filtración bacteriana se controló diariamente. Los datos registrados fueron analizados por medio de las pruebas de Kaplan-Meyer y de Fischer, con un nivel de significación de P<0,05. Resultados: el tiempo de supervivencia para Rely-X Luting Plus no pudo ser estimado, ya que fue superior a los 60 días, tiempo máximo de duración de la experiencia. Para Ketac-Cem fue de 60 días, con un intervalo de confianza (95 por ciento) de 29,6-90,4. Y para Harvard Cement fue de 40 días, con un intervalo de confianza de 32,6-47,4. Las diferencias entre los grupos fueron estadísticamente significativas. Conclusión: Rely-X Plus demostró una capacidad de sellado superior.

Operatoria dental y endodoncia 1: la degradación de la interfaz resina-dentina favorece la filtración bacteriana / Operative dentistry and endodontics 1: the interface resin-dentin degradation allows for the bacterial microleakage

La integridad y la estabilidad de la interfase adhesivo/dentina en las restauraciones realizadas mediante resinas compuestas se encuentra constantemente comprometida por la hidrólisis progresiva de sus componentes hidrofílicos y la degradación de la matriz colágena, producida por la reactivación de una serie de endopeptidasas denominadas metaloproteinasas (MMP) y otras enzimas colagenolíticas que se encuentran fosilizadas en la matriz de la dentina. Esto lleva a la destrucción de la capa híbrida y facilita la penetración bacteriana en la interfase, el aumento de la hipersensibilidad posoperatoria y la formación de caries recurrentes. Estos problemas inciden además en la pérdida de retención de la restauración y se constituyen en el principal factor etiológico de los procesos inflamatorios que comprometen seriamente la salud de la pulpa dental. Debido a que la integridad de la matriz colágena es esencial para preservar la durabilidad de la adhesión de las restauraciones, se han intentado algunas estrategias, con el objeto de inhibir o al menos reducir en lo posible la acción de las enzimas colagenolíticas sobre la estabilidad de la interfase. A pesar de que algunas de las estrategias ensayadas hasta el momento han demostrado ser eficaces, aún se encuentran en una etapa netamente experimental y requieren ser más profundamente investigadas

Operatoria dental y endodoncia 1: la degradación de la interfaz resina-dentina favorece la filtración bacteriana / Operative dentistry and endodontics 1: the interface resin-dentin degradation allows for the bacterial microleakage

La integridad y la estabilidad de la interfase adhesivo/dentina en las restauraciones realizadas mediante resinas compuestas se encuentra constantemente comprometida por la hidrólisis progresiva de sus componentes hidrofílicos y la degradación de la matriz colágena, producida por la reactivación de una serie de endopeptidasas denominadas metaloproteinasas (MMP) y otras enzimas colagenolíticas que se encuentran fosilizadas en la matriz de la dentina. Esto lleva a la destrucción de la capa híbrida y facilita la penetración bacteriana en la interfase, el aumento de la hipersensibilidad posoperatoria y la formación de caries recurrentes. Estos problemas inciden además en la pérdida de retención de la restauración y se constituyen en el principal factor etiológico de los procesos inflamatorios que comprometen seriamente la salud de la pulpa dental. Debido a que la integridad de la matriz colágena es esencial para preservar la durabilidad de la adhesión de las restauraciones, se han intentado algunas estrategias, con el objeto de inhibir o al menos reducir en lo posible la acción de las enzimas colagenolíticas sobre la estabilidad de la interfase. A pesar de que algunas de las estrategias ensayadas hasta el momento han demostrado ser eficaces, aún se encuentran en una etapa netamente experimental y requieren ser más profundamente investigadas (AU)

Resistance against bacterial leakage of four luting agents used for cementation of complete cast crowns.

PURPOSE: To assess the sealing properties of four luting materials used for cementation of full cast crowns. METHODS: 40 human premolars were prepared with a chamfer finish line. Stone dies were fabricated and copings were waxed, invested and cast in gold. Ten samples (n = 10) were randomly assigned to four groups. In two groups, resin modified glass-ionomer cements were used, ACTIVA BioACTIVE-CEMENT/BASE/LINER and FujiCem2; the third group received the self-adhesive resin cement Embrace WetBond, while the fourth group served as control with a zinc phosphate cement. After cementation, excess cement was removed followed by bench-set for 10 minutes. All samples were stored in water at 37 degrees C and subjected to thermal cycling (x2000 between 5 and 55 degrees C). Subsequently the occlusal surface was reduced exposing the dentin. After sterilization the specimens were subjected to bacterial microleakage with E. faecalis in a dual chamber apparatus for a period of 60 days. Bacterial leakage was checked daily. Data were analyzed using the Kaplan-Meyer survival test. Significant pairwise differences were analyzed using the Log Rank test and the Fishers' exact test at P < 0.05. RESULTS: ACTIVA BioACTIVE-CEMENT/BASE/LINER, FujiCem2 and Embrace WetBond showed the lowest microleakage scores and differed statistically significantly (P < 0.05) from zinc phosphate cement.