How does nano-focus computed tomography impact the quantification of debris within the root canal system?

The aim of this study was to compare the quantification of hard-tissue debris by using micro-computed tomography (micro-CT) and nano-focus computed tomography (nano-CT) after root canal instrumentation. Ten mandibular molars containing an isthmus in the mesial root were scanned in a SkyScan 1172 micro-CT device with a voxel size of 12.8 µm and in a NanoTom nano-CT device with 5.5 µm. The mesial root canals were irrigated with 5 mL of saline solution at the orifice level, instrumented with Reciproc R25 files and a second scanning was performed by micro-CT and nano-CT devices for post-instrumentation images. DataViewer software was used for registering the pre- and post-operative micro-CT and nano-CT images. The root canal and the debris were segmented for quantitative analysis of the volume of the canal and volume of debris using CTAn software. Statistical analysis was performed using the T test for comparison between volume of the canal after instrumentation and volume of debris in both image modalities. The level of significance was set at p < 0.05. Nano-CT images showed higher values of debris when compared with micro-CT (p < 0.05) after root canal instrumentation. No difference was observed between the volume of the root canal after instrumentation in the two imaging methods used (p > 0.05). Nano-CT technology can be recommended as a more precise method for quantitative analysis of hard-tissue debris. Moreover, in Endodontic research it is a promising method, as it is capable of providing higher spatial and contrast resolution, faster scanning and higher image quality.

How does nano-focus computed tomography impact the quantification of debris within the root canal system?

Abstract The aim of this study was to compare the quantification of hard-tissue debris by using micro-computed tomography (micro-CT) and nano-focus computed tomography (nano-CT) after root canal instrumentation. Ten mandibular molars containing an isthmus in the mesial root were scanned in a SkyScan 1172 micro-CT device with a voxel size of 12.8 µm and in a NanoTom nano-CT device with 5.5 µm. The mesial root canals were irrigated with 5 mL of saline solution at the orifice level, instrumented with Reciproc R25 files and a second scanning was performed by micro-CT and nano-CT devices for post-instrumentation images. DataViewer software was used for registering the pre- and post-operative micro-CT and nano-CT images. The root canal and the debris were segmented for quantitative analysis of the volume of the canal and volume of debris using CTAn software. Statistical analysis was performed using the T test for comparison between volume of the canal after instrumentation and volume of debris in both image modalities. The level of significance was set at p < 0.05. Nano-CT images showed higher values of debris when compared with micro-CT (p < 0.05) after root canal instrumentation. No difference was observed between the volume of the root canal after instrumentation in the two imaging methods used (p > 0.05). Nano-CT technology can be recommended as a more precise method for quantitative analysis of hard-tissue debris. Moreover, in Endodontic research it is a promising method, as it is capable of providing higher spatial and contrast resolution, faster scanning and higher image quality.

Uso do instrumento Reciproc Blue associado à terapia fotodinâmica: relato de caso / Use of the Reciproc Blue instrument associated with photodynamic therapy: case report

Introdução: A presença de microrganismos é considerada a principal causa de insucesso da terapia endodôntica. Além disso, a anatomia interna dos dentes também representa um grande desafio para os endodontistas. Desse modo, lançar mão da tecnologia reduz tempo clínico e aumenta a chance de sucesso da terapia endodôntica. Objetivo: O objetivo do presente estudo foi relatar um caso clínico com a utilização de instrumentação mecanizada e o sistema Reci- proc Blue associados à terapia fotodinâmica. Descrição: Paciente do sexo feminino, melanoderma, compareceu à clínica escola de uma faculdade de Odontologia apresentando duas fístulas intrabucais ativas na região de fundo de vestíbulo próxima aos ápices dos dentes #12 e #22. Após os exames clínicos, radiográficos, testes de sensibilidade e rastreamento de fístulas, estabeleceu-se o diagnóstico de necrose pulpar, sugestível de abscesso apical crônico dos incisivos laterais superiores. Resultados: O tratamento endodôntico dos dois elementos dentários foi realizado em sessão única, utilizando o instrumento Reciproc Blue em movimento reciprocante associado à terapia fotodinâmica. Após 30 dias da conclusão dos tratamentos endodônticos e restauradores, os dentes apresentavam-se assintomáticos e com cicatrização das fístulas intrabucais. Conclusão: O uso do sistema Reciproc Blue associado à terapia fotodinâmica foi eficaz. Constatou-se o sucesso clínico e radiográfico da terapêutica aplicada, verificando-se o restabelecimento da região periapical, com regressão da lesão radiograficamente e ausência de sinais clínicos e sintomas de infecção do canal radicular. O acompanhamento por tempo prolongado é necessário para se avaliar o total reparo da lesão periapical (AU).

Introduction: The presence of microorganisms is considered the main cause of endodontic therapy failure. In addition, an internal anatomy also poses a major challenge for endodontists. In this way, avail a series of quick techniques and increase the chance of success. The reason of this study was to relate clinical cases, root canal treatment, using mechanized instrumentation with the system Reciproc Blue instrument, associated with photodynamic therapy. Case report: A female genetic patient, brown skin, presented at the school clinic of a dental school, with a major complaint of "blistering on the gum." At the clinical examination, the target dates are inside the mouth active in the selection bottom region near the apexes of the elements 12 and 22. Through clinical, radiographic, sensitivity and screening tests of fistulae, diagnosis and diagnosis of pulp necrosis, suggestive of chronic apex abscess of the incisors. Results: Endodontic treatment of the two dental elements was performed in a single session using the Reciproc Blue instrument in a reciprocating motion associated with photodynamic therapy. After 30 days of completion of endodontic and restorative treatments, one patient returned for evaluation and clinical follow-up. The new asymptomatic presentation and with a healing of the intrabucal fistulas. Conclusion: The system Reciproc Blue associated with photo-dynamic therapy was effective. It was verified the clinical and radiographic success of apicality, confirming the reestablishment of the apex region with regression of the radiographic lesion and the absence of clinical signs and signs of infection of the root canal. The patient is with the clinician and radiographic studies (AU).

Cleaning efficacy and uncontrolled removal of dentin of two methods of irrigant activation in curved canals connected by an isthmus.

The aim of this study was to compare the efficacy of UAI with ESI, sonic activation with Eddy® and syringe irrigation in removing debris, and dentin removal during canal irrigation. Twenty-four mandibular molars containing isthmus type V and with a mean curvature of 32.5° were instrumented and divided into three groups for final irrigation: UAI with ESI, sonic activation with Eddy and syringe irrigation. The samples were scanned in a SkyScan 1172 micro-CT device for pre-, post-instrumentation and post-irrigation images and analysis of dentin removal. Statistical analysis was performed using Wilcoxon, Kruskal-Wallis and Dunn tests. UAI and sonic activation significantly improved debris removal (P < 0.05). No significant difference was observed regarding dentin removal between the groups (P > 0.05), although higher values were found for UAI. Sonic activation with Eddy® showed to be an effective and safe device since it was able to remove debris without causing damage to the canal walls.

Root canal shaping of curved canals by Reciproc Blue system and Pro Taper Gold: A micro-computed tomographic study.

BACKGROUND: This study aimed to evaluate the centralization and transportation of ProTaper Gold (PTG) rotary system and Reciproc Blue (RB) reciprocating system in curved canals, by using micro-CT. MATERIAL AND METHODS: Twenty extracted mandibular molars were previously scanned by using the SkyScan 1174 microtomograph to select the Vertucci IV anatomic type. The specimens were divided into two groups (n=10) according to the mechanized system used to prepare the root canals. The teeth were scanned by micro-CT to calculate the increase volume, percentage of dentin removed, remaining dentin thickness, structure model index (SMI), degree of transportation and centering ability of root canals. The Student's t test was used to evaluate differences between PTG and RB in each measurement evaluated. RESULTS: No significant differences were found between the groups in the increase of the total root canal and apical volume; percentage of dentin removed after preparation; SMI of the mesiolingual canal; degree of transportation of the canal and centering ability of the cervical and middle thirds (P>0.05). There were significant differences in the mesiobuccal canal in SMI and in the centering ability of the apical third (P<0.05). Concerning the remaining dentin thickness, there was also no significant diferences between the groups, except for some regions were RB was observed to have a superior cutting capacity (P<0.05). CONCLUSIONS: Both systems were efficient and safe for performing preparation of the moderately curved root canals of mandibular molars. RB instruments produced more circular and better centralized canals in the apical third of the mesiobuccal canal, with superior cutting action when compared with PTG instruments. Key words:Nickel-titanium instrument, heat treatment, micro-computed tomography, canal transportation.

Influence of CBCT-based volumetric distortion and beam hardening artefacts on the assessment of root canal filling quality in isthmus-containing molars.

OBJECTIVES: To evaluate the influence of artefacts in cone beam CT (CBCT) images of filled root canals in isthmus-containing molars. METHODS: 10 teeth presenting canals with an isthmus were instrumented and filled with a thermoplasticised obturation technique. The teeth were scanned using a micro-CT device and two CBCT devices: 3D Accuitomo 170 (ACC) and NewTom VGi evo (NT), with different acquisition protocols: larger and smaller voxel size. Three examiners assessed the CBCT images for: (1) detection of filling voids; (2) assessment of under- or overestimation of the filling material and (3) resemblance of CBCT images to the reference standard. Analyses of Task 1 yielded accuracy, sensitivity and specificity for detection of filling voids. For tasks 2 and 3, statistical analysis was performed using Wilcoxon test. The level of significance was set at p < .05. RESULTS: For Task 1, ACC showed higher sensitivity, whereas NT presented higher specificity. No significant difference was found between the protocols in ACC, however, for NT, differences between protocols were significant for all diagnostic values. In Task 2, visualisation of the filling was overestimated for NT, while for ACC, underestimation was observed. For Task 3, images with smaller voxel size were more similar to the reference image, for both CBCT devices. CONCLUSIONS: Different artefacts compromise the detection of filling voids on CBCT images of canals in mandibular molars with isthmus. ACC and NT present rather similar diagnostic accuracy, even though artefact expression remains device-specific.

Analysis of the physicochemical properties, cytotoxicity and volumetric changes of AH Plus, MTA Fillapex and TotalFill BC Sealer.

BACKGROUND: To evaluate the physicochemical properties and cytotoxicity of AH Plus, MTA Fillapex and TotalFill BC Sealer. Volumetric changes were also evaluating using micro-computed tomography (micro-CT). MATERIAL AND METHODS: Radiopacity and flow were evaluated in accordance with the ISO 6876, while setting time was evaluated in accordance with the ASTM- C266-08 specifications. The release of Ca2+ ions and pH were measured with spectrophotometer and pH meter, respectively, after different time intervals (1h, 3h, 24h, 72h, 168h, and 360h). Cytotoxicity was evaluated by MTT reduction assay to check 3T3 cells viability at 24, 48 and 72 hours. Volumetric change was evaluated by micro-CT, by using 30 acrylic teeth, filled with gutta-percha cones and the tested root canal sealer. The samples were evaluated after 168h, 360h and 720h of immersion in distilled water. Data were statistically analyzed by one-way ANOVA and Tukey test or by Kruskal-Wallis and Dunn tests (P<0.05). RESULTS: MTA Fillapex and TotalFill BC Sealer showed lower radiopacity than AH Plus (P<0.05). The MTA Fillapex showed the highest flow, while AH Plus showed the lowest flow (P<0.05). The initial and final setting time of AH Plus were lower than MTA Fillapex and TotalFill BC Sealer (P<0.05). In general, TotalFill BC Sealer presented higher Ca2+ ion release and pH than the other tested sealers. TotalFill BC Sealer also showed overall lower cytotoxicity when compared to the other sealers. Volumetric change of AH Plus and TotalFill BC Sealer was lower than MTA Fillapex (P<0.05). CONCLUSIONS: AH Plus, MTA Fillapex and TotalFill BC Sealer showed slight differences in the physicochemical properties and cytotoxicity, but all suitable for an endodontic sealer. However, AH Plus and TotalFill BC Sealer showed low volumetric changes when compared to MTA Fillapex. Key words:Calcium silicate, cytotoxicity, physicochemical properties, micro computed tomography.

Dentoalveolar Abscesses Not Associated with Caries or Trauma: A Diagnostic Hallmark of Hypophosphatemic Rickets Initially Misdiagnosed as Hypochondroplasia.

Hypophosphatemic rickets is a rare genetic disorder involving the regulation of fibroblast growth factor 23 (FGF23), a phosphaturic agent, clinically showing bowing of the legs, short stature and dentoalveolar abscesses. A 7-year-old boy, with previous hypochondroplasia diagnosis, was referred to our pediatric dentistry clinic presenting short stature, bone deformities and sinus tracts at deciduous teeth apex levels not related with trauma, restorations or dental caries. After deciduous teeth extraction, due to root resorption and mobility, light microscopy exhibited typical hypophosphatemic dentin, and micro-computed tomography revealed tubular clefts and porosities throughout the teeth. Laboratory tests confirmed the HR diagnosis, after which the treatment was initiated.

Interactive audience response systems in oral and maxillofacial radiology undergraduate lectures.

OBJECTIVES: To evaluate the impact of audience response systems (ARS) on student participation (SP) during Oral and Maxillofacial Radiology (OMR) undergraduate lectures and on final examination scores (FES). Furthermore, an analysis of unanimity assessed the influence of ARS on students' responses. Students' perceptions were also assessed. METHODS: A controlled crossover study was designed. Four lectures covering topics of OMR were each taught with ARS and without ARS (i.e. hand-raising method). SP and FES were compared between ARS and HR groups. Unanimity of answers was analyzed for both groups. Questionnaires assessed students' impressions about ARS. RESULTS: Mean SP of ARS and HR groups were 97.6% and 47.3%, respectively, and this difference was statistically significant (P<.05). Mean FES for the ARS group (77%) was slightly higher than HR group (75.1%), however, not statistically significant. There was positive correlation between SP and FES. With ARS, only 5.7% of the questions were unanimous, whilst 51.4% were unanimous with HR method. Most students reported that the use of ARS had positive influence on their attention (92%), participation (96%), classmates' participation (82.7%), interest (74.7%), and learning (86.7%). For the five-point scale ratings of the relevance of ARS features, anonymity had an average 3.6, whilst other items received an average 4.6 or higher. CONCLUSIONS: ARS significantly increased participation in OMR lectures; however, an increase in FES could not be associated with ARS by itself. Not taking into consideration which method was used to answer questions posed during lectures, higher participation correlated with higher scores. ARS is well-accepted and students believe that these devices positively influence their performance. Among the recognized advantages of ARS, anonymity was considered the least relevant.

Efetividade de diferentes medicações intracanais no combate ao enterococcus faecalis / Effectiveness of different intracanal medications in combating Enterococcus Faecalis

Introdução: a medicação intracanal deve ter excelente propriedade antimicrobiana e apresentar baixa toxicidade. O Enterococcus faecalis é um microrganismo resistente e raramente encontrado em infecções primárias, mas predominante em retratamentos endodônticos. Objetivo: discutir sobre a eficácia de várias medicações intracanais contra o E. faecalis baseado em uma revisão da literatura. Método: foram realizadas buscas em artigos científicos, através das plataformas de dados online, nacionais e internacionais (PUBMED/ MEDLINE, Google acadêmico, Scielo, Revodonto, LILACS, BBO e Portal CAPES). Conclusões: apesar do hidróxido de cálcio apresentar capacidade antimicrobiana satisfatória na infecção endodôntica, a associação de agentes antimicrobianos à pasta de hidróxido de cálcio ou a associação de diferentes antibióticos tem se mostrado mais eficaz no combate a microrganismos resistentes ao tratamento endodôntico, como o E.faecalis.

Introduction: intracanal medication should have excellent antimicrobial properties and low toxicity. Enterococcus faecalis is a microorganism resistant and rarely found in primary infections, but predominant in endodontic retreatments. Objective: to review the literature on the efficacy of various intracanal medications against E. faecalis. Method: for this paper, searches were carried out in scientific articles, through the national and international online data platforms such as PUBMED / MEDLINE, Google academic, Scielo, Revodonto, LILACS, BBO and Portal CAPES. Conclusions: Although calcium hydroxide has a satisfactory antimicrobial capacity in endodontic infection, the association of antimicrobial agents with calcium hydroxide paste or the combination of different antibiotics has been shown to be more effective in the control of endodontic treatment resistant microorganisms, such as E. faecalis

Comparison of two methods of irrigant agitation in the removal of residual filling material in retreatment.

The aim of this study was to compare the efficacy of passive ultrasonic irrigation and EasyClean for removing residual filling material in retreatment. Twenty-two maxillary lateral incisors with apical curvature were instrumented with ProTaper files and filled with Endofill using the lateral compactation technique. Removal of filling material was performed with Reciproc, Mtwo and ProDesign Logic 50/.01 files. The teeth were inserted in a silicone mould, which was placed in a metal muffle, and split to visualize the residual filling material. The samples were divided into two groups (n = 11) according to the irrigation protocol: Passive ultrasonic irrigation (PUI group) with 3 activations of 20 seconds and EasyClean (Easy Equipamentos Odontológicos, Belo Horizonte, Brazil) (EC group) used in continuous rotation with 3 activations of 20 seconds, both using NaOCl and EDTA. Environmental scanning electron microscopic images of the apical, middle, and cervical thirds were taken before and after the irrigant activation. The Kappa test was used to determine interexaminer agreement. Statistical analysis was performed using Kruskal-Wallis, Mann-Whitney, and Wilcoxon tests (p < 0.05). PUI and EC improved the removal of remnant filling material in all root canal thirds (p < 0.05). PUI and EC presented similar performance in the final step of retreatment (p > 0.05). No significant difference was observed in the removal of filling material in the apical, middle, and cervical thirds in both groups (p > 0.05). EasyClean in continuous rotary motion is useful in retreatment and was shown to be as effective as ultrasonic activation in the removal of remnant filling material.

Evaluation of methods for removal of filling material in endodontic retreatment and assessment of antimicrobial action of solutions used in final irrigation / Avaliação de métodos de desobturação do canal radicular no retratamento endodôntico e avaliação da ação antimicrobiana de soluções utilizadas na irrigação final

When endodontic treatment fails, an alternative could be root canal retreatment. During this procedure, all filling material should be removed to allow a new root canal preparation and new obturation of the root canal system. Bacteria are the main cause of endodontic treatment failure, and persistent infection may be related to microorganism ability to penetrate into dentinal tubules. Therefore, this requires the use of irrigating solutions with antimicrobial action and low toxicity. The aim of this study was to evaluate the performance of instruments made of different alloys in root canal re-instrumentation during endodontic retreatment of lateral incisors with apical curvature, using computed microtomography and assessment of these samples by scanning electron microscopy after irrigant activation. Furthermore, the antimicrobial action of a root canal irrigant containing silver nanoparticles, 2% chlorhexidine and 2.5% sodium hypochlorite was evaluated against Enterococcus faecalis biofilm and dentin infected with this microorganism. Thirty extracted maxillary lateral incisors with apical curvature were selected. The teeth were instrumented, filled and divided into three different groups according to the protocol for removal of filling material: Group 1: re-instrumentation with Reciproc R25 instruments, Mtwo 40 and ProDesign Logic 50.01; Group 2: re-instrumentation with ProDesign R, ProDesign Logic 40 and ProDesign Logic 50.01; Group 3: re-instrumentation with Gates-Glidden drills and manual instruments K-file and Hedstroem files. For filling material removal analysis, the samples were scanned in a microtomograph device SkyScan 1174, for comparison of images taken before and after removing the root canal filling, and in each sample the volume was calculated at four levels (apical 1, apical 2, middle and cervical). These samples were split and analyzed by scanning electron microscopy to visualize filling material residues before and after irrigant activation with an ultrasonic device and with the EasyClean system used in continuous rotary motion. Statistical analyses were performed using Kruskal-Wallis, Friedman, Wilcoxon and Dunn tests. Furthermore, the minimum inhibitory concentration of an irrigating solution containing silver nanoparticles was determined against strains of Enterococcus faecalis, by using the microdilution method. Additionally, the antimicrobial activity of silver nanoparticle solution, 2% chlorhexidine and 2.5% sodium hypochlorite was tested against Enterococcus faecalis biofilm in vitro. For biofilm formation, bovine dentin blocks were placed in 24-well culture plates and Enterococcus faecalis biofilm was developed for 21 days. The dentin blocks were divided into 9 experimental groups of 5 blocks each, according to the irrigating solution used and the time in contact with the irrigant (5, 15 and 30 minutes). The samples were stained with Live/Dead reagent for analysis by confocal laser scanning microscopy (CLSM). Finally, the antimicrobial action of these solutions was tested after dentinal tubules were contaminated with Enterococcus faecalis. Dentin tubes were made from bovine incisors, taken to a centrifuge and infected with Enterococcus faecalis. The dentin tubes were treated with silver nanoparticle solution, 2% chlorhexidine and 2.5% sodium hypochlorite, and analyzed by CLSM to assess the antimicrobial activity of these solutions against bacteria in the dentinal tubules. The results showed that residues of filling material were found after root canal reinstrumentation in all groups. No significant difference was observed in removal of filling material between the reciprocating instruments Reciproc and ProDesign R and between rotary instruments Mtwo 40 and ProDesign Logic 40. The ProDesign Logic 50/.01 instrument significantly improved the removal of filling material compared with the use of Reciproc and ProDesign R instruments. The apical levels presented greater amount of remnant filling material compared with middle and cervical levels. After canal reinstrumentation, the passive ultrasonic irrigation and irrigant agitation with EasyClean significantly improved the removal of residual filling material in all root canal thirds. There was no significant difference between the performance of ultrasonics and EasyClean regarding the removal of residual filling material, as well no significant difference was observed in the removal of these residues when comparing apical, middle and cervical thirds. Regarding the action of the irrigating solutions against Enterococcus faecalis, the minimum inhibitory concentration of silver nanoparticle solution capable of eliminating this microorganism in broth and agar plates was 94 ppm. After the irrigation of Enterococcus faecalis biofilm, the silver nanoparticle solution was significantly less effective in killing bacteria compared with chlorhexidine when used for time of contact of 5 minutes. The sodium hypochlorite solution presented antimicrobial activity significantly higher compared with the silver nanoparticle solution and chlorhexidine. This solution also presented higher ability to dissolve biofilm in all times tested, whereas the silver nanoparticle solution presented higher ability to dissolve biofilm compared with chlorhexidine in times of 5 and 15 minutes. In infected intratubular dentin with Enterococcus faecalis, the sodium hypochlorite solution presented significant higher effectiveness than the silver nanoparticle solutions and chlorhexidine, especially in middle third and deep areas of the root canal. When comparing the antimicrobial activity of these solutions in biofilm and infected intratubular dentin, it was shown that when the silver nanoparticle solution was used for shorter periods of time, it was more effective in intratubular dentin compared with biofilm. On the other hand, with longer time of 30 minutes, the number of viable bacteria was higher in intratubular dentin than in biofilm, which was also observed when using the sodium hypochlorite solution in this time of action. It was concluded that to increase the rate of success in endodontic retreatment, the combination of the use of reciprocating and rotary instruments in the removal of filling material, the agitation of irrigants and the use of antimicrobial agents could be used in an attempt to eliminate bacteria that resisted to endodontic treatment. (AU)

Em casos de insucesso do tratamento endodôntico, uma alternativa seria o retratamento do canal radicular. Durante este procedimento deve haver remoção de todo o material obturador para que seja realizada novo preparo biomecânico e nova obturação do sistema de canais radiculares. Bactérias são o principal fator etiológico em casos de fracasso da terapia endodôntica, e esta infecção persistente pode estar relacionada à capacidade dos microganismos em penetrar nos túbulos dentinários. Por este motivo é necessário o uso de soluções na irrigação do canal radicular com ação antimicrobiana e com boa tolerância tecidual. O objetivo deste trabalho foi avaliar o desempenho dos instrumentos de diferentes ligas metálicas na desobturação do canal radicular durante o retratamento endodôntico de incisivos laterais superiores com curvatura apical, por meio da microtomografia computadorizada e análise destas amostras no microscópio eletrônico de varredura após a ativação de irrigantes. Posteriormente foi avaliada a capacidade antimicrobiana de um irrigante do canal radicular contendo nanopartículas de prata, clorexidina a 2% e hipoclorito de sódio a 2,5% frente ao biofilme de Enterococcus faecalis e à dentina contaminada com este mesmo microrganismo. Foram selecionados trinta incisivos laterais superiores humanos extraídos que apresentavam curvatura apical. Os dentes foram instrumentados, obturados e divididos em três diferentes grupos de acordo com o protocolo de remoção do material obturador do canal radicular: no Grupo 1: a desobturação foi realizada com os instrumentos Reciproc R25, Mtwo 40 e ProDesign Logic 50.01; no Grupo 2: foram utilizados os instrumentos ProDesign R, ProDesign Logic 40 e ProDesign Logic 50.01; e no Grupo 3: a desobturação foi realizada com brocas de Gates-Glidden e instrumentos manuais tipo K e Hedstroem. Para a análise da remoção do material obturador, as amostras foram escaneadas em micrótomogafo SkyScan 1174 para que fossem comparadas as imagens antes e após a desobturação do canal radicular, e em cada amostra este volume foi calculado nos quatro níveis (apical 1, 2, médio e cervical). Estas amostras posteriormente foram clivadas e analisadas no microscópio eletrônico de varredura, para a visualização de resíduos de material obturador antes e após a ativação de irrigantes com o ultrassom e com o sistema EasyClean utilizado em rotação contínua. Para a análise estatística dos resultados foram utilizados os testes de Kruskal-Wallis, Friedman, Wilcoxon e Dunn. Posteriormente, foi determinada a concentração inibitória mínima de uma solução irrigadora do canal contendo nanopartículas de prata frente a cepas de Enterococcus faecalis, através do método de diluição em caldo. Em seguida, foi testada a atividade antimicrobiana das soluções de nanopartículas de prata, da clorexidina a 2% e do hipoclorito de sódio a 2,5% sobre o biofilme de Enterococcus faecalis in vitro. Para isso, foram utilizados blocos de dentina bovina colocados em placas de 24 poços e biofilme de Enterococcus faecalis foi formado durante 21 dias. Os blocos de dentina foram divididos em 9 grupos experimentais com 5 blocos cada um, em função dos irrigantes avaliados e do tempo de exposição à solução irrigadora (5, 10 e 15 minutos). As amostras foram coradas com corante Live/Dead para posterior análise no microscópio confocal de varredura a laser (MCVL). Por fim, foi testada a atividade antimicrobiana destas soluções irrigadoras após a contaminação de túbulos dentinários com Enterococcus faecalis. Foram confeccionados tubos de dentina a partir de incisivos bovinos que foram levados à centrífuga e contaminados com Enterococcus faecalis. Os tubos de dentina receberam tratamento com a solução de nanopartículas de prata, com clorexidina a 2% e com hipoclorito de sódio a 2,5%, e foram analisados no MCVL para avaliar a atividade antimicrobiana das soluções sobre bactérias presentes nos túbulos dentinários. Os resultados demonstraram que resíduos de material obturador foram encontrados após a desobturação do canal em todos os grupos. Não houve diferença significante na remoção de material obturador entre os instrumentos reciprocantes Reciproc e ProDesign R e entre os instrumentos rotatórios Mtwo 40 e ProDesign Logic 40. O instrumento ProDesign Logic 50/.01 melhorou significantemente a remoção de material obturador comparado com o uso dos instrumentos Reciproc e ProDesign R. Os níveis apicais apresentaram uma maior quantidade de material obturador remanescente comparados com os níveis médio e cervical. Após a desobturação do canal radicular, a irrigação ultrassônica passiva e agitação dos irrigantes com o EasyClean melhoraram significantemente a remoção de resíduos de material obturador em todos os terços do canal radicular. Não houve diferença significante no desempenho do ultrassom e do EasyClean em relação à remoção de resíduos de material obturador, assim como não foi observada diferença significante na remoção destes resíduos quando comparados terços apical, médio e cervical. No que diz respeito à ação das soluções irrigadoras sobre o Enterococcus faecalis, a concentração inibitória mínima da solução de nanopartículas de prata capaz de eliminar este microrganimo em meio de cultura e ágar foi de 94 ppm. Após a irrigação no biofilme de Enterococcus faecalis, a solução de nanopartículas de prata foi significantemente menos efetiva em matar bactérias comparada com a clorexidina quando utilizadas pelo tempo de 5 minutos. A solução de hipoclorito de sódio apresentou atividade antimicrobiana significantemente maior comparada com as soluções de nanopartículas de prata e clorexidina. Essa solução ainda apresentou maior capacidade de dissolução do biofilme em todos os tempos testados, enquanto que a solução de nanopartículas de prata apresentou maior capacidade de dissolver o biofilme comparada à clorexidina nos tempos de 5 e 15 minutos. Na dentina intratubular infectada com Enterococcus faecalis, a solução de hipoclorito de sódio apresentou efetividade significantemente maior que as soluções de nanopartículas de prata e clorexidina, principalmente no terço médio e na região profunda do canal radicular. Quando comparada a atividade antimicrobiana destas soluções no biofilme e na dentina intratubular infectada, verificou-se que quando a solução de nanopartículas de prata foi utilizada por um tempo mais curto, foi mais efetiva na dentina intratubular comparada com o biofilme. De maneira contrária, com tempo maior de 30 minutos, o número e bactérias viáveis foi maior na dentina intratubular do que no biofilme, o que ocorreu também com a solução de hipoclorito de sódio neste tempo de ação. Conclui-se que para se aumentar a chance de sucesso em tratamentos retratamentos endodônticos, a combinação do uso de instrumentos reciprocantes e rotatórios na desobturação do canal, agitação de irrigantes e uso de agentes com capacidade antimicrobiana podem ser utilizados na tentativa de se eliminar bactérias resistente ao tratamento endodôntico. (AU)

Prevalence and morphometric analysis of three-rooted mandibular first molars in a Brazilian subpopulation.

OBJECTIVES:: To determine the prevalence of three-rooted mandibular molars in a Brazilian population using cone beam computed tomography (CBCT) and to analyze the anatomy of mandibular first molars with three roots through micro-CT. MATERIAL AND METHODS:: CBCT images of 116 patients were reviewed to determine the prevalence of three-rooted first mandibular molars in a Brazilian subpopulation. Furthermore, with the use of micro-CT, 55 extracted three-rooted mandibular first molars were scanned and reconstructed to assess root length, distance between canal orifices, apical diameter, Vertucci's classification, presence of apical delta, number of foramina and furcations, lateral and accessory canals. The distance between the orifice on the pulp chamber floor and the beginning of the curvature and the angle of canal curvature were analyzed in the distolingual root. Data were compared using the Kruskal-Wallis test (α=0.05). RESULTS:: The prevalence of three-rooted mandibular first molars was of 2.58%. Mesial roots showed complex distribution of the root canal system in comparison to the distal roots. The median of major diameters of mesiobuccal, mesiolingual and single mesial canals were: 0.34, 0.41 and 0.60 mm, respectively. The higher values of major diameters were found in the distobuccal canals (0.56 mm) and the lower diameters in the distolingual canals (0.29 mm). The lowest orifice distance was found between the mesial canals (MB-ML) and the highest distance between the distal root canals (DB-DL). Almost all distal roots had one root canal and one apical foramen with few accessory canals. CONCLUSIONS:: Distolingual root generally has short length, severe curvature and a single root canal with low apical diameter.

Prevalence and morphometric analysis of three-rooted mandibular first molars in a Brazilian subpopulation

ABSTRACT The knowledge of the internal anatomy of three-rooted mandibular molars may help clinicians to diagnose and plan the root canal treatment in order to provide adequate therapy when this variation is present. Objectives: To determine the prevalence of three-rooted mandibular molars in a Brazilian population using cone beam computed tomography (CBCT) and to analyze the anatomy of mandibular first molars with three roots through micro-CT. Material and Methods: CBCT images of 116 patients were reviewed to determine the prevalence of three-rooted first mandibular molars in a Brazilian subpopulation. Furthermore, with the use of micro-CT, 55 extracted three-rooted mandibular first molars were scanned and reconstructed to assess root length, distance between canal orifices, apical diameter, Vertucci's classification, presence of apical delta, number of foramina and furcations, lateral and accessory canals. The distance between the orifice on the pulp chamber floor and the beginning of the curvature and the angle of canal curvature were analyzed in the distolingual root. Data were compared using the Kruskal-Wallis test (α=0.05). Results: The prevalence of three-rooted mandibular first molars was of 2.58%. Mesial roots showed complex distribution of the root canal system in comparison to the distal roots. The median of major diameters of mesiobuccal, mesiolingual and single mesial canals were: 0.34, 0.41 and 0.60 mm, respectively. The higher values of major diameters were found in the distobuccal canals (0.56 mm) and the lower diameters in the distolingual canals (0.29 mm). The lowest orifice distance was found between the mesial canals (MB-ML) and the highest distance between the distal root canals (DB-DL). Almost all distal roots had one root canal and one apical foramen with few accessory canals. Conclusions: Distolingual root generally has short length, severe curvature and a single root canal with low apical diameter.

Efficacy of CM-Wire, M-Wire, and Nickel-Titanium Instruments for Removing Filling Material from Curved Root Canals: A Micro-Computed Tomography Study.

INTRODUCTION: The aim of this ex vivo study was to evaluate the removal of filling material after using CM-wire, M-wire, and nickel-titanium instruments in both reciprocating and rotary motions in curved canals. METHODS: Thirty maxillary lateral incisors were divided into 9 groups according to retreatment procedures: Reciproc R25 followed by Mtwo 40/.04 and ProDesign Logic 50/.01 files; ProDesign R 25/.06 followed by ProDesign Logic 40/.05 and ProDesign Logic 50/.01 files; and Gates-Glidden drills, Hedström files, and K-files up to apical size 30 followed by K-file 40 and K-file 50 up to the working length. Micro-computed tomography scans were performed before and after each reinstrumentation procedure to evaluate root canal filling removal. Statistical analysis was performed with Kruskal-Wallis, Friedman, and Wilcoxon tests (P < .05). RESULTS: No significant differences in filling material removal were found in the 3 groups of teeth. The use of Mtwo and ProDesign Logic 40/.05 rotary files did not enhance filling material removal after the use of reciprocating files. The use of ProDesign Logic 50/.01 files significantly reduced the amount of filling material at the apical levels compared with the use of reciprocating files. CONCLUSIONS: Association of reciprocating and rotary files was capable of removing a large amount of filling material in the retreatment of curved canals, irrespective of the type of alloy of the instruments. The use of a ProDesign Logic 50/.01 file for apical preparation significantly reduced the amount of remnant material in the apical portion when compared with reciprocating instruments.

Avaliação do EDTA, vinagre de maçã e SmearClear, com e sem ativação ultrassônica, na remoção da smear layer em diferentes níveis do canal radicular / Evaluation of EDTA, apple vinegar and SmearClear with and without ultrasonic activation on smear layer removal in different root canal levels

Avaliar, in vitro, a eficácia do EDTA, do vinagre de maçã e do SmearClear, com e sem ativação ultrassônica, na remoção da smear layer. Métodos: setenta caninos extraídos foram aleatoriamente divididos em oito grupos e preparados utilizando-se instrumentos ProTaper. O protocolo de irrigação final utilizado foi: Grupo 1 (controle) (SF) e Grupo 2 (controle) (SFUS) – soro fisiológico por 3 minutos, sem e com ultrassom, respectivamente; Grupo 3 (EDTA) e Grupo 4 (EDTAUS) – EDTA a 17% por 3 minutos, sem e com ultrassom, respectivamente; Grupo 5 (VM) e Grupo 6 (VMUS) – vinagre de maçã por 3 minutos, sem e com ultrassom, respectivamente; Grupo 7 (SC) e Grupo 8 (SCUS) – SmearClear por 1 minuto, sem e com ultrassom, respectivamente. Os espécimes foram examinados por meio de microscópio eletrônico de varredura e foram atribuídos escores para a remoção da smear layer nos terços cervical, médio e apical. Resultados: a remoção de smear layer foi mais eficiente quando o EDTA a 17% e o SmearClear foram utilizados. O ultrassom não promoveu uma maior remoção de smear layer que fosse estatisticamente significativa em todos os grupos. Os piores resultados foram observados no terço apical do canal radicular, com diferença estatisticamente significativa entre o terço cervical em todos os irrigantes utilizados.

Filling of simulated lateral canals using different obturation techniques: analysis through IDA digital radiograph system

Introduction: Lateral canals are part of the rootcanal system and may be relatedto periodontal-endodontic diseases. The filling techniques that employ thermoplasticized gutta-percha have demonstrated better results in filling lateral canals. Objective: The aim of this study was to evaluate, through digital radiographs, three techniques of root canal obturation (Lateral Condensation, Obtura II System, Tagger’s Hybrid) regarding to the ability of filling artificial lateral canals. Material and methods: 30 extracted human lower premolars were used in this study. The crowns were removed and artificial laterals canals were prepared on the coronal, medium and apical thirds of the roots by using a reamer made of a K 10 file. The root canals were instrumented and obturated by the following techniques: Lateral Condensation, Obtura II System, and Tagger’s Hybrid. The teeth were radiographed with IDA digital radiograph system and the filling of the lateral canals was evaluated by scores for further statistical analysis. Results: No significant difference was found in the filling of lateral canals between Lateral Condensation and Obtura II, but a significant difference was found among these two and Tagger’s Hybrid technique. Conclusion: Tagger’s Hybrid technique promoted the highest numbers of obturated lateral canals. In the three groups, the root thirds presenting greater number of filled lateral canals were coronal and middle, regardless of the obturation technique employed.

Effect of different radiopacifying agents on the physicochemical properties of white Portland cement and white mineral trioxide aggregate.

INTRODUCTION: The aim of this study was to evaluate the pH, calcium ion release, setting time, and solubility of white mineral trioxide aggregate (WMTA) and white Portland cement (WPC) combined with the following radiopacifying agents: bismuth oxide (BO), calcium tungstate (CT), and zirconium oxide (ZO). METHODS: Fifty acrylic teeth with root-end filling material were immersed in ultrapure water for measurement of pH and calcium release (atomic absorption spectrophotometry) at 3, 24, 72, and 168 hours. For evaluation of setting time, each material was analyzed according to the American Society for Testing and Materials guidelines 266/08. The solubility test was performed according to American National Standards Institute/American Dental Association specification no. 57/2000. Solubility, setting time, and pH values were compared by using analysis of variance and Tukey test, and the values of calcium release were compared by the Kruskal-Wallis and Miller tests. The significance level was set at 5%. RESULTS: The pH and calcium release were higher at 3 and 24 hours. WPC was the material with the higher values for both properties. WMTA had the greatest solubility among all materials (P < .05). All radiopacifiers increased the setting time of WPC, and WMTA had the shortest setting time among all materials (P < .05). CONCLUSIONS: All materials released calcium ions. Except for WPC/CT at 168 hours, all materials promoted an alkaline pH. On the basis of the obtained results, ZO and CT can be considered as potential radiopacifying agents to be used in combination with Portland cement.

Avaliação das soluções irrigadoras da "smear layer" nos diversos níveis do conduto radicular com e sem o uso do ultra-som: estudo em microscopia eletrônica de varredura / Evaluation of irrigating solutions on smear layer removal at different levels of root canal with and without ultrasonics: a scanning electron microscopic study

Este estudo teve como objetivo avaliar a capacidade de remoção da smear layer das paredes de canais radiculares instrumentados pelas soluções de soro fisiológico, EDTA a 17%, vinagre de maçã e SmearClear®, nos três níveis radiculares, associadas ou não ao ultra-som. Para tal propósito, foram utilizados 70 dentes caninos humanos superiores e inferiores extraídos os quais tiveram suas coroas removidas. O comprimento de trabalho foi determinado pela visualização da ponta de uma lima tipo K com diâmetro 10 no forame apical, subtraindo-se 1 milímetro dessa medida. Para o preparo biomecânico, instrumentou-se os dentes com o sistema rotatório ProTaper®, pela técnica coroa-ápice, até o instrumento F5, irrigando os canais com hipoclorito de sódio a 2,5% a cada troca de instrumento. Os dentes foram divididos aleatoriamente em 6 grupos de 10 dentes e 2 grupos controle de 5 dentes de acordo com o método de irrigação final a serem testados: Grupo 1 (controle) Soro fisiológico por 3 minutos sem ultra-som; Grupo 2 - (controle) Soro fisiológico por 3 minutos, sendo o primeiro minuto ativado pelo ultra-som; Grupo 3 - EDTA a 17% por 3 minutos sem ultra-som; Grupo 4 - EDTA a 17% por 3 minutos, sendo o primeiro minuto ativado pelo ultra-som; Grupo 5 - Vinagre de maçã por 3 minutos sem ultra-som; Grupo 6 - Vinagre de maçã por 3 minutos, sendo o primeiro minuto ativado pelo ultra-som; Grupo 7 - SmearClear® por 1 minuto sem ultra-som; Grupo 8 - SmearClear® por 1 minuto ativado pelo ultra-som. Em seguida, os dentes foram irrigados com hipoclorito de sódio a 2,5% e soro fisiológico e secos com cones de papel absorvente. As raízes foram seccionadas longitudinalmente e preparadas para a microscopia eletrônica de varredura com o aumento de 750 vezes. Fotomicrografias foram obtidas dos terços cervical, médio e apical e analisadas por três examinadores para a atribuição de escores para posterior análise estatística. Concluiu-se que as soluções de EDTA e SmearClear® foram...

The aim of this study was to evaluate the smear layer removal from instrumented root canal walls by saline solution, 17% EDTA, apple vinegar and SmearClear®, at three radicular levels, with or without ultrasonics. For that purpose, 70 upper and lower human canines were used, which had their crowns removed. The working length was established by visualizing the tip of a 10 K-type file at the apical foramen, by reducing 1 mm from this measurement. For preparation of root canal, the teeth were instrumented with rotatory files ProTaper®, using the crown-down technique, up to F5 instrument, irrigating with 2,5% sodium hypochlorite between each instrument change. The teeth were randomly divided into 6 groups of 10 teeth each and 2 control groups of 5 teeth according to the final irrigation protocol: Group 1 (control) Saline solution for 3 minutes without ultrasonics; Group 2 (control) Saline solution for 3 minutes, with ultrasonic activation for the first minute; Group 3 17% EDTA for 3 minutes without ultrasonics; Group 4 17% EDTA for 3 minutes, with ultrasonic activation for the first minute; Group 5 Apple vinegar for 3 minutes without ultrasonics; Group 6 Apple vinegar for 3 minutes, with ultrasonic activation for the first minute; Group 7 - SmearClear® for 1 minute without ultrasonics; Group 8 - SmearClear® for 1 minute with ultrasonic activation. Subsequently, the teeth were irrigated with 2,5% sodium hypochlorite and dried with paper points. The teeth were split open longitudinally and prepared for scanning electron microscopy at magnification of 750X. Photomicrographs were taken from coronal, middle and apical thirds and analyzed by three examiners for scores attribution for statistical analysis. It was concluded that EDTA and SmearClear® were efficient for smear layer removal from root canals, with a discrete superiority of EDTA, however, without statistical significance. The saline solution showed significant inferior results compared with the others...