Influence of bioceramic sealers on dentinal tubule penetration and antimicrobial effectiveness: a systematic review and meta-analysis of in vitro studies.

The aim of this systematic review and meta-analysis (SRM) was to evaluate whether bioceramic sealers have better penetration capacity in dentinal tubules and antimicrobial activity when compared to AH Plus® sealer. This SRM was recorded in the Open Science Framework database and followed the guidelines of the PRISMA 2020. Five databases were searched by two independent reviewers. Only in vitro studies that evaluated the effects of bioceramic sealers on dentinal tubule penetration and antimicrobial activity outcomes compared to AH Plus® sealer were included. Meta-analysis was conducted using R software, using the effect measure of the standardized mean difference (SMD) and inverse variance method. A modified Joanna Briggs Institute's Checklist was used for the risk of bias assessment. A total of 1486 studies were identified, and only 54 studies that fulfilled our eligibility criteria were included in this review. There was no statistical difference between the sealers evaluated for dentinal tubule penetration, in the thirds evaluated: coronal SMD 0.58 [0.14; 1.31], p = 0.12; middle SMD 0.07 [0.54; 0.39], p = 0.75; and apical SMD 0.08 [0.73; 0.56], p = 0.80. Both sealers demonstrated similar antimicrobial action (SMD [3.42; 5.32], p = 0.67 and SMD 0.67 [1.89; 0.55], p = 0.28). The studies presented a low risk of bias. Based on the in vitro studies included and according to the limitations of the present review, the data suggest that bioceramic and AH Plus® sealers present similar penetration capacity in dentinal tubules and antimicrobial effect, making them suitable materials to be considered in clinical practice.

Postoperative pain after root canal filling with bioceramic sealers: a systematic review and meta-analysis of randomized clinical trials.

The aim of this systematic review and meta-analysis (SRM) was to assess postoperative pain (PP) after endodontic treatment with bioceramic root canal sealer compared to AH Plus® sealer. This SRM was carried out in accordance with the items on the PRISMA 2020 checklist and Cochrane guidelines and registered in PROSPERO (CRD42021259283). Only randomized clinical trials (RCTs) were included. Meta-analysis was conducted using R software, the standardized means difference (SMD) measure of effect was calculated for quantitative variables, and the odds ratio (OR) for binary variables. The Cochrane tool (RoB 2.0) was used to assess the risk of bias, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess the quality of evidence. Qualitative and quantitative analysis included 18 and 17 studies, respectively. For quantitative variables, the bioceramic root canal sealer presented less occurrence of postoperative pain than the AH Plus® sealer in 24 h (SMD - 0.17 [- 0.34; - 0.01], p = 0.0340). For binary variables, there was no difference observed between the sealers evaluated, except for sealer extrusion where the bioceramic group had lower post-filling material extrusion (OR 0.52 [0.32; 0.84], p = 0.007). Regarding the risk of bias analysis, low risk was observed for most domains, except allocation that was considered unclear, while the certainty of evidence ranged from moderate to low. The results showed that bioceramics sealers reduced postoperative endodontic pain only after 24 h and showed less sealer extrusion compared to the AH Plus® sealer. However, more robust and standardized clinical trials are needed to confirm the results with less heterogeneity and higher quality of evidence.

A new approach to endodontic access in anterior teeth: a pilot study / Uma nova abordagem para acesso endodôntico em dentes anteriores: estudo piloto

Introduction: The coronal opening is essential, during endodontic treatment, for direct access to the root canals. Usually, in the anterior teeth, endodontic access is achieved on the palatal/lingual surface, more specifically in the cingulum region. However, the lack of observation for dental positioning can lead to some accidents and complications, such as buccal perforations, causing esthetic damage and compromising the treatment. Objective: To evaluate the applicability of a new approach for performing coronal opening in anterior teeth, regarding the wear caused on the tooth crown, and to evaluate the ease of performing the new technique to minimize the risk of perforation. Material and method: Ten students (n=10) from the Improvement in Endodontics program participated in the present study. Twenty artificial teeth were used, which were upper, central incisors. Each participant performed two coronal openings. First, with no guidance (Group A - Conventional Technique) and afterward, a new opening, but with guidance with the spherical diamond tip placed parallel to the long axis of the tooth (Group B - Modified Technique). Result: The results showed that 90% of the participants considered the Modified Technique as having lower risk of accidents, as well as being easier for locating the pulp chamber. There was a statistical difference both in the measurement of the total area of wear and in the width, while there was no statistical difference in the height. Conclusion: Preliminary data collected with the survey were satisfactory for the Modified Technique. Statistically, it showed a favorable difference in relation to the area of wear and the width. However, in height there was no statistical difference.

Introdução: A abertura coronária é fundamental durante o tratamento endodôntico para um acesso direto aos canais radiculares. Em geral, em dentes anteriores, o acesso endodôntico é realizado na face palatina/lingual, mais especificamente em região de cíngulo. Entretanto, a falta de observação do posicionamento dentário pode levar a alguns acidentes e complicações, como as perfurações por vestibular, ocasionando dano estético e comprometendo o tratamento. Objetivo: Avaliar a aplicabilidade de uma nova abordagem de realização da abertura coronária em dentes anteriores, quanto ao desgaste ocasionado na coroa dentária, e avaliar a facilidade de execução da nova técnica para minimizar os riscos de perfurações. Material e método: Dez alunos (n=10) do curso de Aperfeiçoamento em Endodontia participaram do estudo. Foram utilizados vinte dentes artificiais, sendo eles incisivos centrais superiores. Cada participante realizou duas aberturas coronárias. Primeiramente sem nenhuma orientação (Grupo A - Técnica Convencional) e após, uma nova abertura, porém com orientação, com a ponta diamantada esférica posicionada paralelamente ao longo eixo do dente (Grupo B - Técnica Modificada). Resultado: Os resultados demonstraram que 90% dos participantes consideraram a Técnica Modificada como a de menor risco de acidentes e, ainda, de mais fácil localização da câmara pulpar. Houve diferença estatística tanto para a medida da área total de desgaste quanto para a largura, enquanto na altura não houve diferença estatística. Conclusão: Os dados preliminares coletados pelo questionário se mostraram satisfatórios para a Técnica Modificada. Estatisticamente, apresentou diferença favorável em relação à área de desgaste e largura, já em altura não houve diferença estatística.

Influência dos cimentos obturadores biocerâmicos versus o AH Plus® na dor pós-operatória, penetração em túbulos dentinários e atividade antimicrobiana: revisões sistemáticas e meta-análises / Influence of bioceramic root canal sealer versus AH Plus® on postoperative pain, penetration into dentinal tubules and antimicrobial activity: systematic reviews and meta-analyses

O objetivo desse estudo de revisões sistemáticas e meta-análises foi responder se os cimentos biocerâmicos resultam melhores efeitos para a dor pós operatória, capacidade em penetração em túbulos dentinários e atividade antimicrobiana em comparação ao cimento AH Plus®. Foram conduzidas duas revisões sistemáticas, orientadas pelas diretrizes PRISMA e foram registradas na PROSPERO (CRD4202125928) (Capítulo 1) e na Open Science Framework (OSF) Registries (https://doi.org/10.17605/OSF.IO/BX7VQ) (Capítulo 2). Uma pergunta foi feita com base na população, intervenção, comparação e resultado (PICO), Capítulo 1: "O uso dos cimentos biocerâmicos resulta em menos dor pós operatória em comparação ao uso do cimento AH Plus® em pacientes tratados endodonticamente?"; Capítulo 2: "Os cimentos obturadores biocerâmicos apresentam superioridade na penetração em túbulos dentinários e atividade antimicrobiana ao cimento obturador AH Plus®?". Foram definidas as estratégias de buscas e realizadas buscas nas bases de dados: PubMed, Scopus, Web of Science, Embase, Cochrane Library, e OpenGrey. O Capítulo 1 utilizou a escala Cochrane para avaliar o risco de viés e a ferramenta GRADE para avaliar a qualidade das evidências. Enquanto, o Capítulo 2 utilizou a escala The Joanna Briggs para avaliar o risco de viés de estudos in vitro. As metaanálises foram conduzidas usando o "Meta" package, version 3.6.3, a diferença média (MD) medida de efeito foi calculada para variáveis quantitativas e odds ratio (OR) (Capítulo 1) e diferenças de médias padronizadas (SMD) (Capítulo 2), com um intervalo de confiança (IC) de 95%. Os resultados do Capítulo 1, foram incluídos 13 artigos na revisão sistemática, 11 foram incluídos na meta-análise. Para as variáveis quantitativas, o cimento biocerâmico apresentou menor ocorrência de dor pós-operatória do que o cimento AH Plus® em 24h (MD - 0,4101 [-0,80; -0,02], p = 0,0386) e 48h (MD -0,31 [-0,59; -0,03], p = 0,0295). Para as variáveis binárias, não houve diferença observada entre os cimentos avaliados: 24h (OR 1,12 [0,69; 1,80] p = 0,6476), 48h (OR 1,56 [0,76; 3,20] p = 0,2267), 72h (OR 1,38 [0,55; 3,45] p = 0,4893) e 7 dias (OR 2,10 [0,55; 8,01], p = 0,2790). Em relação à análise de risco de viés, observou-se baixo risco para a maioria dos domínios, exceto alocação que foi considerada pouco clara, enquanto a certeza da evidência variou de moderada a baixa. Os resultados do Capítulo 2, foram um total de 54 estudos foram incluídos, e 16 estudos foram incluídos na meta-análise. De modo geral, os estudos apresentaram baixo risco de viés. Não foi observado diferença estatística entre os cimentos avaliados para penetração em túbulos dentinários, independentemente dos terços: coronal SMD 0.58 [0.14; 1.31], p = 0.12; médio SMD 0.07 [0.54; 0.39], p = 0.75; e apical: SMD 0.08 [0.73; 0.56], p = 0.80. Os cimentos biocerâmicos e AH Plus® demonstraram similar ação antimicrobiana SMD [3.42; 5.32], p = 0.67 e SMD 0.67 [1.89; 0.55], p = 0.2825. Dessa forma, conclui-se que os cimentos biocerâmicos apresentam menor dor pós operatória nas primeiras 24 e 48 horas, e apresentam respostas similares para penetração em túbulos dentinários e atividade antimicrobiana quando comparado ao cimento AH Plus®(AU)

The aim of this study of systematic reviews and meta-analyses was to answer whether bioceramic sealers have better effects on postoperative pain, ability to penetrate dentinal tubules and antimicrobial activity compared to AH Plus® sealer. Two systematic reviews, guided by PRISMA guidelines, were conducted and registered in PROSPERO (CRD4202125928) (Chapter 1) and Open Science Framework (OSF) Registries (https://doi.org/10.17605/OSF.IO/BX7VQ) (Chapter 2). A question was asked based on population, intervention, comparison and outcome (PICO), Chapter 1: "Does the use of bioceramic sealers result in less postoperative pain compared to the use of AH Plus® sealer in endodontically treated patients?"; Chapter 2: "Do bioceramic filling sealers have superior penetration into dentinal tubules and antimicrobial activity compared to AH Plus® filling sealer?". Search strategies were defined and searches performed in the following databases: PubMed, Scopus, Web of Science, Embase, Cochrane Library, and OpenGrey. Chapter 1 used the Cochrane scale to assess the risk of bias and the GRADE tool to assess the quality of evidence. Meanwhile, Chapter 2 used The Joanna Briggs scale to assess the risk of bias from in vitro studies. Meta-analyses were conducted using the "Meta" package, version 3.6.3, the mean difference (MD) effect measure was calculated for quantitative variables and odds ratio (OR) (Chapter 1) and standardized mean differences (SMD) (Chapter 2), with a 95% confidence interval (CI). The results of Chapter 1 were included 13 articles in the systematic review, 11 were included in the meta-analysis. For quantitative variables, the bioceramic sealer had a lower occurrence of postoperative pain than the AH Plus® sealer in 24 hours (MD - 0.4101 [-0.80; - 0.02], p = 0.0386) and 48h (MD -0.31 [-0.59; -0.03], p = 0.0295). For the binary variables, there was no difference observed between the sealers evaluated: 24h (OR 1.12 [0.69; 1.80] p = 0.6476), 48h (OR 1.56 [0.76; 3.20] p = 0.2267), 72h (OR 1.38 [0.55; 3.45] p = 0.4893) and 7 days (OR 2.10 [0.55; 8.01], p = 0 .2790). Regarding the risk of bias analysis, a low risk was observed for most domains, except for allocation that was considered unclear, while the certainty of evidence ranged from moderate to low. The results of Chapter 2 were a total of 54 studies included, and 16 studies were included in the meta-analysis. Overall, the studies had a low risk of bias. There was no statistical difference between the sealers evaluated for penetration into dentinal tubules, regardless of the thirds: coronal SMD 0.58 [0.14; 1.31], p = 0.12; average SMD 0.07 [0.54; 0.39], p = 0.75; and apical: SMD 0.08 [0.73; 0.56], p = 0.80. Bioceramic sealers and AH Plus® demonstrated similar antimicrobial action to SMD [3.42; 5.32], p = 0.67 and SMD 0.67 [1.89; 0.55], p = 0.2825. Thus, it is concluded that bioceramic sealers have less postoperative pain in the first 24 and 48 hours, and have similar responses for penetration into dentinal tubules and antimicrobial activity when compared to AH Plus® sealer(AU)

Influence of two photodynamic therapy sessions and different photosensitizers on the bond strength of glass-fiber posts in different regions of intraradicular dentin.

BACKGROUND: Although photodynamic therapy associated with photosensitizers can promote microbial reduction, studies evaluating the consequences of two photodynamic therapy sessions associated with different photosensitizers on the bond strength of glass-fiber posts to endodontically treated intraradicular dentin are scarce. This in vitro study aimed to investigate the influence of two photodynamic therapy sessions using methylene blue or curcumin photosensitizers on the bond strength of glass-fiber posts to intraradicular dentin in different root thirds. METHODS: Seventy-two teeth were divided into 9 experimental groups according to photosensitizer type, concentration and light-activation: Control - deionized water; Methylene blue 50 mg/L; Methylene blue 50 mg/L + laser; Methylene blue 100 mg/L; Methylene blue 100 mg/L + laser; Curcumin 500 mg/L; Curcumin 500 mg/L + LED; Curcumin 1000 mg/L; and Curcumin 1000 mg/L + LED. Push-out bond strength of the fiber posts to endodontically treated dentin was evaluated using a universal test machine (n = 8). Bond strength data underwent Kruskal-Wallis test, followed by Dunn test for comparison between treatments, and Friedman test for comparison between thirds (α = 0.05). Illustrative scanning electron microscopy images were obtained to qualify the failure mode. RESULTS: Curcumin at higher concentration, activated or not by blue LED, decreased the bond strength values in the apical region when compared with the control group (P < 0.05). There was no difference between two photodynamic therapy sessions using methylene blue photosensitizer (activated or not) and the control group regardless of concentrations and root canal depth evaluated (P > 0.05). Regarding intraradicular depth, the different thirds showed no statistical difference on bond strength values (P > 0.05). All experimental groups presented predominance of mixed-type failure, excepting the methylene blue group at higher concentration activated by red laser, and the curcumin photosensitizer at both concentrations activated by blue LED. CONCLUSIONS: Methylene blue at a 50 mg/L concentration can be applied in two PDT sessions, after biomechanical preparation and before glass-fiber post luting, as it presents no influence on root dentin bond strength in in vitro conditions.