Análise de metodologias para avaliação da solubilidade do cimento à base de silicato de cálcio Bio-C Sealer / Analysis of methodologies for evaluating the solubility of calcium silicate-based sealer Bio-C Sealer

Introdução: Cimentos endodônticos à base de silicato de cálcio demonstram maior solubilidade em água destilada. Emprego de metodologias alternativas pode auxiliar em melhor compreensão sobre a solubilidade desses materiais. Objetivo: Avaliar o efeito da solução de imersão e do tipo de modelo experimental na solubilidade de cimento pronto para uso Bio-C Sealer. Material e método: Modelos circulares de polietileno ou dentina bovina (n = 16) foram confeccionados. Após inserção do cimento, os espécimes foram mantidos em estufa a 37 °C por 48 horas. Posteriormente, as amostras foram pesadas em balança de precisão para determinação da massa inicial. Na sequência, os espécimes foram imersos em 7,5 mL de água destilada (pH 6,5) ou PBS (pH 7,0) (n = 8) por 28 dias. Após isso, as amostras foram removidas das soluções e pesadas a cada 24 horas até a estabilização da massa final (0,001g). Corpos de prova confeccionados com Bio-C Sealer foram empregados como controle. A solubilidade foi avaliada de acordo com a diferença entre a massa inicial e final em porcentagem. Teste ANOVA Two-Way e teste post-hoc de Tukey foram realizados (α = 0,05). Resultado: Imersão em água destilada proporcionou maior solubilidade em comparação com PBS, independentemente do modelo experimental (p < 0,05). Corpos de prova apresentaram maior solubilidade, seguidos dos modelos de polietileno e dentina imersos em água destilada (p < 0,05). Não houve diferença entre os modelos experimentais imersos em PBS (p > 0,05). Conclusão: Bio-C Sealer apresenta solubilidade significativamente maior em água destilada do que em PBS em todas condições. Modelo experimental empregando dentina bovina e PBS como solução de imersão demonstra diminuir a perda de massa de Bio-C Sealer e pode ser uma alternativa valiosa para avaliar a solubilidade de cimentos biocerâmicos

Introduction: Calcium silicate-based sealers demonstrate greater solubility in distilled water. The use of alternative methodologies can help at better understanding the solubility of these materials. Objective: To evaluate the effect of the immersion solution and the type of experimental model on the solubility of readyto-use Bio-C Sealer. Material and method: Circular models of polyethylene or bovine dentin (n = 16) were made. After insertion of the sealer, the specimens were kept in an oven at 37°C and 95% humidity for 48h. Subsequently, the samples were weighed on a precision balance to determine the initial mass. Next, the specimens were immersed in 7.5 mL of distilled water (pH 6.5) or PBS (pH 7.0) (n = 8) for 28 days. After that, the samples were removed from the solutions and weighed every 24 hours until the final mass stabilized (0.001g). Test specimens made with Bio-C Sealer were used as a control. Solubility was evaluated according to the difference between the initial and final mass in percentage. Two-Way ANOVA test and Tukey post-hoc tests were performed (α=0.05). Result: Immersion in distilled water provided greater solubility compared to PBS regardless of the experimental model (p<0.05). The test specimens showed greater solubility, followed by polyethylene and dentin models immersed in distilled water (p<0.05). There was no difference between the experimental models immersed in PBS (p>0.05). Conclusion: Bio-C Sealer presents significantly greater solubility in distilled water than in PBS under all conditions. Experimental model using bovine dentin and PBS as an immersion solution demonstrates reduction in the mass loss of Bio-C Sealer and can be a valuable alternative for evaluating the solubility of bioceramic sealers

A new proposal for evaluating of the solubility of bioceramic materials in dentin tubes after immersion in PBS: a laboratory investigation / Nova proposta para avaliação da solubilidade de materiais biocerâmicos em tubos de dentina após imersão em PBS: um estudo laboratorial

Introdução: Materiais reparadores devem apresentar baixa solubilidade. Solução salina tamponada com fosfato (PBS) permite simular condição clínica e interação com dentina pode ser importante para correta avaliação da perda de massa de cimentos biocerâmicos. Objetivo: Avaliou o efeito da imersão em água destilada (AD) ou PBS na solubilidade de Bio-C Repair (BCR, Angelus) ou MTA Repair HP (MTAHP, Angelus) usando modelo de tubo de dentina. Material e método: Tubos de dentina bovina foram confeccionados com 4 mm de comprimento, 1,5 mm de diâmetro interno e 1 mm aproximadamente de espessura de parede. Os espécimes foram imersos em AD por 24h, posteriormente preenchidos com BCR ou MTAHP (n = 14) e armazenados em estufa a 37°C e umidade 95% por 24h. Após serem pesados em balança de precisão para determinação da massa inicial, os corpos de prova foram imersos em AD (pH 6,5) ou PBS (pH 7,0) (n = 7) por 28 dias. Tubos vazios também foram utilizados para o cálculo de perda de massa da dentina (n=4). Após esse período, os espécimes foram pesados até a estabilização da massa final (0,001g). A solubilidade de cada material foi avaliada. Testes estatísticos ANOVA e Tukey foram realizados (α=0,05). Resultado: BCR e MTAHP apresentaram ganho de massa em AD e perda de massa em PBS (p<0,05). Conclusão: A solução de imersão influencia a solubilidade de BCR e MTAHP usando modelo de tubo de dentina. Nova proposta metodológica poderá ser uma alternativa às normas ISO para testar a solubilidade de cimentos biocerâmicos

Introduction: Repair materials must have low solubility. Phosphate buffered saline (PBS) allows simulating clinical condition and interaction with dentin may be important for the correct evaluate of mass loss of bioceramic cements. Objective: To evaluate the effect of distilled water (DW), or PBS immersion on the solubility of Bio-C Repair (BCR, Angelus) or MTA Repair HP (MTAHP, Angelus) using a dentin tube model. Material and method: Bovine dentin tubes with a length of 4 mm, an internal diameter of 1.5 mm and walls thickness of approximately 1 mm were made. The specimens were immersed in DW for 24h, then filled with BCR or MTAHP (n = 14) and stored in an oven at 37°C and 95% humidity for 24h. After being weighed on a precision balance to determine the initial mass, the specimens were immersed in DW (pH 6.5) or PBS (pH 7.0) (n = 7) for 28 days. Empty tubes also were used for calculating the mass loss of the dentin (n=4). After this period, the specimens were weighed until stabilization of the final mass occurred (0.001g). The solubility of each material was evaluated. ANOVA and Tukey statistical tests were performed (α=0.05). Result: BCR and MTAHP showing gain of mass in DW and mass loss in PBS (p<0.05). Conclusion: The immersion solution influenced the solubility of BCR and MTAHP using dentin tube model. The new methodological proposal could be an alternative to ISO standards for testing the solubility of bioceramic cement

Tricalcium silicate-based cements: properties and modifications.

Mineral trioxide aggregate (MTA) has been widely used for different reparative procedures in endodontics. The extensive use of this cement for pulp capping, apexifications, apical surgeries, and revascularization is related to its ability to induce tissue repair and to stimulate mineralization. Several research studies have tested modifications in the composition of MTA-based cements in order to enhance their clinical performance. Novel formulations have been introduced in the market with the aim of increasing flowability. Important properties such as appropriate radiopacity and setting time, color stability, alkaline pH, release of calcium ions, and biocompatibility have to be considered in these new formulations. The latest research studies on the physical, chemical, and biological properties of tricalcium silicate-based cements are discussed in this critical review.

Micro-CT analysis of filling ability and porosity of root-end filling materials / Análise em micro-CT da capacidade de preenchimento e porosidade de materiais retrobturadores

Introduction: Filling ability of retrograde cavity and porosity are important properties for root-end filling materials and may be evaluated by using microcomputed tomography (micro-CT). Objective: To evaluate filling ability and porosity of root-end filling materials using microcomputed tomography (micro-CT). Material and method: Cavities with 1 mm internal diameter and 3 mm depth were prepared in bovine dentin sections by using ultrasonic tips (CVD No. 6.1107-6), and filled by Mineral Trioxide Aggregate (MTA); Sealer 26 (S26) and zinc oxide and eugenol cement (ZOE). Before and after filling, cavities were scanned by using micro-CT (SkyScan 1176). Filling and porosity were analyzed by using CTAn software. Filling ability was calculated based on volumetric percentage of the filled cavity. The number and percentage of closed pores were measured throughout entire extension of the filled cavity (total) and in each third (cervical, middle and apical), by using bi and tridimensional analyses. The filling data were submitted to ANOVA and Tukey statistical tests, and porosity data to Kruskall-Wallis and Dunn tests, at a 5% significance level. Result: S26 and ZOE presented higher filling ability than MTA (p<0.05). S26 showed the highest total porosity (number and percentage) (p<0.05). In all thirds after 2D and 3D analyses, porosity was higher for S26 in comparison to MTA and ZOE (p<0.05). Conclusion: Although Sealer 26 presented more porosity, the material was associated with a great filling ability. Micro-CT analysis showed no correlation between filling ability and porosity.

Introdução: Capacidade de preenchimento da cavidade retrógrada e porosidade são propriedades importantes de materiais retrobturadores e podem ser avaliadas por meio de microtomografia computadorizada (micro-CT). Objetivo: Avaliar a capacidade de preenchimento e porosidade de materiais retrobturadores por meio de micro-CT. Material e método: Cavidades com 1 mm de diâmetro e 3 mm de altura foram preparadas em dentina bovina utilizando pontas ultrassônicas (CVD No. 6.1107-6) e foram preenchidas com Mineral Trióxido Agregado (MTA), Sealer 26 (S26) e cimento de óxido de zinco e eugenol (OZE). As cavidades foram escaneadas em micro-CT antes e após o preenchimento. A capacidade de preenchimento foi calculada com base na porcentagem em volume, das cavidades preenchidas. O número e porcentagem dos poros fechados foram avaliados em toda extensão da cavidade preenchida (total) e por terços (cervical, médio e apical) por meio de análises bi e tridimensionais. Os dados de preenchimento foram submetidos aos testes estatísticos ANOVA e Tukey e a porosidade aos testes de Kruskall-Wallis e Dunn, com nível de significância de 5%. Resultado: S26 e OZE apresentaram maior capacidade de preenchimento que o MTA (p<0,05). S26 mostrou maior porosidade total (em número e porcentagem) (p<0,05). Em todos os terços, após as análises 2D e 3D, a porosidade foi maior para S26 em comparação ao MTA e OZE (p<0,05). Conclusão: Embora Sealer 26 tenha apresentado maior porosidade, o material foi associado a uma adequada capacidade de preenchimento. A análise em micro-CT mostrou ausência de correlação entre capacidade de preenchimento e porosidade.

Antibacterial activity of intracanal medications based on calcium hydroxide and zinc oxide micro- or nanoparticles: an ex vivo study / Atividade antibacteriana de medicações intracanal à base de hidróxido de cálcio e óxido de zinco micro- e nanoparticulado: estudo ex vivo

Introduction: Nanoparticles and associations to calcium hydroxide can be used to increase antimicrobial activity. Objective: To evaluate antibacterial activity against Enterococcus faecalis and pH of intracanal medications (IM) based on calcium hydroxide (CH) and zinc oxide (ZnO) micro- or nanoparticles, and their association with 0.4% chlorhexidine (CHX). Material and method: Root canals from single-rooted human teeth were inoculated and incubated for 21 days. After sample (S1), the root canals were filled with the medications for 7 days and samples were collected immediately after medication (S2) and 7 days later (S3). Counting of CFU mL-1 was performed. Polyethylene tubes filled with the medications were used for the pH evaluation after 3, 7, 14 and 28 days. Data were submitted to ANOVA and Tukey tests (p<0.05). Result: All IM promoted elimination of E. faecalis immediately after medication (S2). All the pastes promoted a similar pH increase. Conclusion: CH/ZnO micro- or nanoparticles associated with CHX promoted greater bacterial reduction in the root canals and similar pH.

Introdução: Nanopartículas e associações ao hidróxido de cálcio podem ser usados para aumentar a ação antimicrobiana. Objetivo: Avaliar a atividade antibacteriana sobre Enterococcus faecalis e o pH de medicações intracanal (MI) à base de hidróxido de cálcio (HC) e óxido de zinco (OZn) micro- e nanoparticulado, e suas associações com clorexidina (CHX) a 0,4%. Material e método: Canais radiculares de dentes humanos unirradiculados foram inoculados e incubados por 21 dias. Após coleta (C1), os canais radiculares foram preenchidos com os medicamentos durante 7 dias e as amostras foram coletadas imediatamente após a medicação (C2) e 7 dias depois (C3). Contagem de UFC mL-1 foi realizada. Os tubos de polietileno preenchidos com os medicamentos foram utilizados para a avaliação do pH após 3, 7, 14 e 28 dias. Os dados foram submetidos aos testes de ANOVA e Tukey (p<0,05). Resultado: Todas as MI promoveram eliminação de E. faecalis imediatamente após a medicação (C2). Todas as pastas promoveram similar aumento de pH. Conclusão: HC/OZn micro- ou nanoparticulado associado com CHX promove maior redução bacteriana nos canais radiculares e pH similar.

Radiographic evaluation of root canal cleaning, main and laterals, using different methods of final irrigation / Avaliação radiográfica da limpeza de canais radiculares, principal e laterais, utilizando diferentes métodos de irrigação final

Objective: To evaluate the efficacy of passive ultrasonic irrigation (PUI) using intermittent or continuous flushing and conventional manual irrigation (CMI) on the cleaning of main and simulated lateral root canals. Material and Method: The root canals of 24 artificial teeth were prepared and simulated lateral canals were made in the medium and apical thirds of the root. The specimens were divided into three groups: G1- CMI, G2- PUI 1 (intermittent flushing) and G3- PUI 2 (continuous flushing). Root canals were filled with contrast solution and the roots were radiographed pre- and post-irrigation. The digital images were transferred to Image Tool 3.0 software and the areas of root canal completely filled with contrast, and after irrigation with contrast remnant, were measured to obtain percentage data. Statistical analysis between groups was performed by ANOVA and Tukey tests. Result: In the apical third, G2 and G3 (PUI) groups showed higher percentage of cleaning than G1 (CMI) (p<0.05). Conclusion: Passive ultrasonic irrigation using intermittent flushing promoted a higher cleaning of simulated lateral canals than conventional manual irrigation in the apical third. There were no differences between groups in the main root canal and the middle third. .

Objetivo: O objetivo deste estudo foi avaliar a eficácia da irrigação ultrassônica passiva (IUP), utilizando os fluxos intermitente ou contínuo, e da irrigação manual convencional (IMC) na limpeza de canais radiculares, principal e laterais simulados. Material e Método: Os canais radiculares de 24 dentes artificiais foram preparados e os canais laterais foram confeccionados nos terços médio e apical. Os espécimes foram divididos em três grupos: G1- IMC, G2- IUP 1 (fluxo intermitente) e G3- IUP 2 (fluxo contínuo). Os canais radiculares foram preenchidos com uma solução de contraste e as raízes foram radiografadas antes e após a irrigação. As imagens digitais foram importadas para o programa Image Tool 3.0 e as áreas do canal totalmente preenchidas com o contraste, e após a irrigação, com remanescente do contraste, foram mensuradas para obtenção de dados percentuais. A análise estatística entre os grupos foi realizada por meio dos testes ANOVA e Tuckey. Resultado: No terço apical, os grupos G2 e G3 (IUP) mostraram melhor limpeza do que o grupo G1 (IMC) (p<0.05). Não houve diferenças estatisticamente significantes entre os grupos G2 e G3 (p>0.05). Conclusão: Irrigação ultrassônica passiva com fluxo intermitente promoveu melhor limpeza dos canais laterais simulados do que a irrigação manual convencional no terço apical do canal radicular. Não houve diferenças entre os grupos no canal principal e no terço médio. .

Influência do diâmetro foraminal do canal radicular, do tipo e da penetração de agulha, e do fluxo da solução irrigadora na limpeza e na extrusão apical / Influence of apical foramen diameter, design and penetration depth of the needle and irrigating solution flow rate on cleaning and apical extrusion

Introdução: A irrigação do canal radicular visa a limpeza e desinfecção do sistema de canais radiculares, sem promover extrusão apical. Objetivo: Avaliar a influência do diâmetro foraminal do canal radicular, da penetração e do tipo de agulha, e do fluxo na limpeza e na extrusão apical da solução irrigadora. Material e método: Doze dentes incisivos inferiores humanos com canal único foram instrumentados e, após ampliação foraminal com diferentes diâmetros (LK #40 e 60), os canais radiculares foram preenchidos com solução de contraste radiológico espessada com propilenoglicol e óxido de zinco. Foram utilizados dois tipos de agulhas de irrigação 27G com diferentes designs (abertura apical ou lateral), dois fluxos correspondentes a 15 ou 25 mL/min, e com penetração das agulhas em duas profundidades (3 e 6 mm aquém do ápice). Antes e após irrigação, os dentes foram radiografados utilizando um sistema radiográfico digital. As áreas do canal radicular antes (preenchido pelo contraste) e após irrigação (remanescente do contraste) foram submetidas à subtração de imagens no programa Adobe Photoshop CS4 e mensuradas por meio do programa Image Tool 3.0, obtendo o percentual de limpeza e de extrusão. Os dados foram analisados por meio dos testes ANOVA e Tukey, com nível de significância de 5%. Resultado: Não houve diferença estatística entre o diâmetro foraminal, o tipo e a profundidade de penetração da agulha, e a velocidade do fluxo de irrigação nos parâmetros limpeza (acima de 97%) e extrusão apical (menor do que 0,38 mm2), com p>0,05. Conclusão: Todos os protocolos de irrigação avaliados proporcionaram limpeza do canal radicular e pequena extrusão ...

Introduction: The root canal irrigation aims to clean and disinfect the root canal system, without causing apical extrusion. Objective: To evaluate the influence of apical foramen diameter, needle penetration depth and needle design, and the irrigating solution flow rate on the cleaning and apical extrusion. Material and method: Roots of human mandibular incisors with single-canal were instrumented and after enlarged with two different root apical sizes (40 and 60 K-files), the root canals were filled with contrast solution thickened with propylene glycol and zinc oxide. Two types of irrigation needles (27-gauge) with different designs (apical or lateral opening) were used, two flow rates corresponding to 15 or 25 mL/min and needle penetration at two depths (3 and 6 mm from the apex). Before and after irrigation, the teeth were radiographed using a digital radiographic system. Pre-irrigation (canals filled with contrast) and post-irrigation (canals with remaining contrast) images were submitted to digital subtraction using the Adobe Photoshop CS4 software and the areas were measured using the Image Tool 3.0 software, obtaining the percentage of cleaning and extrusion. Data obtained were subjected to one-way ANOVA and Tukey's tests with the significance level of 5%. Result: There was no statistical difference between the apical foramen diameter, needle penetration depth and needle design, and the irrigating solution flow rate on the cleaning results (more than 97%) and the level of apical extrusion (less than 0.38 mm2), (p>0,05). Conclusion: All irrigation protocols evaluated provided cleaning of the root canal and low apical extrusion of irrigating solution. .

Ex-vivo effect of intracanal medications based on ozone and calcium hydroxide in root canals contaminated with Enterococcus faecalis.

This ex vivo study evaluated the antibacterial effect of intracanal medications in root canals contaminated with Enterococcus faecalis. Fifty single-rooted human teeth were contaminated with E. faecalis (ATCC 29212) and incubated at 37°C for 21 days. The specimens were randomly divided into 5 groups according to the intracanal medication used: OZ-PG: ozonized propylene glycol; CH/CPMC: calcium hydroxide/camphorated paramonochlorophenol; OZ-PG/CH ozonized PG/CH; PC: positive control group (no medication); and NC: negative control group (no contamination). The samples were collected after 7 days (post-medication) and 14 days (final). Bacterial growth was checked by counting the colony-forming units (CFU). OZ-PG and CH/CPMC reduced significantly the CFU counts compared with PC in the post-medication and final samples, with no statistically significant differences among them. On the other hand, OZ-PG/CH did not reduce significantly the number of bacteria compared with PC. In conclusion, among the evaluated medications OZ-PG and CH/CPMC were the most effective against E. faecalis.

Ex-vivo Effect of Intracanal Medications Based on Ozone and Calcium Hydroxide in Root Canals Contaminated with Enterococcus faecalis

This ex vivo study evaluated the antibacterial effect of intracanal medications in root canals contaminated with Enterococcus faecalis. Fifty single-rooted human teeth were contaminated with E. faecalis (ATCC 29212) and incubated at 37°C for 21 days. The specimens were randomly divided into 5 groups according to the intracanal medication used: OZ-PG: ozonized propylene glycol; CH/CPMC: calcium hydroxide/camphorated paramonochlorophenol; OZ-PG/CH ozonized PG/CH; PC: positive control group (no medication); and NC: negative control group (no contamination). The samples were collected after 7 days (post-medication) and 14 days (final). Bacterial growth was checked by counting the colony-forming units (CFU). OZ-PG and CH/CPMC reduced significantly the CFU counts compared with PC in the post-medication and final samples, with no statistically significant differences among them. On the other hand, OZ-PG/CH did not reduce significantly the number of bacteria compared with PC. In conclusion, among the evaluated medications OZ-PG and CH/CPMC were the most effective against E. faecalis.

Resumo Este estudo ex vivo avaliou o efeito antibacteriano de medicações intracanal em canais radiculares contaminados com Enterococcus faecalis. Cinquenta dentes humanos unirradiculares foram contaminados com E. faecalis (ATCC 29212) e incubados a 37°C durante 21 dias. Os espécimes foram aleatoriamente divididos em diferentes grupos de acordo com a medicação intracanal utilizada: PG-OZ: propilenoglicol ozonizado; HC/PMCC: hidróxido de cálcio/paramonoclorofenol canforado; PG-OZ/CH; CP: controle positivo (sem medicação); e CN: controle negativo (sem contaminação). As amostras foram coletadas após 7 dias (pós-medição) e 14 dias (final). O crescimento bacteriano foi verificado através da contagem das unidades formadoras de colônias (UFC). PG-OZ e HC/PMCC reduziram estatisticamente o número de bactérias quando comparados com o CP nas amostras pós-medição e final, sem diferenças estatísticas entre si. Por outro lado, PG-OZ/HC não reduziu significativamente o número de bactérias em comparação com o CP. Em conclusão, entre as medicações avaliadas, PG-OZ e HC/PMCC foram as mais eficazes contra E. faecalis. .

Effectiveness of gutta-percha and Resilon in filling lateral root canals using thermomechanical technique / Eficácia da guta-percha e Resilon na obturação de canais laterais usando técnica termomecânica

Objetivo: O objetivo do estudo foi avaliar a efetividade da guta-percha e Resilon no preenchimento de canais laterais nos terços cervical, médio e apical radicular quando utilizada a técnica termomecânica. Material e Método: Canais radiculares de dentes artificiais foram preparados utilizando um método padrão. Canais laterais foram confeccionados utilizando broca com 0,3 mm de diâmetro nos três terços radiculares. Os canais radiculares foram obturados pela técnica híbrida de Tagger utilizando-se o compactador de McSpadden. Foi avaliado o preenchimento dos canais laterais pelos seguintes materiais: cones de guta-percha Dentsply, guta-percha Endopoint e Resilon. A avaliação foi realizada por meio da análise de radiografias digitalizadas usando o programa Image Tool. A porcentagem da área preenchida pela área total de cada canal lateral foi determinada. Os dados foram submetidos à análise de variância (ANOVA) e teste de Tukey com nível de significância de 5%. Resultado: O Resilon mostrou melhor efetividade como material de preenchimento. Na comparação entre os terços, o Resilon foi mais efetivo no terço apical que no cervical (p < 0,05). Conclusão: O Resilon foi o material mais efetivo para o preenchimento dos canais laterais quando utilizada a técnica termoplástica.

Objective: The aim of this study was to evaluate the effectiveness of gutta-percha and Resilon in filling lateral root canals in cervical, middle, and apical third using a thermomechanical technique. Material and Method: Root canals of artificial teeth were prepared using a standard preparation. The lateral canals were fabricated using a 0.3-mm-diameter bur at 3 parts of each root. By using Tagger's hybrid technique with a McSpadden thermomechanical compactor, the root canal was filled using the following filling materials: Dentsply gutta-percha, Endopoint gutta-percha, and Resilon cones. The root canal fillings were evaluated using digitized radiographs and the Image Tool software. The percentage of filled area of each lateral canal was determined. The data were subjected to analysis of variance (ANOVA) and Tukey tests at a 5% significance level. Result: Resilon showed better effectiveness as a filling material. When the three thirds were compared, Resilon was more effective in the apical third than in the cervical third (p < 0.05). Conclusion: Resilon is an effective filling material for lateral root canals using a thermomechanical technique.

Reparo periapical de dentes tratados endodonticamente submetidos à movimentação ortodôntica / Periapical repair of endodontically treated teeth submitted to orthodontic movement: a systematic review

A inter-relação Ortodontia e Endodontia vem sendo esclarecida com aevolução da Odontologia baseada em evidências científicas. Contudo,poucos estudos relacionam o reparo periapical de lesões com movimentaçãoortodôntica. Sendo assim, o objetivo deste estudo foi avaliar a evidênciacientífica disponível sobre o reparo periapical de dentes tratadosendodonticamente durante a movimentação ortodôntica. A estratégiausada foi a de busca eletrônica com palavras-chaves e critérios incluindoartigos publicados até julho de 2011. Foi também realizada avaliaçãoqualitativa da metodologia dos artigos. Embora um significativo númerode estudos reportarem o assunto, apenas dois artigos preencheram oscritérios para inclusão nesta revisão sistemática. Os resultados obtidosna literatura sugerem que o tratamento ortodôntico deve ser interrompidopara realização do tratamento endodôntico. Durante esta terapia,o emprego de curativo de demora à base de hidróxido de cálcio por nomínimo 14 dias e de cimento endodôntico com adequada propriedadebiológica estão indicados. Após esta fase, a movimentação ortodônticado dente tratado endodonticamente pode ser retomada sem necessidadede período de espera.

The relationship of Orthodontics and Endodontics is beingclarified with the development of evidence-based dentistry. However, fewstudies have reported the repair of periapicallesions with orthodontictreatment. Therefore, the aim of this study was to evaluate the availableevidence on periapical repair of endodontically treated teeth duringorthodontic movement. The strategy used was the electronic searchwith keywords and criteria including studies published up to July 2011. Itwas also carried out qualitative assessment of the articles methodology.Although a significant number of studies have reported this topic, onlytwo filled the criteria for inclusion in this systematic review. The resultsobtained in the literature suggest that orthodontic treatment should beinterrupted to perform endodontic treatment. During this therapy, theuse of root canal dressing based on calcium hydroxide for at least 14days, and sealer with adequate biological property are indicated. Afterthis phase, orthodontic movement of the endodontically treated teethcan be resumed without waiting period.

Adaptação marginal do agregado de trióxido mineral com e sem cloreto de cálcio em retrocavidades / Marginal adaptation of the Mineral Trioxide Aggregate with and without calcium chloride in root-end cavities

Objetivo: Avaliar a adaptação marginal do Agregado de Trióxido Mineral (MTA) com e sem cloreto de cálcio (CaCl2) em retrocavidades. Método: Vinte dentes unirradiculados foram instrumentados e obturados com gutapercha e AH-Plus. Os ápices das raízes foram cortados com uma broca Zekrya e preparos retrógrados foram realizados com pontas ultrassônicas. Réplicas em resina dos ápices preparados foram obtidas, metalizadas com ouro e examinadas em microscopia eletrônica de varredura (MEV). Os espécimes foram divididos em dois grupos experimentais (n = 10 dentes), de acordo com o material retrobturador empregado: G1 ­ MTA e G2 ­ MTA + CaCl2. Após as retrobturações, os dentes foram mantidos em ambiente úmido a 37 °C por 24 horas. Novas réplicas de resina foram obtidas e levadas ao MEV. A adaptação marginal dos cimentos foi classificada como: 1) margem contínua; 2) margem não contínua. Além disso, os percentuais de margem contínua foram calculados. Os resultados foram analisados pelo teste de Mann-Whitney. Resultados: Falhas de adaptação foram observadas em duas raízes no G1 e três raízes no G2. O percentual de margem contínua foi de 95,59% no grupo com MTA e 87,48% no grupo com MTA + CaCl2 . Não houve diferença estatística significativa entre os dois grupos (p > 0,05). Conclusão: A adição do cloreto de cálcio ao MTA não alterou a sua capacidade de adaptação marginal às paredes dentinárias das retrocavidades.

Objective: To evaluate the marginal adaptation of the Mineral Trioxide Aggregate (MTA) with and without calcium chloride (CaCl2) in root-end cavities. Method: Twenty extracted single-rooted teeth were instrumented and obturated with gutta-percha and AH Plus. All roots were resected using a Zekrya bur and root-end cavities were prepared by using ultrasonic retrotips. Epoxy resin replicas of root-end surfaces after root-end cavity preparation were obtained, sputter coated with gold, and examined by using a scanning electron microscope (SEM). The sampleswere divided into two experimental groups (n = 10 teeth) according to the root-end filling material employed: G1 - MTA; and G2 - MTA + CaCl2. After the root-end filling, the teeth were stored in moist gauze at 37 °C for24 hours. New replicas of the root-end surfaces were obtained and examined under a SEM. Marginal adaptation of the filling materials were categorized as: 1) continuous margin; 2) non-continuous margin. Besides, percentages of continuous margin were calculated. The results were analyzed by the Mann-Whitney test. Results: Visible gaps were seen in 2 roots in G1 and in 3 roots in G2. A continuous margin was observed with 95,59% of MTA and 87,48% of MTA + CaCl2 root-end fillings. There was not statistical difference between the two groups (p > 0.05).Conclusion: The addition of CaCl2 to MTA did not alter its marginal adaptation capability to the dentin walls of root-end cavities.

Capacidade de termoplastifcação da guta-percha com diferentes conicidades / Thermoplasticity capacity of gutta-percha with different tapers

Objetivo: O objetivo deste estudo foi avaliar a capacidade de termoplastificação da guta-percha com diferentes conicidades utilizadas na obturação de canais radiculares: Dentsply convencional (Dentsply Ind. e Com. Ltda., Petrópolis - RJ, Brasil), Dentsply 0,04, (Dentsply Ind. e Com. Ltda., Petrópolis-RJ, Brasil), Antaeos 0,04 (VDW GmbH, München, Alemanha), Protaper (Dentsply Ind. e Com. Ltda., Petrópolis-RJ, Brasil) e Alfa 0,06 (VDW GmbH, München, Alemanha). Material e método: Corpos de prova de cada material (n = 10) foram confeccionados após aquecimento. Depois de 24 horas, foram novamente aquecidos à temperatura de 70 °C e posicionados entre duas placas de vidro, sendo submetidos a uma compressão de 5 kg por 2 minutos. A imagem digitalizada dos grupos antes e depois da compressão foi analisada no software Image Tool (UTHSCSA Image Tool for Windows version 3.0, San Antonio, TX, USA). A capacidade de escoamento dos diferentes materiais foi determinada pela diferença entre as áreas inicial e final da cada espécime. Os resultados obtidos foram submetidos ao teste ANOVA e Tukey com nível de significância de 5%. Resultado: Dentre os materiais analisados, os cones de guta-percha Alfa 0,06 e Protaper apresentaram maior termoplastificação quando comparados aos demais (p < 0,05). O grupo Dentsply apresentou termoplasticidade intermediária, enquanto que os grupos Dentsply 0,04 e Antaeos 0,04 apresentaram menor termoplastificação após aquecimento (p > 0,05). Conclusão: Os cones de guta-percha apresentam diferentes propriedades de termoplastificação, sendo esta característica importante na seleção das técnicas de obturação termoplásticas.

Objective: The objective of this study was to evaluate the thermoplasticity of the gutta-percha cones used for root canal obturation: Dentsply convencional (Dentsply Ind. e Com., Petrópolis, RJ, Brazil), Dentsply 0.04, (Dentsply Ind. e Com., Petrópolis, RJ, Brazil), Antaeos 0.04 (VDW GmbH, Munich, Germany), ProTaper (Dentsply Ind. e Com., Petrópolis, RJ, Brazil) and Alfa 0.06 (VDW GmbH, Munich, Germany). Material and method: Specimens of each material (n = 10) were prepared after heating. After 24 hours were again heated to 70 °C and placed between two glass plates and subjected to a compression of 5 kg for 2 minutes. The scanned image of the groups before and after the compression was analyzed with the software Image Tool (UTHSCSA Image Tool for Windows version 3.0, San Antonio, TX, USA). The flow capacity of the different materials was determined by the difference between the initial and final area of each specimen. The results were submitted to ANOVA and Tukey test with significance level of 5%. Result: Among the material evaluated, the gutta-percha cones Alpha 0.06 and ProTaper presented more thermoplasticity than other groups (p < 0.05). The Dentsply gutta-percha presented thermoplasticity intermediate. The groups Dentsply 0.04 and 0.04 showed lower thermoplasticity after heating (p > 0.05). Conclusion: The gutta-percha present different property of thermoplasticity, which is important to selection of thermoplastic obturation techniques.

Solvent capacity of different substances on gutta-percha and Resilon.

The aim of this study was to evaluate the effectiveness of 3 solvents (eucalyptol, orange oil, and xylol) on 2 types of gutta-percha (conventional and thermoplastic) and Resilon. Specimens (10 mm diameter x 1 mm thick; n=7 per condition) were prepared and maintained at 37 degrees C for 48 h. Each specimen was weighed on a precision scale every 24 h until its mass was stable, at which time the initial mass was determined. Specimens (n=7) were then immersed in the solvent solutions and, after 48 h at 37 degrees C, they were reweighed at 24- h intervals, until stabilization (final mass). The difference between the final and the initial mass determined the solvent capacity of each solvent. Data were subjected to analysis of variance and Tukey's test at 5% significance level. The results demonstrated that xylol was the most effective, especially on conventional gutta-percha and Resilon (p<0.05). Eucalyptol and orange oil were more effective on thermoplastic gutta-percha than the other materials (p<0.05). It was concluded that all evaluated substances presented solvent action, but xylol was the most effective on both gutta-percha or Resilon.

Solvent capacity of different substances on gutta-percha and Resilon

The aim of this study was to evaluate the effectiveness of 3 solvents (eucalyptol, orange oil, and xylol) on 2 types of gutta-percha (conventional and thermoplastic) and Resilon. Specimens (10 mm diameter x 1 mm thick; n=7 per condition) were prepared and maintained at 37ºC for 48 h. Each specimen was weighed on a precision scale every 24 h until its mass was stable, at which time the initial mass was determined. Specimens (n=7) were then immersed in the solvent solutions and, after 48 h at 37ºC, they were reweighed at 24- h intervals, until stabilization (final mass). The difference between the final and the initial mass determined the solvent capacity of each solvent. Data were subjected to analysis of variance and Tukey's test at 5 percent significance level. The results demonstrated that xylol was the most effective, especially on conventional gutta-percha and Resilon (p<0.05). Eucalyptol and orange oil were more effective on thermoplastic gutta-percha than the other materials (p<0.05). It was concluded that all evaluated substances presented solvent action, but xylol was the most effective on both gutta-percha or Resilon.

O objetivo deste estudo foi avaliar a efetividade de 3 solventes em 2 tipos de guta-percha e no Resilon. Os materiais avaliados foram: guta convencional (Endo points), guta termoplastificada (Endo points TP) e cones de Resilon (RE). Amostras circulares medindo 10 mm de diâmetro e 1 mm de espessura foram preparadas, sendo mantidas a 37°C por 48 h. Cada amostra, com o anel metálico, foi pesada em uma balança de precisão a cada 24 h até estabilização da massa, quando a massa inicial era determinada. As amostras (n=7) foram imersas, então, nas soluções solventes avaliadas (eucaliptol, óleo de laranja, e xilol). Após 48 h a 37ºC, as amostras foram pesadas outra vez a cada 24 h, até a estabilização (massa final). A diferença entre a massa final e inicial determinou a capacidade solvente de cada material. Os dados foram submetidos à análise de variância em nível de significância de 5 por cento e teste de Tukey. Os resultados demonstraram que o xylol foi mais eficaz solvente, especialmente na guta convencional e no Resilon (p<0,05). O eucaliptol e o óleo de laranja foram mais eficazes sobre a guta thermoplastificada em relação aos outros materiais obturadores (p<0,05). Conclui-se que todas as substâncias testadas apresentam ação solvente, contudo, o xilol foi o mais efetivo sobre a guta-percha ou Resilon.

Apical gaps after apicoectomy procedures performed on teeth filled with gutta-percha or ResilonTM

Aim: This ex vivo study compared, under scanning electron microscopy (SEM), the marginal adaptation ofroot canal obturation with either ResilonTM or gutta-percha cones following root-end resection. Methods:Thirty human single-rooted teeth with fully formed apices were collected and decoronated. The root canalswere instrumented up to a size 45 taper .04 and obturated with laterally condensed gutta-percha (Group 1;n=15) or ResilonTM (Group 2; n=15). AH Plus sealer was used in both groups. After 48-h storage in saline, theapical 3 mm of each root were resected with a water-cooled high-speed plain fissure #170L carbide bur.Epoxy resin replicas of the resected root ends were examined by SEM. The total area of apical gap in eachreplica was measured using UTHSCSA ImageTool software. Data were analyzed statistically by the Mann-Whitney U-test (á=5%). Results: The mean area of apical gap in groups 1 and 2 was 0.0042 mm2 and 0.0015mm2, respectively, with no statistically significant difference (P = 0.83). Conclusions: The type of materialdid not influence at the apical adaptation of root canal obturation after apicoectomy, and the misfit may berelated to anatomic factors.

Periapical repair after root canal filling with different root canal sealers.

The aim of this study was to evaluate periapical repair after root canal filling with different endodontic sealers. Sixty-four root canals from dog s teeth were filled, divided into 4 groups (n=16). Root canals were instrumented with K-type files and irrigated with 1% sodium hypochlorite solution. Root canals were filled in the same session by active lateral condensation of the cones and sealers: Intrafill, AH Plus, Roeko Seal and Resilon/Epiphany System. After 90 days, the animals were euthanized and the tissues to be evaluated were processed and stained with hematoxylin and eosin. For histopathological analysis, the following parameters were evaluated: inflammatory process, mineralized tissue resorption, and apical mineralized tissue deposition. Histopathological analysis demonstrated that Intrafill had less favorable results in terms of apical and periapical repair, compared to the other sealers (p<0.05). AH Plus, Roeko Seal, and Epiphany sealers had similar and satisfactory results (p>0.05). In conclusion, AH Plus and the materials Roeko Seal and Epiphany are good options for clinical use in Endodontics.

Periapical repair after root canal filling with different root canal sealers

The aim of this study was to evaluate periapical repair after root canal filling with different endodontic sealers. Sixty-four root canals from dog´s teeth were filled, divided into 4 groups (n=16). Root canals were instrumented with K-type files and irrigated with 1 percent sodium hypochlorite solution. Root canals were filled in the same session by active lateral condensation of the cones and sealers: Intrafill, AH Plus, Roeko Seal and Resilon/Epiphany System. After 90 days, the animals were euthanized and the tissues to be evaluated were processed and stained with hematoxylin and eosin. For histopathological analysis, the following parameters were evaluated: inflammatory process, mineralized tissue resorption, and apical mineralized tissue deposition. Histopathological analysis demonstrated that Intrafill had less favorable results in terms of apical and periapical repair, compared to the other sealers (p<0.05). AH Plus, Roeko Seal, and Epiphany sealers had similar and satisfactory results (p>0.05). In conclusion, AH Plus and the materials Roeko Seal and Epiphany are good options for clinical use in Endodontics.

O objetivo deste estudo foi avaliar o reparo periapical após obturação de canal radicular usando os cimentos Roeko Seal e Epiphany. Sessenta e quatro canais radiculares de dentes de cães foram obturados, divididos em 4 grupos (n=16). Os canais radiculares foram instrumentados com limas tipo K e irrigados com solução de hipoclorito de sódio a 1 por cento. Os canais radiculares foram obturados na mesma sessão usando condensação lateral ativa dos cones e os cimentos: Grupo I - Intra Fill; Grupo II - AH Plus; Grupo III - Roeko Seal e Grupo IV - Sistema Resilon/Epiphany. Após 90 dias, os animais foram mortos e os tecidos a serem avaliados foram processados e corados por hematoxilina e eosina. Para análise histopatológica, os seguintes parâmetros foram avaliados: processo inflamatório, reabsorção dos tecidos mineralizados e deposição de tecido mineralizado apical. A análise histopatológica demonstrou que o Intrafill teve resultados menos favoráveis em relação ao reparo apical e periapical comparado aos outros cimentos (p<0,05). AH Plus, Roeko Seal e Epiphany demonstraram resultados similares e satisfatórios (p>0,05). Conclui-se que o AH Plus e os materiais Roeko Seal e Epiphany são boas opções para uso clínico em endodontia.

Radiopacity evaluation of root-end filling materials by digitization of images.

The purpose of this study was to evaluate the radiopacity of 5 root-end filling materials (white MTA-Angelus, grey MTA-Angelus, IRM, Super EBA and Sealer 26). Five specimens (10 mm diameter X 1 mm thickness) were made from each material and radiographed next to an aluminum stepwedge varying in thickness from 2 to 16 mm. Radiographs were digitized and the radiopacity of the materials was compared to that of the aluminum stepwedge using VIXWIN 2000 software in millimeters of aluminum (mm Al). Data were analyzed statistically by ANOVA and Tukey's test at 5% significance level. Radiopacity values varied from 3 mm Al to 5.9 mm Al. Sealer 26 and IRM presented the highest radiopacity values (p<0.05), while white/grey MTA and Super EBA presented the lowest radiopacity values (p<0.05). The tested root-end filling materials presented different radiopacities, white/grey MTA and Super EBA being the least radiopaque materials.

Maximum inhibitory dilution of mouthwashes containing chlorhexidine and polyhexamethylene biguanide against salivary Staphylococcus aureus.

OBJECTIVE: The aim of the present study was to determine the in vitro maximum inhibitory dilution (MID) of two chlorhexidinebased oral mouthwashes (CHX): Noplak, Periogard, and one polyhexamethylene biguanide-based mouthwash (PHMB): Sanifill Premium against 28 field Staphylococcus aureus strains using the agar dilution method. MATERIALS AND METHODS: For each product, decimal dilutions ranging from 1/10 to 1/655,360 were prepared in distilled water and added to Mueller Hinton Agar culture medium. After homogenization, the culture medium was poured onto Petri dishes. Strains were inoculated using a Steers multipoint inoculator and dishes were incubated at 37 degrees C for 24 hours. For reading, MID was considered as the maximum dilution of the mouthwash still capable of inhibiting microbial growth. RESULTS: Sanifill Premium inhibited the growth of all strains at 1/40 dilution and of 1 strain at 1/80 dilution. Noplak inhibited the growth of 23 strains at 1/640 dilution and of all 28 strains at 1/320 dilution. Periogard showed inhibited growth of 7 strains at 1/640 dilution and of all 28 strains at 1/320 dilution. Data were submitted to Kruskal-Wallis statistical test, showing significant differences between the mouthwashes evaluated (p<0.05). No significant difference was found between Noplak and Periogard (p>0.05). Sanifill Premium was the least effective (p<0.05). CONCLUSION: It was concluded that CHX-based mouthwashes present better antimicrobial activity against S. Aureus than the PHMB-based mouthwash.