In vitro analysis of microbial contamination of paper points

Introduction: During endodontic treatment, the maintennance of the aseptic chain is mandatory. Therefore, all substances, instruments, and medications inserted into root canals must be free of microorganisms. Objective: To evaluate in vitro and microbiologically the contamination of absorbent paper points. Material and methods: Absorbent paper points of different brands and under different conditions were evaluated and subdivided into the following groups: esterilized by the manufacturer (G1 to G5), not esterilized by the manufacturer (G6), esterilized in autoclave by the operator (G7), and intentionally contaminated (G8). The two last groups were the positive and negative controls, respectively. All paper points were unpacked and immersed into tubes with culture medium for 48 hours and then analyzed according to culture broth turbidity. Results: Only the samples esterilized by the manufacturers Dentsply® (G1), Endopoints® (G2), and Meta® (G3), and the samples esterilized in autoclave by the operator (G7) did not evidence microbial growth after 48 hours. Although sterilized by the manufacturer, both the brands Tanari® (G4) and Roeko® (G5) showed bacterial contamination; Dentsply® (G6) non-sterile paper points also showed bacterial contamination. Conclusion: Paper point esterilization before clinical use should be recommended regardless of the commercial brand.

Influência do limite e do calibre apical após a instrumentação mecanizada com instrumentos reciprocantes na extrusão bacteriana apical / Influence of limit and apical caliber after mechanical instrumentation with reciprocating instruments in bacterial extrusion

O objetivo deste estudo foi avaliar ex vivo a extrusão bacteriana apical após instrumentação com um sistema de instrumento único reciprocante e verificar a influência de diferentes limites e diâmetros apicais nesta. Sessenta e quatro raízes de pré-molares foram utilizadas. Os dentes foram acessados e seus canais radiculares foram contaminados com uma suspensão de Enterococcus faecalis e incubados por 30 dias possibilitando crescimento bacteriano em biofilme. Os dentes contaminados foram divididos em quatro grupos com 15 espécimes cada. O calibre dos instrumentos utilizados e comprimento de trabalho de cada grupo foram respectivamente R25 à 0mm do forame, R25 aquém 1mm, R40 a 0mm e R40 aquém 1mm. Foram feitos grupos controle de crescimento bacteriano positivo e negativo. As bactérias extruídas apicalmente durante a instrumentação foram coletadas em frascos de vidro contendo 0,9% de NaCl. As amostras microbiológicas foram retiradas destes frascos e incubadas em meio BHI ágar, durante 24 horas. O crescimento bacteriano foi contado e os resultados foram expressos em unidades formadoras de colônia (UFC). Os dados foram analisados pelo teste estatístico de Kruskal-Wallis. Não houve diferença estatisticamente significante no número de UFC entre os quatro grupos (p>0,05). A partir da análise dos resultados e dentro das limitações deste estudo foi possível concluir que independente do comprimento de trabalho e da ampliação foraminal haverá similar quantidade de extrusão bacteriana.

The aim of this work was to evaluate ex vivo the apical bacterial extrusion after instrumentation with a single instrument reciprocating system and the influence of differents working lengths and apical diameters on it. Sixty-four premolar roots were used. Endodontic access cavities were prepared and root canals were contaminated with an Enterococcus faecalis suspension and incubated for thirty days to promote bacterial biofilm growth. The contaminated teeth were divided into four groups with 15 specimens each. The files used and lengths from each group were respectively R25 at 0mm from foramen, R25 1mm shorter, R40 at 0mm from foramen and R40 1mm shorter. Positive and negative bacterial growth control groups were done. Bacterial extruded from the apical foramen during instrumentation were collected into vials containing 0.9% NaCl. The microbiological samples were taken from the vials and incubated in BHI agar medium during 24h. Bacterial growth was counted and the results were given by colony-forming units (CFU). These data were analyzed by Kruskal–Wallis H-test. After data analysis, no significant difference was found in the number of CFU among the four groups (p > 0.05). Based on the results evaluation and within the limitation of this study, it was possible to conclude that regardless of the working length and foraminal enlargement will be similar amount of bacterial extrusion.

Avaliação ex vivo da precisão de um localizador apical antes e após o pré-alargamento das paredes dos canais sob a influência de diferentes substâncias irrigadoras / Evaluation ex vivo precision of an apex locator before and after pre-flaring of the root canals under the influence of different irrigants

O objetivo desse trabalho foi avaliar, ex vivo, a influência do peróxido de hidrogênio (H 2 O 2 ) a 3,0% e do hipoclorito de sódio (NaOCl) a 2,5% e 5,25% na precisão das medidas obtidas por um localizador apical eletrônico antes e após o pré-alargamento. Foram utilizadas 25 raízes mesiais de primeiros molares inferiores, totalizando 50 canais radiculares, que tiveram as coroas cortadas na junção amelocementária. A medida real de cada canal foi realizada e, em seguida, as amostras foram incluídas em uma mistura de alginato, usada como meio condutor, onde foram realizadas as medições eletrônicas com o localizador apical auxiliadas com o uso das três soluções irrigadoras antes e após o desgaste do terço médio e cervical dos canais com brocas Gates-Glidden. As medidas obtidas pelo método eletrônico foram então comparadas com a medida real dos canais. Os resultados obtidos foram tabulados e submetidos ao teste estatístico t de Student. Os resultados revelaram que não houve significância estatística (p>0,05) entre as leituras obtidas antes e após o desgaste dos terços cervical e médio dos canais com uso de NaOCl 2,5 e 5,25%, com resultados demonstrando, em média, leituras mais próximas do comprimento real do canal no grupo sem pré-alargamento. Porém, observamos diferença estatística com uso de H 2 O 2 (p<0,05) entre as leituras obtidas tanto antes quanto após o desgaste dos dois terços iniciais do canal. Desta forma, conclui-se que o preparo médio-cervical com brocas Gates Glidden não foi capaz de interferir significativamente na precisão do localizador apical testado

The aim of this paper was to evaluate the influence of 3% hydrogen peroxide (H 2 O 2 ) and 2.5% and 5.25% sodium hypochlorite (NaOCl) measured by a root apex locator before and after the pre-flaring of the root canal. The mesial root of twenty five mandibular first molars, total of 50 root canals, was tested with the crown cut off from the enamel-cementum junction. The real measure of each root was defined and after that the samples were stored in a mix of alginate, used as a conductor. The measures were done with a root apex locator using three different irrigation solutions before and after the instrumentation of the medium and cervical parts of the roots by means of Gates-Glidden drills. The measures obtained by the electronic method were compared to the real length of each root canal. These data were evaluated by means of the student t test for statistical analysis that demonstrate no statistical differences between the measures before and after the pre-flaring using 2.5% or 5.25% sodium hypochlorite (p>0.05). The results showed measures closer to the actual root canal length in the group without the pre-flaring, however statistical significance was observed with 3% hydrogen peroxide between the measures done before and after the root canal pre-flaring (p<0.05). Thus, we concluded that the medium and cervical preparation with Gates-Glidden drills was not able to interfere in the root apex locator precision

Effectiveness of an electronic apex locator used after preflaring of cervical and middle third

Introduction: The electronic method has been studied and improved aiming to add precision, speed and reliability of the measurement technique to determine the exact location of the working length. Currently, the root canal preparation recommends prior to determine the tooth length and consequent perform instrumentation of the apical portion, a previous preflaring of the cervical and middle thirds in various techniques. This procedure may provide a reduction in system impedance, leading to read errors by the apex locators. Objective: Investigate the influence of preflaring of the cervical and middle thirds on the accuracy of measuring the working length by apex locators. Material and methods: Twenty-five mesial roots of molars were used and had their crowns cut at the cemento-enamel junction. The actual measure of each root canal was performed and then the samples were embedded into a mixture of alginate, used as a conducting medium, where electronic measurements were taken with apex locator before and after preflaring of the canals with Gates-Glidden drills in descending order (#4, #3, #2). Measurements obtained by electronic method were then compared with the actual measurement of the root canal. The results were tabulated and submitted to the Student t test. Results: The results show that there was no statistical significance (p<0.05) between the readings before and after preflaring. Readings closer to the foraminal ending occurred in the group after preflaring with Gates Glidden. Conclusion: It was concluded that preflaring with Gates Glidden drills were not able to influence significantly the accuracy of apex locator in determining the exact working length.