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1.
Int Endod J ; 54(11): 1993-2005, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34352123

RESUMO

AIM: To evaluate the effect of an enhanced infection control protocol on root canal treatment outcomes and on microbial load within root canals after chemomechanical preparation. METHODOLOGY: A total of 144 molar teeth from 139 healthy patients receiving primary root canal treatment were block randomized to a standard protocol (StP) or an enhanced infection control protocol (EnP). Both treatment arms adhered to current best practice recommendations, while the EnP comprised additional steps that included replacing rubber dams, gloves, files, all instruments and surface barriers at the time of canal filling to reduce the chances of iatrogenic contamination. Patients and radiographic examiners were blinded to the protocol used. Intracanal microbial samples were taken at baseline (S1) and after completion of chemomechanical preparation (S2). Microbial 16S rDNA copy numbers were enumerated by quantitative polymerase chain reaction (qPCR). Cone beam computed tomography (CBCT) scans were taken before treatment and at one-year follow-up. The outcome was assessed clinically and radiographically using CBCT by logistic regression modelling. RESULTS: At one-year follow-up, 115 teeth were analysed (54 in StP and 61 in EnP). The percentage of favourable outcomes assessed by CBCT was 85.2% in the EnP and 66.7% in the StP. The odds of 12-month success was three times higher in the EnP group compared with the StP group (OR=2.89; p=0.022, CI: 1.17 - 7.15). The median bacterial reads were reduced from 8.1×103 in S1 samples to 3.5×103 in the StP group and from 8.6×103 to 1.3×103 in the EnP group. The enhanced protocol significantly reduced bacterial counts in pre-canal filling samples when compared to the standard protocol (p=0.009). CONCLUSIONS: The implementation of a facile, enhanced infection control protocol in primary root canal treatment resulted in less detectable bacterial DNA before canal filling and significantly more successful outcomes at one year.


Assuntos
Cavidade Pulpar , Tratamento do Canal Radicular , Tomografia Computadorizada de Feixe Cônico , Humanos , Controle de Infecções , Dente Molar/diagnóstico por imagem , Dente Molar/cirurgia , Ensaios Clínicos Controlados Aleatórios como Assunto , Preparo de Canal Radicular , Resultado do Tratamento
2.
Int Endod J ; 54(11): 1974-1981, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34378217

RESUMO

This position statement on the restoration of root filled teeth represents the consensus of an expert committee, convened by the European Society of Endodontology (ESE). Current clinical and scientific evidence, as well as the expertise of the committee, have been used to develop this statement. The aim is to provide clinicians with evidence-based principles for decision-making on the choice of restoration following the completion of root canal treatment. By discussing the evidence in relation to key topics regarding post-endodontic restoration, a series of clinical recommendations are made. The scientific basis of the recommendations made in this paper can be found in a recently published review article (Bhuva et al. 2021, International Endodontic Journal, https://doi.org/10.1111/iej.13438). It is the intention of the committee to update this statement as further evidence emerges.


Assuntos
Endodontia , Dente , Obturação do Canal Radicular , Tratamento do Canal Radicular , Raiz Dentária
3.
Br Dent J ; 2021 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-33986484

RESUMO

Aim To compare the treatment planning decisions made by undergraduate and postgraduate dental students before and after training on the use of the Dental Practicality Index (DPI).Methodology One hundred and eight undergraduate and postgraduate dental students were randomly assigned to test (DPI) or control groups. The baseline knowledge was assessed in the first session; both groups were shown 15 clinical scenarios and asked to assign one of four treatment plan options (no treatment, simple treatment, complex treatment or extract). The most appropriate treatment plan had been agreed by a consensus panel of experienced dentists. The test group was then trained on the use of the DPI. In the second session, both groups were shown the same clinical scenarios again in a different order and asked to assign one of the four treatment plan options. Both groups completed the confidence questionnaire.Results Training with the DPI improved the test (DPI) group mean scores from 9.1 in the first session to 10.3 out of 15 in the second session, which was a statistically significant difference (p = 0.005) when compared to the control group mean scores of 8.9 in the first session to 9.2 out of 15 in the second session. The mean confidence score of the students was 6.5 out of 10. There was no correlation between self-reported confidence scores of the students and the treatment planning result scores.Conclusions The DPI aids in the systematic assessment and appropriate treatment planning of dental restorative problems by dental students.

4.
J Endod ; 47(6): 914-923, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33705831

RESUMO

INTRODUCTION: The aim of this study was to compare periapical radiographs (PRs) and upper standard occlusal (USO) radiographs with cone-beam computed tomographic (CBCT) imaging on clinicians' confidence in the diagnosis and management of traumatic dental injuries (TDIs). METHODS: This study included 35 maxillary anterior teeth from 25 patients with at least 1 PR (parallax view) and a CBCT scan. Fourteen patients also had a USO radiograph. Ten examiners selected a diagnosis and treatment plan, which were compared with a reference standard. Sensitivity, specificity, positive and negative predictor values, and receiver operating characteristic analysis were used to determine the diagnostic accuracy. RESULTS: CBCT imaging exhibited significantly higher sensitivity than both conventional radiographic techniques combined (PRs and PRs + USO radiographs) for all diagnoses (TDI: 99% vs 84%, lateral luxation: 80% vs 34%, extrusions: 92% vs 42%, and cortical plate fracture: 58% vs 1%) other than horizontal root fractures in which the results were close to statistical significance (88% vs 69%). CBCT imaging was significantly more accurate for all diagnoses (TDI: 91% vs 70%, lateral luxations: 83% vs 61%, extrusive luxations: 92% vs 68%, alveolar cortical plate fractures: 78% vs 48%, and horizontal root fractures: 93% vs 82%). Examiners had the most confidence with CBCT imaging and the least confidence in diagnosing using PRs + USO radiographs than with PRs alone. Agreement with management plans was significantly better using CBCT imaging compared with PRs and PRs + USO radiographs. CONCLUSIONS: CBCT imaging improved the clinical diagnosis of TDIs. The addition of USO radiographs to PRs did not improve the diagnosis of TDIs in this investigation. CBCT imaging improved confidence in the diagnosis of TDI cases and treatment planning compared with conventional radiography.


Assuntos
Fraturas dos Dentes , Dente , Tomografia Computadorizada de Feixe Cônico , Humanos , Curva ROC , Radiografia Dentária , Radiografia Dentária Digital , Fraturas dos Dentes/diagnóstico por imagem , Fraturas dos Dentes/terapia
5.
J Endod ; 47(3): 415-423, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33359531

RESUMO

INTRODUCTION: Previous studies have shown that in teeth presenting with symptoms of irreversible pulpitis (IP), bacteria and their by-products driving inflammation are confined mainly within the coronal pulpal tissue. The present study aimed to determine the presence and identity of bacteria within pulps presenting with clinical symptoms of IP using molecular methods. METHODS: Samples were obtained from 30 adult patients presenting to the dental emergency department with signs and symptoms of IP. After meticulous surface decontamination, the pulp space was accessed, and clinical samples were collected from inflamed pulp tissue using sterile paper points. Genomic DNA was extracted from the clinical samples, and quantification of bacteria was performed using quantitative polymerase chain reaction targeting the conserved 16S ribosomal RNA (rRNA) gene. To characterize the microbial composition, the V3-V5 hypervariable regions of the 16S rRNA gene were amplified and subjected to next-generation sequencing on the MiSeq platform (Illumina, San Diego, CA). RESULTS: Of the 30 teeth that presented with IP, half of the intracanal samples had a substantial bacterial load (16S rRNA copies) within the IP vital pulp as determined by quantitative polymerase chain reaction. Next-generation sequencing microbial identification was successful in 7 intracanal samples and yielded 187 bacterial operational taxonomic units within the IP samples. The most abundant genera observed among the vital cases were Veillonella (16%), Streptococcus (13%), Corynebacterium (10%), Cutibacterium (9.3%), and Porphyromonas (5.7%). CONCLUSIONS: The current study highlighted the evidence of vital teeth diagnosed as IP harboring considerable bacterial loads and composed of genera reflective of established endodontic pathology and thus may offer insights into the initial events preceding pulpal necrosis.


Assuntos
Microbiota , Pulpite , Adulto , Cavidade Pulpar , Humanos , Microbiota/genética , RNA Ribossômico 16S/genética , Tratamento do Canal Radicular
6.
J Clin Med ; 9(11)2020 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-33218015

RESUMO

BACKGROUND: Infections of the root canal space involve polymicrobial biofilms and lead to chronic, low grade inflammatory responses arising from the seeding of microbes and by-products. Acute exacerbation and/or disseminating infections occur when established microbial communities undergo sudden changes in phenotypic behaviour. METHODS: Within clinical endodontic infections, we assessedcategorical determinants comprising, and changing microbial composition of, chronic polymicrobial infections and their association with amoebae. After standardised assessment, primary or secondary infections underwent sampling and DNA processing, targeting bacteria, fungi and amoebae, including 16S high-throughput sequencing. After taxonomic assignment, community composition was correlated with clinical signs and symptoms. Diversity and abundance analyses were carried out in relation to the presence of non-bacterial amplicons. RESULTS: Clinical specimens revealed two distinct community clusters, where specific changes correlated with clinical signs. An association between the compositions of microbiomes was found between these groups and the presence of Entamoeba gingivalis in 44% of cases. When amoebae were present in endodontic infections, we demonstrate changes in microbial community structure that mirror those observed in treatment-resistant or recurrent infections. CONCLUSIONS: Amoeba are present in endodontic infections at a high prevalence, and may promote increased virulence by enrichment for phagocytosis-resistant bacteria.

7.
J Clin Med ; 9(9)2020 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-32846942

RESUMO

PURPOSE: This study compared the antimicrobial efficacy of calcium silicate sealers (BioRoot RCS and Total Fill BC) and conventional sealers (AH Plus and Tubli-seal) against planktonic bacteria and a nutrient-stressed multispecies biofilm. METHODS: Antimicrobial properties of freshly mixed sealers were investigated using the direct contact test (DCT) and a nutrient-stressed multispecies biofilm comprised of five endodontic strains. Antimicrobial activity was determined using quantitative viable counts and confocal laser scanning microscopy (CLSM) analysis with live/dead staining. The pH of the sealers was analysed over a period of 28 days in Hanks Balanced Salt Solution (HBSS). Analysis of variance (ANOVA) with Tukey tests and the Kruskal-Wallis test were used for data analysis with a significance of 5%. RESULTS: All endodontic sealers exhibited significant antimicrobial activity against planktonic bacteria (p < 0.05). BioRoot RCS caused a significant reduction in viable counts of the biofilms compared to AH Plus and the control (p < 0.05), while no significant difference could be observed compared to TotalFill BC and Tubli-seal (p > 0.05). CLSM analysis showed that BioRoot RCS and TotalFill BC exhibited significant biofilm inhibition compared to Tubli-seal, AH Plus and the control (p < 0.05). BioRoot RCS presented with the highest microbial killing, followed by TotalFill BC and Tubli-seal. Alkalizing activity was seen from the onset by BioRoot RCS, TotalFill BC and AH Plus. After 28 days, BioRoot RCS demonstrated the highest pH in HBSS (pH > 12). CONCLUSIONS: Calcium silicate sealers exhibited effective antimicrobial properties. This was demonstrated by superior biofilm inhibition capacity and microbial killing, with strong alkalizing activity compared to epoxy-based and zinc oxide-eugenol-based sealers.

8.
J Clin Med ; 9(9)2020 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-32854206

RESUMO

BACKGROUND: the aim of this study was to assess the 2-year pulp survival of deep carious lesions in teeth excavated using a self-limiting protocol in a single-blind randomized controlled clinical trial. METHODS: At baseline, 101 teeth with deep carious lesions in 86 patients were excavated randomly using self-limiting or control protocols. Standardized clinical examination and periapical radiographs of teeth were performed after 1- and 2-year follow-ups (REC 14/LO/0880). RESULTS: During the 2-year period of the study, 24 teeth failed (16 and 8 at T12 and T24, respectively). Final analysis shows that 39/63 (61.9%) of teeth were deemed successful (16/33 (48.4%) and 23/30 (76.6%) in the control and experimental groups, respectively with a statistically significant difference (z score = 2.3, p = 0.021). Of teeth with severe and mild symptoms at T0, 42.9% and 36.7% respectively failed at T24 (p > 0.05). Within the self-limiting group, there was a lower success in premolars compared to molars (p < 0.05). CONCLUSION: after 2 years, there was a statistically significant higher pulp survival rate of teeth with deep carious lesions excavated using self-limiting protocols in patients with reversible pulpitis. Molars showed higher success than premolars in teeth excavated using the self-limiting protocol. There was no statistically significant association between the outcome and the severity of symptoms at T0 (ClinicalTrials.gov NCT03071588).

9.
J Clin Med ; 9(7)2020 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-32635158

RESUMO

BACKGROUND: The aim of this longitudinal, one-year cohort study was to explore the hypothesis that fluorescence sampling of the root canal space prior to obturation could predict the outcome of root canal treatment (RCT). METHODS: Sixty-five teeth underwent primary RCT and were followed up clinically and radiographically. The outcome was determined radiographically with periapical radiographs (PR) and cone beam computed tomography (CBCT) scans. RESULTS: Success at 12 months was predictable based on the fluorescence score. When the fluorescence score (defined as the percentage of signal over total signal including background) was lower than 67, there was a 4.5 times (Odds ratio (OR) = 0.028; 95% confidence interval (CI): 0.003, 0.291, p = 0.001) greater chance of success (90% overall). When the readings were above this threshold, the success rate was 20%. CONCLUSION: A chairside sampling method is able to predict the outcome of RCT, through the use of paper point sampling and fluorescence staining. This has reduced the prevalence of persistent infections by guiding the optimum time for obturation. ClinicalTrials.gov trial NCT03660163.

10.
BMC Oral Health ; 20(1): 133, 2020 05 06.
Artigo em Inglês | MEDLINE | ID: mdl-32375759

RESUMO

BACKGROUND: To assess the change of the Schneider membrane thickness measured by CBCT before and after root canal treatment, retreatment and pulp capping procedures. METHODS: This retrospective study was conducted on CBCT scans of a patient population of Guy's Hospital NHS Foundation Trust, London. Three groups of patients were studied: Group 1 consisted of patients referred for primary endodontic treatment; Group 2 for endodontic retreatment; Group 3 for indirect pulp capping procedures (serving as a control group). Follow up scans were carried out 1 year after treatment. Measurements were carried out on CBCT scans and data were analysed statistically by Wilcoxon Signed Rank Test. Linear regression was used to assess predictive parameters for membrane thickness. RESULTS: A statistically significant reduction of the Schneider membrane thickness was observed one year after endodontic treatment and retreatment (P < 0.05) but no significant reduction was observed after pulp capping procedures. Linear regression showed that age and gender were significant predictors influencing the Schneider membrane thickness. CONCLUSIONS: Within the limitations of this retrospective study, following root canal treatment and re-treatment a Schneiderian membrane thickness reduction occurred at 1-year follow-up. The removal of odontogenic infection following endodontic treatment may help reducing the thickness of the Schneider membrane.


Assuntos
Tomografia Computadorizada de Feixe Cônico/métodos , Capeamento da Polpa Dentária , Cavidade Pulpar/diagnóstico por imagem , Mucosa Nasal/diagnóstico por imagem , Tratamento do Canal Radicular , Feminino , Humanos , Londres , Masculino , Mucosa Nasal/anatomia & histologia , Retratamento , Estudos Retrospectivos
11.
J Clin Med ; 9(3)2020 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-32183124

RESUMO

BACKGROUND: The aim of this study was to compare the success rate of root canal treatments undertaken using a calcium silicate root canal sealer in combination with a single cone with non-calcium silicate cement and warm vertical condensation. METHODS: 150 necrotic or pulpitic teeth were treated. (REC: 08/H0804/79). Following standardized root canal chemo-debridement. The canals were obturated using warm vertical condensation of gutta-percha and epoxy-based sealer (AH plus) or a calcium silicate sealer (BioRootTM RCS) with a single cone technique. Follow-up assessment was conducted at 12 months using Cone Beam Computed Tomography (CBCT). RESULTS: At 1-year recall, 104 teeth were assessed (51 AH plus, 53 BioRootTM RCS). The success rate using loose criteria for the CBCT images and PA radiographs was respectively 80% and 89% in the AH plus/warm vertical condensation group, 84% and 90% in the BioRootTM RCS/single cone group. There was no statistically significant difference between the two groups (Fisher exact test p value 0.6099 for the CBCT images). CONCLUSION: Within the limitations of this non-randomized trial, a calcium silicate cement in combination with single cone resulted in a similar proportion of successful cases compared to warm vertical condensation and epoxy-based sealer.

12.
Dent Mater ; 35(11): 1614-1629, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31530433

RESUMO

OBJECTIVE: The deleterious caustic effects of sodium hypochlorite (NaOCl) as a root canal irrigant makes it imperative that alternative methods are developed for root canal disinfection. The purpose of this study was to examine the antimicrobial efficacy of silver nanoparticles (AgNPs) synthesized on an aqueous graphene oxide (GO) matrix (Ag-GO), with different irrigant delivery methods to enhance the disinfection regimen, using a novel ex vivo infected tooth model. METHODS: AgNPs were prepared by reducing AgNO3 with 0.01M NaBH4 in presence of GO. Elemental analysis was performed with scanning electron microscopy/energy dispersive X-ray spectroscopy (SEM/EDS) and scanning transmission electron microscopy (STEM) was used for size and morphology analysis of GO and Ag-GO. Nutrient stressed, multi-species biofilms were grown in prepared root canals of single-rooted teeth. The irrigants used were sterile saline, 1% and 2.5% NaOCl, 2% chlorhexidine gluconate (CHX), 17% EDTA and an aqueous suspension of 0.25% Ag-GO. The antimicrobial efficacy of the irrigants were performed with paper point sampling and measurement of microbial counts. The biofilm disruption in dentine tubule surfaces was analysed with confocal laser scanning microscopy (CLSM). The acquisition of total biovolume (µm3/µm2) and biofilm viability was performed using software BioImage_L. Two-way analysis of variance (ANOVA) with post hoc Tukey tests was used for data analysis with level of statistical significance set at P<0.05. RESULTS: SEM/EDS analysis confirmed impregnation of Ag within the GO matrix. TEM images showed polygonal GO sheets and spherical AgNPs of diameter 20-50nm, forming a network on the surface of GO sheets. The use of ultrasonic activation enhanced the efficacy of Ag-GO compared to 1% NaOCl, 2% CHX, 17% EDTA and sterile saline (P<0.05). The microbial killing efficacy of 2.5% NaOCl was superior compared to the experimental groups. The maximum biofilm disruption, in dentine tubule surfaces, was achieved by 2.5% NaOCl, however Ag-GO caused a significant reduction of total biovolumes compared to the rest of the experimental groups (P<0.05%). SIGNIFICANCE: The successful documentation of the microbial killing and biofilm disruption capacity of Ag-GO is a promising step forward to explore its unique properties in clinical applications and biomaterials in dentistry.


Assuntos
Nanopartículas Metálicas , Prata , Biofilmes , Cavidade Pulpar , Enterococcus faecalis , Grafite
13.
Dent Mater J ; 38(4): 511-521, 2019 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-31270293

RESUMO

This study evaluates the reinforcement of semi-interpenetrating network composites of 2,2-bis[4-(2-hydroxy-3-methacryloyloxypropyl)phenyl] propane (Bis-GMA)/ triethyleneglycol dimethacrylate (TEGDMA)/polymethyl methacrylate (PMMA) and 25% titanium dioxide (TiO2) nanofiller with surface treated Kevlar fibers for potential application as dental posts. The post material was subjected to thermo-cycling and flexural strength determined, characterised by dynamic mechanical analysis, water sorption, radiopacity and cytotoxicity tests. The results were compared with everStick®POST. Kevlar pre-treatment with acetic acid and silane coupling agent demonstrated a clear effect on the flexural strength of the composites with a significant increase compared to composites with fibers without surface treatment. The inclusion of TiO2 into the final formulation provided the desired radiopacity and improved both aesthetics and flexural strength, which exhibits a higher resistance on thermocycling. The ratios of fatigue limit to static flexural strength were about 0.73 for Kevlar and 0.58 for everStick®POST; MTT assay confirmed the absence of any toxic eluents, indicating its feasibility as new intracanal post material.


Assuntos
Estética Dentária , Técnica para Retentor Intrarradicular , Bis-Fenol A-Glicidil Metacrilato , Resinas Compostas , Materiais Dentários , Teste de Materiais , Maleabilidade , Polietilenoglicóis , Ácidos Polimetacrílicos , Silanos
14.
Clin Oral Investig ; 23(4): 1931-1939, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30232625

RESUMO

OBJECTIVES: Assess calcium silicate cement (Biodentine™) vs. glass ionomer cement (Fuji IX™, control) as indirect pulp capping (IPC) materials in patients with reversible pulpitis after a 2-year follow-up. Evaluate the integrity of the overlying resin composite restorations using modified USPHS criteria and FDI criteria. Investigate the sensitivity of the modified USPHS criteria compared to the FDI criteria in the assessment of the restorations. MATERIALS AND METHODS: Seventy-two restorations (36 Biodentine™, 36 Fuji IX™) were placed randomly in 53 patients. Periapical radiographs were taken at pre-treatment (T0), 12-month (T12), and 24-month (T24) review. Restorations were assessed using the modified USPHS and FDI criteria at T12 and T24. RESULTS: At 24 months, 15 teeth had failed to maintain vitality (6 Biodentine™, 9 Fuji IX™). Clinical success rate of IPC for both materials was 72% and is related to the intensity of reversible pulpitis symptoms. No difference was found between T12 and T24 in the periapical (PA) radiographs and in the integrity of the resin composite restorations overlying Biodentine™ compared to Fuji IX™. There was no difference in the efficacy of the USPHS criteria compared to the FDI criteria in the assessment of the resin composite restorations. CONCLUSIONS: Biodentine™ and Fuji IX™ were clinically effective when used as IPC materials in teeth with reversible pulpitis at T24. Resin composite restorations overlying both materials performed well at T24. Using the USPHS or FDI criteria is equally efficient at T24; however, longer term follow-up is needed to establish whether there are sensitivity differences between these assessment criteria. CLINICAL SIGNIFICANCE: Teeth with deep carious lesions approaching the pulp and with signs of reversible pulpitis can be treated successfully by indirect pulp capping using either Biodentine™ or Fuji IX™. Using the USPHS or FDI criteria to assess restorations is equally effective at 2 years. TRIAL REGISTRATION: NCT02201641.


Assuntos
Compostos de Cálcio , Resinas Compostas , Capeamento da Polpa Dentária , Restauração Dentária Permanente , Cimentos de Ionômeros de Vidro , Silicatos , Cálcio , Feminino , Humanos , Masculino
15.
PLoS One ; 13(9): e0198649, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30199524

RESUMO

Root canal irrigation with sodium hypochlorite (NaOCl) is an indispensable part of the chemomechanical preparation of infected root canals in Endodontology. However, there is limited information on the emergence of toxic or hazardous volatile compounds (VOCs) from the interaction of NaOCl with the infected content of tooth biomaterials. The aim of this study was to assess the formation of VOCs and disinfection by-products (DBPs) following the interaction of NaOCl 2.5% v/v with a model system of different sources of natural organic matter (NOM) present in infected root canals, including dentine powder, planktonic multi-microbial suspensions (Propionibacterium acnes, Staphylococcus epidermidis, Actinomyces radicidentis, Streptococcus mitis and Enterococcus faecalis strain OMGS3202), bovine serum albumin 4%w/v and their combination. NaOCl was obtained from a stock solution with iodometric titration. Ultrapure water served as negative control. Samples were stirred at 37°C in aerobic and anaerobic conditions for 30min to approximate a clinically realistic time. Centrifugation was performed and the supernatants were collected and stored at -800 C until analysis. The reaction products were analysed in real time by selected ion flow tube mass spectrometry (SIFT-MS) in triplicates. SIFT-MS analysis showed that the released VOCs included chlorinated hydrocarbons, particularly chloroform, together with unexpected higher levels of some nitrogenous compounds, especially acetonitrile. No difference was observed between aerobic and anaerobic conditions. The chemical interaction of NaOCl with NOM resulted in the formation of toxic chlorinated VOCs and DBPs. SIFT-MS analysis proved to be an effective analytical method. The risks from the rise of toxic compounds require further consideration in dentistry.


Assuntos
Substâncias Perigosas/análise , Irrigantes do Canal Radicular/química , Hipoclorito de Sódio/química , Compostos Orgânicos Voláteis/análise , Bactérias/química , Desinfecção/métodos , Humanos , Espectrometria de Massas/métodos , Preparo de Canal Radicular/métodos
16.
J Endod ; 43(11): 1852-1856, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28951029

RESUMO

INTRODUCTION: The aim of this study was to evaluate the bacterial contamination in endodontic consumables (gutta-percha points, rubber dams, paper mixing pads, caulking agents, and endodontic instrument sponges [EISs]) before and after clinical use and storage. METHODS: Materials were randomly sampled in triplicates at 3 time points (t0, at package opening; t1, at 7 days; and t2, at 14 days) during their clinical usage. The gutta-percha points and caulking agent (25 mg) were added to 1 mL phosphate-buffered saline (PBS). The rubber dam, paper mixing pad, and EIS were added to 25 mL PBS. After vortexing, centrifuging, and removing the supernatant, the pellet was resuspended in 1 mL PBS, plated on fastidious anaerobic agar, and incubated aerobically and anaerobically. The grown colonies were identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). The total bacterial load was calculated in the remaining volume (800 µL) from each sample by quantitative polymerase chain reaction after DNA extraction. RESULTS: All tested materials showed a varied number of contaminated samples at the 3 time points (except EIS at t0) using MALDI-TOF MS. The most isolated genera were Propionibacterium (42%) and Staphylococcus (32%). By using non-culture-based approaches, all tested materials at the 3 time points (except gutta-percha at t0 and the caulking agent at t0, t1, and t2) carried bacterial DNA. CONCLUSIONS: The majority of the tested materials harbored bacteria in their samples before and after clinical storage. Nosocomial infection derived from commonly used consumables could have an impact on the outcome of endodontic treatment.


Assuntos
Materiais Dentários/efeitos adversos , Endodontia/métodos , Contaminação de Equipamentos , Bactérias/genética , DNA Bacteriano/genética , Contaminação de Equipamentos/estatística & dados numéricos , Humanos , Reação em Cadeia da Polimerase , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz
17.
J Mech Behav Biomed Mater ; 69: 355-361, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28161689

RESUMO

To evaluate the bioactivity and the cytocompatibility of experimental Bioglass-reinforced polyethylene-based root-canal filling materials. The thermal properties of the experimental materials were also evaluated using differential scanning calorimetry, while their radiopacity was assessed using a grey-scale value (GSV) aluminium step wedge and a phosphor plate digital system. Bioglass 45S5 (BAG), polyethylene and Strontium oxide (SrO) were used to create tailored composite fibres. The filler distribution within the composites was assessed using SEM, while their bioactivity was evaluated through infrared spectroscopy (FTIR) after storage in simulated body fluid (SBF). The radiopacity of the composite fibres and their thermal properties were determined using differential scanning calorimetry (DSC). The cytocompatibility of the experimental composites used in this study was assessed using human osteoblasts and statistically analysed using the Pairwise t-test (p<0.05). Bioglass and SrO fillers were well distributed within the resin matrix and increased both the thermal properties and the radiopacity of the polyethylene matrix. The FTIR showed a clear formation of calcium-phosphates, while, MTT and AlamrBlue tests demonstrated no deleterious effects on the metabolic activity of the osteoblast-like cells. BAG-reinforced polyethylene composites may be suitable as obturation materials for endodontic treatment. Since their low melting temperature, such innovative composites may be easily removed in case of root canal retreatment. Moreover, their biocompatibility and bioactivity may benefit proliferation of human osteoblast cells at the periapical area of the root.


Assuntos
Materiais Biocompatíveis , Cerâmica , Teste de Materiais , Materiais Restauradores do Canal Radicular , Líquidos Corporais , Células Cultivadas , Humanos , Osteoblastos/citologia , Polietileno
18.
Quintessence Int ; 48(1): 69-82, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-27834417

RESUMO

OBJECTIVE: The objective of the present systematic review was to evaluate, in patients with irreversible pulpitis affecting mandibular posterior teeth, if premedication with nonsteroidal anti-inflammatory drugs can increase the efficacy of inferior alveolar nerve block (IANB) if compared to placebo administration; if one anesthetic agent is more effective than another; if 1.8 mL injection is more effective than 3.6 mL injection to increase the efficacy of IANB; and if supplementary buccal injection is able to increase the efficacy of IANB as compared to a negative control/placebo group. DATA SOURCES: Randomized controlled clinical trials investigating different aspects (technique, premedication with anti-inflammatory drugs, different anesthetic agents) were searched. Success of IANB, as defined in the studies, was considered as the primary outcome. A meta-analysis was performed evaluating relative risks (RRs). Electronic databases (Medline, Embase, Cochrane Central) were searched after preparation of an appropriate search string. After application of selection criteria, a total of 37 studies were included; 19 of them were considered in the meta-analysis. There was evidence of a difference in favor of the use of premedication with anti-inflammatory drugs (RR, 1.80; CI 95%, 1.50-2.14; P < .0001). There was no evidence of a difference between articaine and lidocaine (RR, 1.05; CI 95%, 0.91-1.21; P = .94). With regard to the volume of anesthetic infiltrated, the computed RR was 1.17 (CI, 0.73-1.88) without any significant difference between the use of one or two cartridges (P = .52). The estimated RR for a supplementary buccal infiltration was 1.56 (CI, 1.00-2.42; P = .05). CONCLUSION: The use of premedication with anti-inflammatory drugs before IANB can increase the efficacy of the IANB. The type of anesthetic agent, the volume of anesthetic, and the use of a supplemental buccal infiltration do not seem to affect the efficacy of anesthesia.


Assuntos
Nervo Mandibular/efeitos dos fármacos , Bloqueio Nervoso/métodos , Pulpite/cirurgia , Anti-Inflamatórios não Esteroides/uso terapêutico , Humanos , Manejo da Dor , Medição da Dor , Ensaios Clínicos Controlados Aleatórios como Assunto
19.
J Endod ; 43(1): 121-125, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27939734

RESUMO

INTRODUCTION: The aim of this study was to compare the diagnostic efficacy of 2 cone-beam computed tomographic (CBCT) units with parallax periapical (PA) radiographs for the detection and classification of simulated external cervical resorption (ECR) lesions. METHODS: Simulated ECR lesions were created on 13 mandibular teeth from 3 human dry mandibles. PA and CBCT scans were taken using 2 different units, Kodak CS9300 (Carestream Health Inc, Rochester, NY) and Morita 3D Accuitomo 80 (J Morita, Kyoto, Japan), before and after the creation of the ECR lesions. The lesions were then classified according to Heithersay's classification and their position on the root surface. Sensitivity, specificity, positive predictive values, negative predictive values, and receiver operator characteristic curves as well as the reproducibility of each technique were determined for diagnostic accuracy. RESULTS: The area under the receiver operating characteristic value for diagnostic accuracy for PA radiography and Kodak and Morita CBCT scanners was 0.872, 0.99, and 0.994, respectively. The sensitivity and specificity for both CBCT scanners were significantly better than PA radiography (P < .001). There was no statistical difference between the sensitivity and specificity of the 2 scanners. The percentage of correct diagnoses according to the tooth type was 87.4% for the Kodak scanner, 88.3% for the Morita scanner, and 48.5% for PA radiography.The ECR lesions were correctly identified according to the tooth surface in 87.8% Kodak, 89.1% Morita and 49.4% PA cases. The ECR lesions were correctly classified according to Heithersay classification in 70.5% of Kodak, 69.2% of Morita, and 39.7% of PA cases. CONCLUSIONS: This study revealed that both CBCT scanners tested were equally accurate in diagnosing ECR and significantly better than PA radiography. CBCT scans were more likely to correctly categorize ECR according to the Heithersay classification compared with parallax PA radiographs.


Assuntos
Tomografia Computadorizada de Feixe Cônico/métodos , Radiografia Dentária/métodos , Reabsorção da Raiz/diagnóstico por imagem , Humanos , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
20.
Int J Comput Dent ; 20(4): 377-392, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29292412

RESUMO

OBJECTIVES: To evaluate the in vitro accuracy of digital impressions for three-dimensional (3D) volumetric measurement of residual coronal tooth structure postendodontic cavity preparation, with reference to micro-computed tomography (µCT). METHODS: Quantification of the accuracy and precision of the intraoral digital scanner (3M True Definition Scanner - IOS) was performed using a metrology gauge block and a profilometric calibration model. Thirty-four human extracted molars with endodontic access cavities were scanned using both intraoral scanning (test scanner) in high-resolution mode, and µCT (reference scanner: GE Locus SP µCT scanner) in high- (HiResCT) and low- (LoResCT) resolution modes. Comparisons of volumetric accuracy and 3D profilometric deviations were performed using surface metrology software. One-way repeated measures analysis of variance (ANOVA), in combination with the Bonferroni post hoc test, was implemented to compare the differences in volume measurements between scanning methods. RESULTS: Digital scanning revealed smaller volume measurements by 1.36% and 0.68% compared to HiResCT and LoResCT, respectively. There was a statistically significant difference in the volumetric measurements obtained from the IOS scanner and both HiResCT and LoResCT scans (P < 0.001). Analysis of the mean 3D profilometric deviations revealed that the IOS displayed greater surface deviation (± 27/33 µm) vs HiResCT and LoResCT (± 16/32 µm). CONCLUSIONS: Although volumetric measurements of endodontically accessed teeth were up to 1.36% smaller in comparison to µCT, the digital scanner was able to reliably measure the extra- and intracoronal aspect of the endodontically accessed tooth.


Assuntos
Técnica de Moldagem Odontológica , Processamento de Imagem Assistida por Computador , Dente não Vital , Microtomografia por Raio-X , Modelos Dentários , Humanos , Imageamento Tridimensional
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