Importancia de la activación de la irrigación durante el tratamiento de conductos: Una revisión de la literatura / Importance of the activation of irrigation during root canal treatment: A review of the literature

Introducción: La compleja anatomía presente en el sistema de conductos limita nuestra habilidad para limpiar y desinfectar de manera predecible. La remoción de cualquier resto pulpar vital y necrótico, microorganismos y sus toxinas, así como el barrillo dentinario que se produce durante la instrumentación, es esencial para el éxito del tratamiento de conductos. Durante los últimos años se han desarrollado nuevas técnicas de irrigación, empleando sistemas de activación y liberación, con el objetivo de mejorar la técnica convencional y lograr que el irrigante acceda a las zonas más inaccesibles del entramado radicular, como son: áreas no instrumentadas, conductos laterales, deltas apicales,etc. En este estudio se revisará la bibliografía existente acerca de dos de las técnicas de irrigación mecánicas más importantes: la activación sónica y la ultrasónica, para comprobar su eficacia respecto a la técnica convencional, y también para compararlas entre sí. Ambas técnicas se han probado más eficaces que la manual. No obstante, la técnica ultrasónica ha obtenido mejores resultados a la hora de eliminar detritus del conducto, así como al distribuir el irrigante y penetrar en áreas no instrumentadas en comparación con la activación sónica (AU)

The complex anatomy of root canal systems has limited our ability to clean and disinfect it predictably. The removal of any vital and necrotic pulp tissue, microorganisms and their toxins, along with the smear layer is essential for endodontic success. Proper cleaning of the canal system is a necessary goal for endodontic treatment success, and so has been the subject of numerous studies. Recently, new irrigation techniques have been developed, which use mechanical systems in order to improve the manual technique and to help the irrigant get to the most intricated areas of the canal system. This study will review the literature about two important mechanical irrigation techniques: Sonic and ultrasonic irrigation, in order to check its effectiveness over the conventional technique, and to compare them. Both techniques have been proven to be more efficient than the traditional one. however, the use of ultrasonics has been more successful in removing debris from the duct, distributing irrigant and penetrating uninstrumented areas compared to sonic activation (AU)

Eliminación de Enterococcus faecalis por medio del uso de hipoclorito de sodio, clorhexidina y MTAD en conductos radiculares / Elimination of Enterococcus faecalis using sodium hypochlorite, chorhexidine and MTAD in root canals

Objetivos: Comparar la efectividad de diferentes soluciones irrigadoras en la eliminación de cepas de Enterococcus faecalis en pacientes con patología periapical crónica, mediante pruebas microbiológicas. Métodos: Se evaluaron 21 dientes con diagnóstico de periodontitis apicales crónicas no supurativas de pacientes que asistieron a consulta en las clínicas odontológicas de la Universidad de Cartagena, previa firma y aprobación del consentimiento informado para participar en el estudio. Los sujetos de estudio se asignaron aleatoriamente en tres grupos usando las siguientes sustancias irrigantes: hipoclorito de sodio al 5%, clorhexidina al 2% e hipoclorito de sodio 2,5% con irrigación final de MTAD. Se identificaron microorganismos por medio de la prueba Reacción en Cadena de la Polimerasa (PCR) y se cuantificaron las unidades formadoras de colonias de Enterococcus faecalisantes y después de ser utilizadas las sustancias irrigadoras. Análisis estadístico: Se realizó el test de Kruskal wallis. Resultados: La investigación demostró que todas las sustancias fueron efectivas en la eliminación de E. faecalisen pacientes con periodontitis apicales crónicas no supurativas. El hipoclorito de sodio al 5% (p= 0,018), hipoclorito de sodio y MTAD (p= 0,021) y clorhexidina al 2% (p= 0,028) fueron igual de efectivas. Conclusiones: El hipoclorito de sodio al 5%, clorhexidina al 2%, hipoclorito de sodio y MTAD pueden ser utilizadas en pacientes con periodontitis apical crónica no supurativa por ser efectivas en la eliminación de E. faecalis (AU)

Objectives: To compare the effectiveness of different irrigating solutions in eliminating of Enterococcus faecalisin patients with chronic periapical pathology by applying microbiological tests. Methods: Twenty one teeth with chronic apical periodontitis of non suppurative diagnosis of patients that attended the dental clinics of the University of Cartagena were evaluated after the patients signed the consent form to participate in the study. The study subjects were randomized into three groups using the following irrigating substances: Sodium hypochlorite at 5%, chlorhexidine 2% and sodium hypochlorite and MTAD. Microorganisms were identified through the Chain Reaction (PCR) and quantified the colony forming units before and after Enteroccocus faecalis be used irrigating substances for cleansing. Statistical analysis: We performed the Kruskal Wallis test. Results: The research showed that all substances were effective in eliminating E. faecalis in patients with chronic apical periodontitis non suppurative. Sodium hypochlorite 5% (p= 0,018), sodium hypochlorite and MTAD (p= 0,021) and chlorhexidine 2% (p= 0,028) were equally effective. Conclusions: Sodium hypochlorite 5% chlorhexidine 2% and sodium hypochlorite and MTAD can be used in patients with chronic apical periodontitis non suppurative after being proven effective in eliminating E. faecalis (AU)

Decalcifying effects of antimicrobial irrigating solutions on root canal dentin

Objective: The aim of this study was to determine the decalcifying efficacy of 7% maleic acid (MA), 2% chlorhexidine (CHX), and combinations of 7% MA + 0.2% cetrimide (CTR) and 2% CHX + 0.2% CTR, in four time periods. Study Design: Four specimens per tooth were obtained from a 2-mm thick slice of the cervical third of the root of ten human incisors. At 1, 2, 3 and 5 minutes of immersion, the concentrations of Ca2+ were measured by atomic absorption spectrophotometry. The results were analyzed using the Mann-Whitney U-test. Results: Statistically significant differences were seen for the extracted calcium in all time periods. The amount of calcium extracted by 7% MA was the highest at all four immersion times, followed by 7% MA + 0.2% CTR. Two percent CHX and its combination with 0.2% CTR extracted virtually no calcium. Conclusions: The decalcifying capacity of 7% MA and 2% CHX diminished when combined with 0.2% CTR (AU)

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Actividad antimicrobiana de la solución de nanopartícula de plata en cultivo de Enterococcus faecalis / Antimicrobial activity of silver nanoparticles solution on culture of Enterococcus faecalis

Objetivo. El objetivo del estudio fue evaluar la actividad antimicrobiana de la solución de nanopartículas de plata en cultivo de Enterococcus faecalis (ATCC 29212) comparándola con diversas soluciones de hipoclorito de sodio (NaOCl). Material y Métodos. Cinco placas de Petri en agar fueron inoculadas con E. faecalis y sobre cada una de ellas se colocó un disco de celulosa saturado de solución de nanopartículas de plata, así como en cada una de las soluciones de hipoclorito de sodio evaluadas (Viarzon, Cloralex, Clorox). El digluconato de clorhexidina al 2% y solución salina estéril fueron utilizados como control. Transcurridas 24 horas de incubación a 37°C, en condiciones de aerobiosis, las zonas de inhibición de crecimiento bacteriano fueron medidas y los resultados sometidos a la prueba “t” entre los grupos experimentales (= 5%). Resultados. El Cloralex presentó la mayor media de inhibición en comparación con las demás substancias (p < 0,05), excepto con digluconato de clorhexidina al 2% (p > 0,05). La solución de nanopartículas de plata proporcionó mayor zona de inhibición que Clorox y Viarzon (p <0,05). El Clorox y el Viarzon no proporcionaron zonas de inhibición y fueron semejantes entre sí (p > 0,05). Conclusiones. La solución de nanopartículas de plata presenta actividad antimicrobiana en cultivo de E. faecalis, incluso mayor que las formas comerciales de hipoclorito de sodio. Futuros estudios deben ser realizados para comprobar su viabilidad como solución de irrigación en endodoncia (AU)

Objective. The objective of this study was to evaluate the antimicrobial activity of the silver nanoparticles solution in enterococcus faecallis cultures (ATCC 29212), compared with various solutions of sodium hypoclorithe (NaOCl). Material and methods. Five Agar Petri plates were inoculated with E. faecallis and each of them was placed a cellulose dish embedded with silver nanoparticles solution, or a solution of sodium hypochlorite evaluated (Viarzon, Cloralex, Clorox). Chlorhexidine digluconate 2% was used as positive control and sterile saline solution was used as negative control. After 24 hours of incubation at 37ºc, under aerobic conditions, the zones of inhibition of bacterial growth were measured and the results subjected to the statistical t test among the experimental groups (= 5%). Results. The Cloralex showed to be the most effective reflected in the extent of inhibition in relation to other substances (p< 0.05), except that the chlorhexidine digluconate 2% (p> 0.05). The solution of silver nanoparticles provided a greater zone of inhibition than the sodium hypochlorite solution (Clorox) and Viarzon (p< 0.05). Clorox and Viarzon didn’t provide zones of inhibition and were similar to each other (p> 0.05). Conclusions. The solution of silver nanoparticles presents antimicrobial activity in cultured E. faecallis, even higher than other commercial forms of sodium hypochlorite. Further studies should be carried out to determine its viability as irrigating solution in endodontics (AU)

Biofilm en endodoncia y su tratamiento / Biofilm in Endodontics and its treatment

El biofilm es la forma más habitual que utilizan las bacterias para crecer y sobrevivir en la naturaleza. Hoy en día se considera que bajo ciertas condiciones ambientales, todos los microorganismos son capaces de formar biofilms. Por ello y por todos los problemas que causan tanto en el entorno médico como odontológico causando infecciones crónicas difíciles de erradicar con los tratamientos convencionales conocidos, el interés por su estudio ha aumentado en las dos últimas decadas. El objetivo de esta revisión es actualizar los conocimientos de tratamiento para el control y eliminación del biofilm en la terapia endodóntica (AU)

Biofilm is the most common form in nature used by bacteria to grow and survive. Nowadays it is considered that under certain environmental conditions, all organisms are able to create biofilms. Due to this ability and to the potential problem both in Medicine and Dentistry related to chronic infections difficult to eradicate with conventional treatments, the studies about biofilm have increased over the past two decades.I The aim of this review is to update the knowledge of treatment for the control and elimination of the biofilm in endodontic therapy (AU)

Capacidad de disolución de tejido pulpar vital del hipoclorito de sodio al 5, 25% y clorhexidina al 2% / Dissolution capacity of pulp vital tissue by sodium hypochlorite 5, 25% and 2% chlorhexidine

Objetivo. Comprobar la capacidad de disolución de tejido pulpar vital de hipoclorito de sodio al 5.25% y Clorhexidina al 2% post instrumentación rotatoria. Material y método. Se analizaron treinta y dos primeros premolares superiores con vitalidad pulpar que se obtuvieron post exodoncia. Fueron agrupados en: grupo 1, irrigación con NaOCI 5,25%; grupo, 2, irrigación con CHX 2%; grupo 3 o control irrigación con suero fisiológico, seguidamente las piezas dentarias fueron instrumentadas con sistema de limas rotatorias, irrigadas con las soluciones descritas y posteriormente muestras histológicas fueron teñidas y finalmente observadas en microscopio óptico. Resultados. Mostraron que no hubo diferencia estadística significativa tanto en los grupos irrigados por NaOCI 5.25% y CHX 2% debido a que fueron encontrados tejido pulpar residual en todos los grupos. Los tercios coronarios fueron mayormente desprovisto de tejido pulpar que en los tercios apicales. La anatomía accesoria no fue desprovista de tejido pulpar. Conclusión. Aunque la CHX no tenga capacidad de disolver tejido pulpar y los resultados de este estudio no hayan demostrado diferencia estadística significativa en relación al NaOCI este resultado no se debe al efecto disolutorio de las soluciones irrigadoras sino a que el NaOCI no tuve suficiente tiempo de contacto con tejido pulpar (AU)

Aim. Of this study was to test the ability of vital pulp tissue dissolution of 5.25% sodium hypochlorite and 2% chlorhexidine after rotary instrumentation system. Material and methods. Thrity-two freshly extracted premolar teeth, with pulps vital at the time of extraction were assigned in groups. Group 1, 5.25% NaOCI irrigation, group 2, 2% CHX irrigtation, group 3 with distilled water irrigation as control. After to teeth were instrumented with rotary files system, irrigated with the solutions described and decalcified. Each root was divided in thirds and transverse histological sections were perfomed at four levels, then histological samples were stained and observed in microscope optical. Results. No statistically significant differences were found in both groups irrigated by 5.25% NaOCI and CHX 2% residual pulp tissue were found in all groups. Coronal parts were more frequently devoid of pulp tissue than the apical. The isthmus had residual pulp tissue less frequently in the NaOCI groups. Accessory anatomy was unaffected regardless of irrigant. Conclusions. Although CHX has no ability to dissolve pulp tissue and the results of this study were not statistically significantly compared to NaOCI. This results this is not due to the dissolving effect of irrigating solutions but that NaOCI did not have enough time contact with pulp tissue (AU)

In vitro antimicrobial activity of Sodium hypochlorite, Chlorhexidinegluconate and Octenidine Dihydrochloride in elimination of microorganisms within dentinal tubules of primary and permanent teeth

The aim of this study was to evaluate the effectiveness of different irrigation solutions at different time intervals for the elimination of E.faecalis and C.albicans penetrated into the dentine tubules of primary and permanent teeth in vitro.The 4mm primary and permanent teeth sections were sterilized and contaminated with a mixture of E.faecalis and C.albicans strains. After the apllication of different irrigation solutions (..) (AU)

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Biofilm. Un Nuevo concepto de infección en Endodoncia / Biofilm. A new infection concept in endodintics

Distintos estudios concluyen que el porcentaje de éxito del tratamiento de conductos en dientes necróticos es menor que en dientes vitales. Hoy día, se postula que la verdadera causa de fracaso de muchos tratamientos de conductos aparentemente correctos es la entidad infecciosa conocida como biofilm. Además, se ha mostrado como un tipo de infección doble. Por un lado, conocer el papel del biofilm en Endodoncia: morfología, metabolismo, formación, evolución y localización. Por otro, actualizar los métodos que propone la Endodoncia para controlarlo y eliminarlo, poniendo especial atención EN la técnica de irrigación. Elegida por muchos autores como la clave para su tratamiento (AU)

Different studies have concluded that the success rate of root canal treatment in necreotic teeth is lower than in vita l teeth. Nowadays, the real cause of failure in many root canal treatment that have apparently been correctly carried out is considered to be the infectious matter know as biofilm. Elimination form the canal of this type of infection has proved to be very difficult and has become one of the great challenges in modern endodontics. The aim of this review article is twofold: firstly, to understand the role of bifilm in endodontics, with respect to its morphology, metabolism, formation, evolution and localization, and, secondly to update endodontic procedures for controlling and eliminating it, paying particular attention to the technique of irrigation which is the preferred key to treatment of many authors (AU)

Limpieza de las paredes del conducto usando una combinaciónde hipoclorito de sodio 2, 5% - ácido cítrico 10% y clorhexidina 2% - ácido citrico 10% / Clenalness of the root canal walls using a combination of 2, 5% sodium hypoclorte – 10% citric acid and 2% chlorhexidine – 10% citric acid

Objetivo. El propósito de este estudio fue comparar el grado de limpieza de lasparedes del conducto radicular utilizando como irrigantes la combinación de hipoclorito de sodio 2,5% - ácido cítrico 10% y clorhexidina 2% ácitdo cítrico 10%. Material y métodos: Se emplearon raíces de 35 premolares, unirradiculares de conducos rectos recientemente extraídos. L amismas fueron instrumentadas e irigadas con ls soluciones citadas, secciondas longitudinalmente y observadas al MEB a nivel cervial, medio y apical. Resultados: Los resultados indicaron limpieza de las paredes del conducto radicular con el uso de ambas cobinaciones,siendo en e terci medio, estadísticamente más efectiva la obtenida con a asociación hipoclori de sodio 2,5% - ácido cítrico 10% (p= 0,00<0,05). Conclusioes: La asociacion d ehipoclorito de sodio 2,5% - ácido cítirico 10% demostró mayor apacidad para remover la capa residual que la asociación de clorexidina 2%- ácido citrico 10% (AU)

Objective: In this study the cleanliness of the root canal walls was copared, using as irrigators the combinations of 2,5% sodium hypochlorite – 10% citric acid, and 2% chrohexidene – 10% citric acid. Material and methods: 35 single- rooted human premolars, recently extracted wereused. The same roots were instrumented and irigated with the combinatios mentioned above , then roots were sectione and observed with Scanning Electron Microscopic in cervical, middle and apical levels. Reslts: The results showed cleanliness o the root canal walls with the use of both combiations, being statistcaly more significantin the third middle, the one obtained with the combination of 2,5% sodium hypochlorite –10% citric acid (p=0 0<0,05). Conclussions: The association of 2,5% sodium hypochloite 10% citic acid was more efficiente than the combination of 2% chorhexidine- 10% citric acid (AU)

Evaluación comparativa del poder de desinfección del hipoclorito de sodio 5,25% versus hipoclorito de sodio 0,5% asociado al Endo-PTC, de conductos radiculares contaminados in vitro por Enterococcus faecalis / No disponible

Objetivo: El objetivo de este estudio fue evaluar la desinfección propiciada por diferentes sustancias químicas auxiliares en 34 incisivos centrales superiores extraídos y contaminados in vitro pro Enterococcus faecalis. Material y método. Los clientes tenían el foramen apical estandarizado y sellado con resina epoxi. Después de la inoculación del medio de cultivo con las bacterias, los conductos fueron instrumentados utilizando soda clorada (Grupo 1) y el líquido de Dakin asociado al Endo-PTC (Grupo 2). Terminada la preparación, los conductos se lavaron con Tiosulfato de Sodio y suero fisiológico, cuando se realizó la primera recogida de muestras para el cultivo. Después de 24 horas se realizó un nuevo cultivo. El crecimiento bacteriano fue evaluado a través de patrones en dos medios de cultura -BHI y Agar-sangre. Resultados: Los resultados muestran no existir diferencias estadísticamente significativas entre los grupos (AU)

Objective The objective of this study was to evaluate the disinfection´s properties of the sodium hypoclorite 5,25% compared to the sodium hypoclorite 0,5% associated with Endo-PTC in vitro Enterococcus foecalis infected canals. Materials and methods: The canals of 34 extracted superior central incisors had been instrumented 2mm beyond the apical foramen, with a K-file 40 and the apexes were closed with epoxi resin. Canals had been inoculated with 5 drops of the BHI broth containing the bacteria and incubated at 37ºC for seven days. The experimental groups were instrumented using sodium hypoclorite 5,25% (Group1 - 15 teeth), or sodium hypoclorite 0,5% associated to Endo-PTC (Group 2-15 teeth). After that, the canals were rinsed with 5ml of sodium tiosulfate and 5 ml of saline solution. A first sample for culture was taken, and a new one was carried out after 24 hours. The bacterial growth was evaluated through scores - without growth, minimum, medium and intense growth in BHI broth and Agar blood plates. Results. The results had shown no statistically differences among them (AU)

Recontamination of coronally unsealed root canals medicated with camphorated paramonochlorophenol or calcium hydroxide pastes after saliva challenge / Recontaminação de canais radiculares não selados coronariamente medicados com paramonoclorofenol canforado ou pastas de hidroxido de cálcio após exposição com a saliva

This in vitro study evaluated the ability of some medications to prevent recontamination of coronally unsealed root canals by bacteria from saliva. The medications tested were camphorated paramonochlorophenol (CPMC) applied in cotton pellts in the pulp chamber; calcium hydroxide/saline solution paste filling the root canal; and calcium hydroxide/CPMC/glycerin paste also filling the root canal. Medicated canals were exposed to saliva, and the number of days required for total recontamination to occur was recorded. Canals medicated with CPMC in cotton pellets were thoroughly recontaminated within an average of 6.9 days. Canals filled with calcium hydroxide/saline solution and calcium hydroxide/CPMC/glycerin showed entire recontamination within an average of 14.7 and 16.5 days, respectively. Calcium hydroxide pastes were significantly more effective than CPMC (p<0.05)

Reação do tecido conjuntivo subcutâneo de rato ao MTA e ao hidróxido de cálcio / Reaction of rat connective tissue to implanted Mineral Trioxide Aggregate (MTA) and to calcium hydroxide

Foram analisadas as reações que ocorrem no tecido conjuntivo de ratos em contato com tubos de polietileno, contendo agregado de trióxido mineral (MTA) e uma pasta de hidróxido de cálcio (Calen). Os animais foram sacrificados nos períodos de 7, 14 e 30 dias. A maioria dos espécimes foram corados com hematoxilina e eosina, os demais com a técnica de Von Kossa para tecidos mineralizados. Próximo às aberturas do tubo foi constatada a presença de insenso infiltrado inflamatório, que no período de 30 dias de apresentou leve. Foi observada tanto junto ao agregado de trióxido mineral como junto à pasta de hidróxido de cálcio (Calen), a formação de uma cápsula fibrosa fina. Nos espécimes tratados pela técnica de Von Kossa somente foram encontradas áreas positivas nos que continham hidróxido de cálcio (Calen)

Antimicrobial activity of drugs used in pulp therapy of deciduous teeth

The antimicrobial effectiveness of seven drugs used in pulp therapy of deciduous teeth-Guedes Pinto, zinc oxide, calcium hydroxide and mixed pastes, formocresol, 1/5 formocresol and 2 per cent glutaradehyde - was evaluated againts S. aureus, S. epidermidis, S. mutans, S. sanguis, E. faecalis and E. coli, microorganisms that can be detected in infected root canals, and also against B. subtilis, a spore-forming bacteria which possesses recognized resistance to many chemical agents, The activity tests were carried out according to the disk diffusion method on Brain-Heart Infusion Agar supplemented with blood; the drugs were placed on filter paper disks and then on culture medium. Samples of the antimicrobial agents were assayed just after their preparation and 7, 14, 28, 60 and 90 days later; the agents were kept at 37ºC throughout. After incubation at 37ºC, the diameters of the inhibition zones were measured. The antimicrobial effect decreased with time depending on the drug used and on the bacterial strain tested. The data indicate that the zinc oxide paste had the strongest and 1/5 formocresol the weakest antimicrobial activity. The differences were all statiscally significant except for 2 per cent glutaraldehyde and formocresol, which were similar to each other

Análise pela microscopia eletrônica de varredura da limpeza das paredes dos canais radiculares segundo as substâncias irrigadoras de acordo com três diferentes técnicas / Analisys through the scanning electron microscopy of root canals walls cleaning as to the irrigation substances in accordance with three differents techniques

Buscou-se verificar in vitro a remoçäo de restos pulpares e magma dentinário das paredes dos canais radiculares, quando do emprego na irrigaçäo final de substâncias químicas segundo três diferentes técnicas. No P.Q.C. utilizou-se a técnica telescópica e hipoclorito de sódio a 1 por cento. A irrigaçäo final foi de 30 ml: Grupo I - 10ml de hipoclorito de sódio a 1 por cento + 10 ml de ácido cítrico a 10 por cento + 10ml de água destilada; Grupo II - 15ml de hipoclorito de sódio a 0,5 por cento + 15 ml de EDTA-T; Grupo III - 10 ml de hipoclorito de sódio a 5 por cento + 10 ml de água oxigenada a 3 por cento + 10 ml de hipoclorito de sódio a 5 por cento. A avaliaçäo pelo MEV fez-se pela média da leitura dos túbulos dentinários visíveis segundo 3 observadores de uma fotomicrografia de cada terço...