To flat or not to flat? Exploring the impact of flat-side design on rotary instruments using a comprehensive multimethod investigation.

AIM: To assess the influence of a flat-side design on the geometry, metallurgy, mechanical performance and shaping ability of a novel nickel-titanium rotary instrument. METHODOLOGY: Sixty-five new 25-mm flat-side rotary instruments (size 25, taper 0.04) and their nonflat-side prototypes (n = 65) were assessed for major deformations and examined regarding macroscopic and microscopic design, determination of nickel and titanium elements ratio, measurement of phase transformation temperature and evaluation of mechanical performance parameters including time/cycles to fracture, maximum torque, angle of rotation, maximum bending and buckling strengths and cutting ability. Additionally, unprepared canal areas, volume of hard tissue debris and percentage reduction of dentine thickness were calculated for each tested instrument after preparing mesial canals of mandibular molars (n = 12), using micro-CT imaging. Statistical analyses were performed using the U-Mann-Whitney test and independent Student t-test (α = 5%). RESULTS: The number of spirals (n = 8) and blade direction (clockwise) were similar between both flat and nonflat instruments, whilst the helical angles were equivalent (⁓25°). Flat-instruments showed inconsistencies in the homogeneity of the gold colour on the flat-side surface, blade discontinuity, and incomplete and variable S-shaped cross-sections. The titanium-to-nickel ratios were equivalent, but significant differences in the R-phase finish and austenitic start phase transformation temperatures were observed between the flat and nonflat-side instruments. The flat-side instruments demonstrated superior cutting ability compared to the nonflat instruments, as well as, significantly lower values for time to fracture, rotation to fracture and maximum torque to fracture (p < .001). No statistical difference was observed between tested instruments regarding angle of rotation (p = .437), maximum bending (p = .152) and buckling load (p = .411). Preparation protocols using flat and nonflat instruments did not show any statistically significant differences (p > .05). All flat-side instruments exhibited deformation after shaping procedures. CONCLUSIONS: The flat-side instrument showcased enhanced cutting ability compared to its nonflat counterpart. However, it exhibited inferior performance in terms of time, rotation and maximum torque to fracture, along with distinct phase transformation temperatures. No differences were observed in the titanium-to-nickel ratios, angle of rotation, maximum bending, buckling load, preparation time, percentage of untouched canal walls, volume of hard tissue debris and percentage reduction of dentine thickness.

Influence of ultrasonic agitation on bond strength, marginal adaptation, and tooth discoloration provided by three coronary barrier endodontic materials.

OBJECTIVES: The effect of ultrasonic agitation (UA) on bond strength and adaptation of cervical plugs prepared with MTA Angelus (MTA), MTA Repair HP (MTAHP), and Biodentine (BIO) was evaluated. Dentin discoloration caused by the materials/treatment was also assessed. MATERIALS AND METHODS: Seventy-two single rooted teeth were divided into six groups depending on the materials/treatment. After cervical plug preparation, dentin discs were excised for the push-out test; additional discs were analyzed under the confocal microscope to determine adaptation (gaps occurrence). For dentin discoloration analysis (ΔE), blocks of bovine incisors had cavities prepared and filled with the materials/treatment (from 7 to 180 days). RESULTS: Both bond strength and adaptation were positively influenced by UA (P < 0.05). Comparison between materials showed an advantage for BIO when compared to MTAHP (P < 0.05). The best and worst results were provided by BIO/UA (12.66 MPa and 1.87%) and MTAHP (2.54 MPa and 28.58%), respectively. For ΔE, significant differences were observed throughout the periods. Just the MTA without UA exhibited noticeable discoloration at 180 days (P < 0.05). CONCLUSIONS: UA favored a better adaptation of the materials to the dentin root, resulting in higher bond strength and adaptation of the materials to the root canal walls. Moreover, UA reduced MTA discoloration, keeping it imperceptible over the period evaluated. CLINICAL RELEVANCE: The better adaptation and higher bond strength provided by UA can be considered clinically relevant due to the importance of maintaining blood clot integrity and the possible esthetic compromise provided by reparative materials when used as coronary barrier in regenerative procedures.

Retrospective analysis of the effects of orthognathic surgery on the pharyngeal airway space.

PURPOSE: Dentofacial deformities can be defined as defects in the growth and development of facial bones, mainly the maxilla and mandible. Such deformities can change the dimension and function of the pharyngeal airway space and orthognathic surgery is the treatment of choice. The aim of this study was to evaluate changes in the pharyngeal airway space after orthognathic surgery and test the ability of cone-beam computed tomographic (CBCT) imaging to allow analysis of the airway. MATERIALS AND METHODS: Pre- and postoperative measurements were taken using CBCT images of 100 patients who underwent orthognathic surgery. RESULTS: The results showed an increase of the airway at the middle portion in the anteroposterior and lateral directions in the maxillary advancement, mandibular advancement, and maxillomandibular advancement groups. The results also showed an increase of total area in the maxillary advancement, mandibular advancement, maxillomandibular advancement, and maxillary advancement and mandibular setback groups. Total sagittal area increased in accord with bone movement. CONCLUSIONS: CBCT imaging allows the analysis of the effects of orthognathic surgery on the pharyngeal airway. Changes to the airway follow the maxillomandibular advancement that is carried out and the maxillary and mandibular advancements increase the upper and middle airway in the anteroposterior and lateral directions.

Influence of Different Apical Foramen Morphologies on the Accuracy of Four Electronic Foramen Locators.

OBJECTIVE: The aim of this study was to evaluate the accuracy of the Root ZX II (RZX), Raypex 6 (RAY), EPex Pro (EPEX), and CanalPro (CNP) electronic foramen locators (EFLs) in different foraminal morphologies (fully formed foramen, immature foramen with parallel walls, and immature foramen with divergent walls); this article also evaluated the influence of different penetration levels (0.0 mm and -1.0 mm). MATERIALS AND METHODS: Thirty single-rooted human premolars were accessed and had their cervical/middle thirds prepared with SX ProTaper files. The apical foramens (AF) were standardized to 250 µm and the initial root canal length (RCL1) was measured under 16x magnification with aid of a digital caliper. Using the alginate model, electronic measurements (EM) were taken 1.0 mm up to AF (EM1/-1) and at AF (EM1/0), always using adjusted hand K-files. The root apexes were then cross-sectioned 3.0 mm from the foramen; then, new RCL (RCL2) and electronic measurements were performed (EM2/-1 and EM2/0.0). Finally, retropreparations were performed with instruments SX ProTaper files introduced 4.0 mm in the apicocervical direction. Then new RCL (RCL3) and electronic measurements (EM3/-1 and EM3/0) were performed. STATISTICAL ANALYSIS: Values were tabulated and tested for normality using the Shapiro-Wilk test, which yielded nonparametric distributions of the data. Data were subjected to the Kruskal-Wallis and Dunn tests to estimate possible differences between devices as a function of foramen morphology and/or apical limit. The significance level was set at 5.0%. RESULTS: In general, the EFLs were accurate in determining the RCL. Statistically significant differences were observed between EPEX and RAY at 0.0, when measuring the divergent AF canals (p < 0.05). Regarding the different foramen morphologies in each EFL, RZX and EPEX showed no interference (p > 0.05), whereas RAY and CNP had lower accuracy levels at 0.0 with divergent AF (p < 0.05). CONCLUSION: The four devices evaluated are accurate to determine the RCL in the conditions tested. The apical limit of penetration did not have significant influence on their accuracy. Conversely, the presence of divergence in the AF walls negatively influenced de RAY and CNP precisions at the foraminal level.

The antimicrobial effect of new and conventional endodontic irrigants on intra-orally infected dentin.

OBJECTIVES: To evaluate if the incorporation of antimicrobial compounds to chelating agents or the use of chelating agents with antimicrobial activity as 7% maleic acid and peracetic acid show similar disinfection ability in comparison to conventional irrigants as sodium hypochlorite or iodine potassium iodide against biofilms developed on dentin. MATERIALS AND METHODS: The total bio-volume of live cells, the ratio of live cells and the substratum coverage of dentin infected intra-orally and treated with the irrigant solutions: MTAD, Qmix, Smear Clear, 7% maleic acid, 2% iodine potassium iodide, 4% peracetic acid, 2.5% and 5.25% sodium hypochlorite was measured by using confocal microscopy and the live/dead technique. Five samples were used for each irrigant solution. RESULTS: Several endodontic irrigants containing antimicrobials as clorhexidine (Qmix), cetrimide (Smear Clear), maleic acid, iodine compounds or antibiotics (MTAD) lacked an effective antibiofilm activity when the dentin was infected intra-orally. The irrigant solutions 4% peracetic acid and 2.5-5.25% sodium hypochlorite decrease significantly the number of live bacteria in biofilms, providing also cleaner dentin surfaces (p < 0.05). CONCLUSIONS: Several chelating agents containing antimicrobials could not remove nor kill significantly biofilms developed on intra-orally infected dentin, with the exception of sodium hypochlorite and 4% peracetic acid. Dissolution ability is mandatory for an appropriate eradication of biofilms attached to dentin.

Effect of Additional Apical Preparation on Retreatment of Curved Root Canals Filled with Different Sealers.

OBJECTIVE: This study assessed the influence of additional apical preparation on material removal during retreatment of curved root canals filled with different sealers. MATERIALS AND METHODS: Twelve mesial roots of mandibular molars with two separate canals and curvature between 25 and 35 degrees were selected. The working length was established 1-mm short of the apical foramen, and all the root canals were prepared using ProDesign R (PDR) 25/0.06. After preparation, the root canals were divided in two groups (n = 12) and filled by continuous wave condensation technique with NeoMTA Plus or AH Plus. All the root canals were retreated using rotary ProDesign Logic RT 25/0.08, reciprocating PDR 25/0.06 and apical preparation with PDR 35/0.05. Additional apical preparation was performed with ProDesign Logic (PDL) 50/0.01. The samples were scanned using a Skycan 1176 micro-computed tomography (micro-CT), voxel size 8.74 µm, before and after the retreatment procedures. Percentages of remaining filling material were evaluated. STATISTICAL ANALYSIS: The data were submitted to paired and unpaired t-tests (α = 0.05). RESULTS: Percentage of remaining filling material was similar between the root canals filled with NeoMTA Plus or AH Plus sealer after retreatment using PDR 35/0.05, and after additional apical preparation using PDL 50/0.01 (p > 0.05). However, PDL 50/0.01 significantly decreased the percentage of remaining filling material in the apical third after the additional apical preparation for both sealers (p < 0.05). CONCLUSION: NeoMTA Plus or AH Plus did not influence the retreatment of curved root canals. ProDesign Logic 50/0.01 promoted greater filling material removal in the apical third.

The Multifarious Functions of Leukotrienes in Bone Metabolism.

Leukotrienes (LTs) are derived from arachidonic acid metabolism by the 5-lipoxygenase (5-LO) enzyme. The production of LTs is stimulated in the pathogenesis of rheumatoid arthritis (RA), osteoarthritis, and periodontitis, with a relevant contribution to bone resorption. However, its role in bone turnover, particularly the suppression of bone formation by modulating the function of osteoclasts and osteoblasts, remains unclear. We investigated the effects of LTs on bone metabolism and their impact on osteogenic differentiation and osteoclastogenesis using a 5-LO knockout (KO) mouse model. Results from micro-computed tomography (µCT) analysis of femur from 8-week-old 5-LO-deficient mice showed increased cortical bone and medullary region in females and males and decreased trabecular bone in females. In the vertebra, we observed increased marrow area in both females and males 5-LO KO and decreased trabecular bone only in females 5-LO KO. Immunohistochemistry (IHC) analysis showed higher levels of osteogenic markers tissue-nonspecific alkaline phosphatase (TNAP) and osteopontin (OPN) and lower expression of osteoclastogenic marker tartrate-resistant acid phosphatase (TRAP) in the femurs of 5-LO KO mice versus wild-type (WT). Alkaline phosphatase activity and mineralization assay results showed that the 5-LO absence enhances osteoblasts differentiation and mineralization but decreases the proliferation. Alkaline phosphatase (ALP), Bglap, and Sp7 gene expression were higher in 5-LO KO osteoblasts compared to WT cells. Eicosanoids production was higher in 5-LO KO osteoblasts except for thromboxane 2, which was lower in 5-LO-deficient mice. Proteomic analysis identified the downregulation of proteins related to adenosine triphosphate (ATP) metabolism in 5-LO KO osteoblasts, and the upregulation of transcription factors such as the adaptor-related protein complex 1 (AP-1 complex) in long bones from 5-LO KO mice leading to an increased bone formation pattern in 5-LO-deficient mice. We observed enormous differences in the morphology and function of osteoclasts with reduced bone resorption markers and impaired osteoclasts in 5-LO KO compared to WT osteoclasts. Altogether, these results demonstrate that the absence of 5-LO is related to the greater osteogenic profile. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

High doses of zoledronic acid induce differential effects on femur and jawbone microstructure.

OBJECTIVES: The aim of this study is to investigate the long-term effects on jaw and femur bone induced by oncologic doses of zoledronic acid in a young rat model. MATERIAL AND METHODS: Six 12-week-old male Wistar rats received zoledronic acid (0.6 mg/kg) and six control rats received saline solution in the same volume. Compounds were administered intraperitoneally in five doses every 28 days. Euthanasia was performed 150 days after therapy onset. After animal sacrifice, their mandibles and femurs were scanned ex vivo using a high-resolution (14 µm) micro-computed tomography. Morphometric bone parameters were calculated using CT-Analyzer (Bruker, Belgium) between the first and second mandibular molars and in the distal femur metaphysis and epiphysis. RESULTS: The treatment group as compared to the controls showed a significantly (p < .05) increased bone quantity (↑BV/TV, ↓Po[Tot], ↑Tb.Th), bone density (↑TMD, ↑BMD), and osteosclerosis of the trabecular bone (↓Tb.Sp, ↓Conn.Dn, ↓Tb.Pf, ↓SMI) in all anatomical sites. Bone remodeling suppression due to zoledronic acid treatment was more pronounced (p < .05) in the femoral metaphysis relative to the mandible and epiphysis. The exploratory linear discriminant analysis showed that for the mandible, it was mainly the bone quantity-related morphometric indices (BV/TV and Tb.Th), while for the femoral epiphysis and metaphysis, it was bone structure-related (Tb.Pf and Tb.N), which are of primary importance to study the treatment effect. CONCLUSION: High doses of bisphosphonates can differently affect the bone quantity, density, and structure in long bones and jawbones. In the metaphysis, bone changes were primarily concentrated in the region of the growth plate. Future studies may consider the use of bone morphometric indices to evaluate the effect of bisphosphonates.

Cyclic and Torsional Fatigue Resistance of Seven Rotary Systems.

Introduction: This study aims to evaluate the cyclic and torsional fatigue resistance of seven rotary systems. Methods and Materials: A total of 140 instruments were tested, 20 of each system including Genius (GN) 25/0.04, TruShape (TS) 25/0.06, Logic (LOG) 25/0.06 taper, Vortex Blue (VB) 25/0.06, ProTaper Gold (PTG) 25/0.08, Hyflex CM (HCM) 25/0.06 and Hyflex EDM (EDM) 25/0.08 taper. Cyclic fatigue resistance testing was performed using an artificial stainless steel canal with a curvature (60° angle and 5-mm radius) located at 5 mm from the tip. The files (n=10) rotated until fracture, and time was recorded in seconds. The torsional test was evaluated according to ISO 3630-1. Data were analysed with one-way ANOVA and Tukey's tests (α=5%). The fractured surface of the instruments were assessed using scanning electron microscopy to confirm the type of fracture. Results: The cyclic fatigue resistance value of EDM was significantly higher than those of all tested instruments (P<0.05). LOG showed a higher cyclic fatigue resistance than GN or TS (P<0.05). There was no difference among the other groups (P>0.05). The torsional test showed that PTG 25/0.08 had the highest torsional strength value of all instruments tested followed by VB and EDM (P<0.05). The LOG showed significant difference only with GN (P<0.05). No difference was found among the other groups (P>0.05). In relation to angular deflection, the GN; TS; HCM, and EDM showed significantly higher values until fracture than the other groups (P<0.05). No difference was found among PTG, LOG, and VB (P>0.05). Conclusion: Our in vitro study EDM group had the highest cyclic fatigue resistance among all the tested instruments. For the torsional test, the PTG showed highest torsional strength and lowest angular deflection values.

Alveolar socket healing in 5-lipoxygenase knockout aged female mice treated or not with high dose of zoledronic acid.

This study investigated the role 5-lypoxigenase (5-LO) on alveolar socket healing in aged female mice treated with zoledronic acid (ZL). Forty 129/Sv female mice (64-68 weeks old), 20 wild type (WT) and 20 5-LO knockout (5LOKO) were equally distributed according to ZL treatment: WT Control, WT ZL, 5LOKO Control, and 5LOKO ZL. ZL groups were treated with an intraperitoneal injection of 250 µg/Kg of ZL, while controls were treated with saline. Treatments were administered once a week, starting four weeks before surgery for tooth extraction and until 7 and 21 days post-surgery. Mice were euthanized for a comprehensive microscopic analysis (microCT, histomorphometry and immunohistochemistry). WT ZL mice presented intense inflammatory infiltrate (7 days), delayed bone formation (21 days), reduced collagenous matrix quality, and a deficiency in Runx-2 + , TRAP + , and macrophages as compared to controls. 5LOKO ZL animals presented decreased number of Runx-2 + cells in comparison to 5LOKO Control at 7 days, but no major changes in bone healing as compared to WT or 5LOKO mice at 21 days. The knockout of 5LO favored intramembranous bone healing in aged female mice, with a direct impact on inflammatory response and bone metabolism on the development of ONJ-like lesions.

Scanning electron microscopic evaluation of the root apex of mandibular premolars.

This aim of this study was to evaluate the root apex of mandibular premolars regarding the presence of main and accessory foramina. The root apexes from fifty extracted mandibular single-rooted premolars were examined by scanning electron microscopy (SEM). The apical openings had their diameter measured and were identified as main or accessory foramina. Double blinded and calibrated examiners analyzed the SEM photographs and classified the premolar roots into three types, based on the presence and size of the apical openings. Type I: roots with a single main apical foramen and no accessory foramina; type II: roots with a main foramen and one or more accessory foramina; type III: roots with accessory foramina only. For the first premolar, 16 roots were classified as type I (48.48%), 4 as type II (12.12%) and 13 as type III (39.40%). For the second premolars, 10 roots were classified as type I (58.83%), 3 as type II (17.65%) and 4 as type III (23.52%). The high incidence of roots with accessory foramina only (type III), mainly in the first premolar, warns of the need for caution during working length determination and apical debridement.

Efficacy of reciprocating systems for removing root filling material plus complementary cleaning methods in flattened canals: Microtomography and scanning electron microscopy study.

The aim of this study was to evaluate three reciprocating systems and complementary cleaning methods on filling material removal during retreatment of flattened canals. Thirty-six mandibular incisors were prepared using rotary instruments up to size 25.08 and filled using the single-cone technique. Subsequently, the teeth were divided into three groups (n = 12) according to retreatment procedures: Reciproc Blue (RB): 25/0.08 and 40/0.06; ProDesign R (PDR): 25/0.06 and 35/0.05; and WaveOne Gold (WOG): 25/0.07 and 35/0.06. The remaining filling volume materials were assessed by means of micro-CT imaging before and after retreatment. After this, the specimens were subdivided into three groups according to complementary cleaning methods: XP-Endo Shaper (30/0.01); passive ultrasonic irrigation (PUI); 60° oscillatory instrumentation with #30 H-file, and micro-CT scan was taken. Then, the roots were cut in half and the samples were analyzed by scanning electron microscope (SEM). The data were analyzed statistically using Kruskal-Wallis and Dunn's Multiple Comparison test with significance level of 5%. None of the reciprocating files promoted complete removal of filling material and there was no statistical difference between the groups, regardless instrument size (p > 0.05). Complementary cleaning methods increased remnant filling removal (p < 0.05). XP-endo Shaper significantly reduced the amount of filling material in the apical and middle thirds, compared with H-files (p < 0.05), with no difference with PUI. In the SEM, there was no statistical difference among the instruments (p > 0.05). The reciprocating systems showed similar effectiveness in removing root filling material. Complementary cleaning method with the XP-Shaper enhanced filling material removal.

Computed microtomography evaluation of calcium hydroxide-based root canal dressing removal from oval root canals by different methods of irrigation.

The aim of this study was to evaluate the capacity of conventional irrigation, passive ultrasonic irrigation (PUI), and Easy Clean for removing calcium hydroxide-based root canal dressing from oval root canals. Thirty mandibular uniradicular incisors with oval canals were used, and subjected to chemical-mechanical preparation with Reciproc R40 instruments. The main canal was filled with a paste based on Ca(OH)2 P.A., iodoform and propylene glycol in the ratio of 3:1:1. The teeth were stored in 100% humidity at a temperature of 37°C for 14 days. Afterwards, the teeth were divided into three groups (n = 10) according to the method of irrigation used (conventional irrigation, PUI, and Easy Clean). The specimens were analyzed by computed microtomography at three time intervals: before placing the root canal dressing, with the root canal dressing in place, and after application of the irrigation methods for removing it. The data were submitted to Kruskal-Wallis and Dunn tests for analyzing the canal as a whole, and Friedman and Dunn for analyzing the root thirds. The results showed that conventional irrigation was less efficient for removing the root canal dressing in comparison with the methods that agitated the irrigant solution (p < .05). When the root canal was analyzed as a whole, Easy Clean, and PUI were similar (p > .05). In analysis of the thirds, Easy Clean was more efficient than conventional irrigation in all the thirds, while PUI showed this behavior only in the cervical third (p < .05). The authors concluded that in oval canals, none of the irrigation methods were capable of removing all the root canal dressing, however, the methods that agitated the irrigant solution were more efficient than conventional irrigation.

Evaluation of apical cavity preparation with a new type of ultrasonic diamond tip.

This study evaluated the time, occurrence of fracture, and quality of apical cavity preparation with three different ultrasonic diamond tips: Satelec, Trinity, and a new type, CVD (chemical vapor deposition), using scanning electron microscopy (SEM) analysis. Thirty human single-rooted premolars were selected, submitted to apicectomy, and prepared with ultrasonic tips; impressions were then obtained. The presence of fractures was evaluated on the impressions, and the quality of preparation was evaluated by SEM analysis of teeth and scoring by two examiners. The group prepared with the CVD tips exhibited the shorter preparation time and did not present fractures. There was no statistically significant difference in the quality of preparation for the three tips. The three brands of ultrasonic tips produced adequate grinding without altering the morphology of the apical foramen.

In Vitro Evaluation of Dentin Hydraulic Conductance After 980 nm Diode Laser Irradiation.

BACKGROUND: Dentin hypersensitivity treatments are based on the physical obliteration of the dentinal tubules to reduce hydraulic conductance. The aim of the present study is to evaluate the hydraulic conductance of bovine root dentin after irradiation with a 980-nm diode laser, with or without associated fluoride varnish. METHODS: Sixty bovine root dentin specimens were divided into six groups (n = 10 in each group): G1, G3, and G5 (0.5 W, 0.7 W, and 1 W diode laser, respectively); G2, G4, and G6 (fluoride varnish application + 0.5 W, 0.7 W, and 1 W diode laser, respectively). The dentin hydraulic conductance was evaluated at four time periods with a fluxmeter: 1) with smear layer, 2) after 37% phosphoric acid etching, 3) after the treatments, and 4) after 6% citric acid challenge. After the dentinal fluid flow measurements, specimens were also evaluated for mineral composition using energy dispersive X-ray spectroscopy (EDS). RESULTS: Analysis demonstrated a better result with increased irradiation power (P < 0.001), especially if the diode laser irradiation was associated with the application of fluoride varnish (P < 0.001), ensuring a greater reduction in permeability. Considering the groups treated only with laser irradiation, the 1 W group was superior when compared with the 0.5 W and 0.7 W irradiated groups immediately after treatment (P < 0.001). After citric acid testing, all groups showed similar results, except when comparing the 1 W groups with the 0.5 W groups (P = 0.04). EDS results of the irradiated groups showed an increase in the proportion of calcium and phosphorus ions, which demonstrates a superficial composition modification after laser treatments. CONCLUSION: Laser irradiation of exposed dentin promoted significant reduction in the dentin hydraulic conductance, mainly with higher energy densities and association with fluoride varnish.

Biocompatibility of Portland cement combined with different radiopacifying agents.

The aim of this study was to evaluate the response of rat subcutaneous tissue to Portland cement combined with two different radiopacifying agents, iodoform (CHI3) and zirconium oxide (ZrO2). These materials were placed in polyethylene tubes and implanted into the dorsal connective tissue of Wistar rats for 7 and 15 days. The specimens were then stained with hematoxylin and eosin, and inflammatory reaction parameters were evaluated by light microscopy. The intensity of the inflammatory response to the sealants was analyzed by two blind calibrated observers throughout the experimental period. Histological analysis showed that all the materials caused a moderated inflammatory reaction at 7 days, which then diminished with time. At 15 days, the inflammatory reaction was almost absent, and fibroblasts and collagen fibers were observed indicating normal tissue healing. The degrees of the inflammatory reaction on different days throughout the experimental period were compared using the non-parametric Kruskal-Wallis test. Statistical analysis demonstrated no significant differences amongst the groups, and Portland cement associated with radiopacifying agents gave satisfactory results. Therefore, Portland cement used in combination with radiopacifying agents can be considered a biocompatible material. Although our results are very encouraging, further studies are needed in order to establish safe clinical indications for Portland cement combined with radiopacifying agents.

Treatment of perforating internal root resorption with MTA: a case report.

Endodontic treatment of teeth with perforating internal root resorption represents a clinical challenge. In most cases, extraction of the tooth and subsequent replacement with an osseointegrated implant is indicated. Presented herein is a case report of a maxillary lateral incisor with advanced perforating internal root resorption in the middle third of the root and the presence of a sinus tract. Mineral Trioxide Aggregate (MTA) was used with the aid of a surgical microscope in order to fill the resorption area after conventional root canal therapy of the apical segment. At the follow-up after 11 years and 8 months, the patient was clinically asymptomatic and the sinus tract had disappeared. The radiographic examination and computerized tomography indicated periodontal bone repair.

Compressive Strength and Setting Time of MTA and Portland Cement Associated with Different Radiopacifying Agents.

Objective. The aim of this study was to evaluate the compressive strength and setting time of MTA and Portland cement (PC) associated with bismuth oxide (BO), zirconium oxide (ZO), calcium tungstate (CT), and strontium carbonate (SC). Methods. For the compressive strength test, specimens were evaluated in an EMIC DL 2000 apparatus at 0.5 mm/min speed. For evaluation of setting time, each material was analyzed using Gilmore-type needles. The statistical analysis was performed with ANOVA and the Tukey tests, at 5% significance. Results. After 24 hours, the highest values were found for PC and PC + ZO. At 21 days, PC + BO showed the lowest compressive strength among all the groups. The initial setting time was greater for PC. The final setting time was greater for PC and PC + CT, and MTA had the lowest among the evaluated materials (P < 0.05). Conclusion. The results showed that all radiopacifying agents tested may potentially be used in association with PC to replace BO.

Avaliação da precisão de dois localizadores foraminais na determinação do limite apical: estudo in vitro / Evaluation of the accuracy of two apex locators in determining apical limit: an in vitro study

O objetivo do presente estudo foi comparar in vitro a precisão de dois localizadores foraminais: Endus (Gnatus, Ribeirão Preto, SP, Brasil) e Root ZX (J. Morita, Tokyo, Japão). Material e Método: Trinta e dois dentes caninos permanentes humanos foram selecionados para o estudo. Após a realização da abertura coronária e preparo do terço cervical e médio, procedeu-se à determinação do comprimento real do dente pelo método visual, com introdução de um instrumento tipo K #10 até ser visto na saída foraminal sob magnificação de 16x com microscópio óptico de luz (DF Vasconcelos, São Paulo, Brasil). Para medição eletrônica, os dentes foram inseridos em um molde de alginato e as medidas realizadas com os dois localizadores foraminais até a saída do forame apical (0,0mm). Resultados: Os resultados evidenciaram um índice de precisão de 96,8% e 91,6% para os localizadores Gnatus e Root ZX, respectivamente. Conclusão: Ambos os localizadores apicais eletrônicos testados apresentaram alto índice de precisão na determinação do limite apical.

The aim of this study was to compare in vitro the precision of two locators foraminal: Endus (Gnatus, Ribeirão Preto, SP, Brazil) and Root ZX (J. Morita, Tokyo, Japan). Methods: Thirty-two canine teeth permanent humans were selected for the study, and, after effectuate the coronary opening and preparation of the cervical and middle third, proceeded to the determination of the real length of the tooth by the visual method, introducing an instrument file K #10 until be seen in foraminal exit under magnification of 16x optical light microscope (DF Vasconcelos, São Paulo, Brazil). For electronic measurement, the teeth were embedded in an alginate mold and electronic measurements with the two locators foraminal to the actual output of the apical foramen (0,0mm). Results: The results showed a 96.8% and 91.6% accuracy rates for the locators Gnatus and Root ZX, respectively. Conclusion: Both electronic apex locators tested presented high index of precision in the precise of determination in the apical limit.

Biofilm dissolution and cleaning ability of different irrigant solutions on intraorally infected dentin.

INTRODUCTION: The aim of this study was to evaluate the biofilm dissolution and cleaning ability of different irrigant solutions on intraorally infected dentin. METHODS: One hundred twenty bovine dentin specimens were infected intraorally by using a removable orthodontic device. Thirty samples were used for each irrigant solution: 2% chlorhexidine and 1%, 2.5%, and 5.25% sodium hypochlorite (NaOCl). The solutions were used for 5, 15, and 30 minutes and at 2 experimental volumes, 500 µL and 1 mL. The samples were stained by using acridine orange dye before and after the experiments and evaluated by using a confocal microscope. The percentage of biofilm, isolated cells, and noncolonized dentin was measured by using a grid system. Differences in the reduction or increase of the studied parameters were assessed by using nonparametric methods (P < .05). RESULTS: The higher values of biofilm dissolution and noncolonized dentin were found in the 30-minute NaOCl group and in the 5-minute and 15-minute groups of 5.25% NaOCL. The use of 2% chlorhexidine solution did not improve the biofilm dissolution or increase the cleaning of the dentin in comparison with the NaOCl solutions (P < .05). CONCLUSIONS: Two percent chlorhexidine does not dissolve the biofilms. Thirty minutes of NaOCl are necessary to have higher values of biofilm dissolution and to increase the cleaning of the dentin independently of the concentration in comparison with the 5-minute and 15-minute contact times.