Assessing push-out bond strength in re-irradiated teeth: Universal resin cement performance in self-etch and self-adhesive modes.

OBJECTIVES: To investigate the effect of cumulative doses of radiation on the pushout bond strength (BS) of a universal resin cement used in the self-etch (SE) and self-adhesive (SA) modes to the intraradicular dentin. MATERIALS AND METHODS: Forty-eight human teeth were distributed into three groups (n = 16) according to the radiation therapy dose (RT): NoRT (no-radiotherapy), 70RT (70 Gy), and 70 + 70RT (70 Gy + 70 Gy). The teeth were redistributed into two subgroups (n = 8), according to the adhesive mode: SE (NoRT-SE, 70RT-SE, and 70 + 70RT-SE) and SA (NoRT-SA, 70RT-SA, and 70 + 70RT-SA). Data were statistically compared after BS test (ANOVA, Tukey's post hoc test, and Fisher's exact test). RESULTS: In the SA mode, BS was significantly higher in nonirradiated teeth compared with 70RT and 70 + 70RT (p < 0.0001). There were no significant differences between SE and SA modes in nonirradiated teeth (p = 0.14). In the 70RT group, SE mode increased BS compared with SA mode (p < 0.0001). Most specimens had adhesive and mixed failures in SA and SE modes, respectively. CONCLUSIONS: The universal resin cement in the SE mode had greater BS to the irradiated dentin. When teeth were re-irradiated, the universal resin cement had similar performance in terms of BS, regardless of the adhesive approach. CLINICAL SIGNIFICANCE: There is no research establishing a correlation between radiotherapy and its impact on the BS of a universal resin cement used in SE and SA modes to intraradicular dentin.

Effect of radiation therapy on fracture resistance of simulated immature teeth submitted to root reinforcement.

BACKGROUND: The literature is scanty regarding the effect of radiation therapy (RT) on the mechanical properties of immature permanent teeth. AIM: To evaluate the effect of RT on the fracture resistance of simulated immature teeth submitted to different types of root reinforcement. DESIGN: Sixty-four human teeth simulating the Cvek stage 3 of root development were distributed into eight groups (n = 8), according to exposure or not to RT (70 Gy) and the root reinforcement method: Group NR (control)-no reinforcement/no RT; Group NR + RT (control)-no reinforcement/RT; Group PO-tricalcium silicate-based cement (TS) apical plug/canal obturation/no RT; Group PO + RT-TS apical plug/canal obturation/RT; Group TS-canal filling with TS/no RT; Group TS + RT-canal filling with TS/RT; Group FP-TS apical plug/fibreglass post/no RT; and Group FP + RT-TS apical plug/fibreglass post/RT. Fracture resistance was determined using a universal testing machine (0.5 mm/min). RESULTS: In the intergroup comparison, nonirradiated teeth had higher fracture resistance (p < .05). Groups FP and FP + RT had higher fracture resistance (p < .001). CONCLUSION: Radiotherapy affected the fracture resistance of simulated immature teeth. Reinforcement with fibreglass posts increased the fracture resistance, regardless of the radiation.

Are electronic apex locators accurate in determining working length in primary teeth pulpectomies? A systematic review and meta-analysis of clinical studies.

BACKGROUND: The lack of a well-defined apical constriction in primary teeth raises concerns regarding the accuracy of electronic apex locators (EALs) for measuring working length. OBJECTIVES: To evaluate the accuracy of EALs in determining working length in primary teeth pulpectomies. METHODS: Two reviewers searched ten databases up to September 2021. Clinical studies evaluating the accuracy of the electronic measurement of working length in primary teeth pulpectomies were included. Studies without a comparison group, with samples smaller than ten root canals, and that did not use a multiple frequency EAL were excluded. A meta-analysis was conducted to assess the paired differences in mean lengths between measurements obtained by electronic and comparative methods. In addition, a meta-analysis of proportion was applied according to the level of difference between the measures. The risk of bias and applicability of the studies were assessed using the QUADAS-2 tool. The certainty of evidence was assessed with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. RESULTS: Twenty-nine studies were included in the qualitative analysis and twenty-three in the quantitative analysis. The methods of comparison for the electronic measurement were the radiographic method, radiovisiographic, scanning electron microscopy, and direct visualization. The meta-analysis showed that the electronic measurement tends to be shorter than radiographic measurement, while the other methods showed no difference. The proportion analysis showed a higher pooled proportion of difference values between electronic and comparative measurements within -0.5 to +0.5 mm (69.31%). The certainty of the evidence suggested very low confidence in estimating the outcome. DISCUSSION: The results of this review denote a good performance of the EALs in determining working length in primary teeth pulpectomies. However, these results are based on clinical studies with low methodological quality and high heterogeneity, which require careful interpretation for clinical practice. CONCLUSIONS: Although the results suggest acceptable accuracy of EALs in determining working length in primary teeth pulpectomies, the low quality of the included studies and the very low certainty of the evidence require clinicians to interpret these results with caution. More robust evidence is required to support that these devices are accurate for primary teeth. REGISTRATION: CRD42021277414 (PROSPERO).

The influence of apical extent of root canal obturation on endodontic therapy outcome: a systematic review.

OBJECTIVES: This systematic review (SR) aimed to investigate the influence of obturation extent on the final outcome of root canal treatment (RCT), by answering the question "among patients requiring RCT on fully formed permanent teeth, is there an association between obturation extent and the final treatment outcome?" MATERIALS AND METHODS: Five electronic databases and three gray literature searches were performed. Observational studies investigating the association between obturation extent and RCT outcome in fully formed permanent teeth with a minimum follow-up of 12 months were included. We evaluated the risk of bias (RoB) in with MAStARI for cohort studies. The overall quality of the evidence was assessed with the GRADE-tool. RESULTS: Twenty-two studies were included, 2 had high RoB, 7 moderate RoB, and 13 low RoB. Underextended obturation demonstrated increased odds of an unfavorable outcome in seven studies, in which the odds varied between 6.94 (95%CI 2.20-21.87) and 1.73 (95%CI 1.02-2.95). Overextended obturation also demonstrated this association in four studies, with odds varying from 1.90 (95%CI 1.23-2.94) to 23.00 (95%CI 5.58-94.75). Due to heterogeneity and the very low level of evidence found in the GRADE analysis, the results from this SR should be interpreted with caution. CONCLUSIONS: Obturation extent seems to influence RCT outcome; overextended and underextended obturations showed higher chance of association with less favorable outcomes than adequate obturation; however, this association was not categorically supported. CLINICAL RELEVANCE: This SR provides information about obturation extent influence on RCT outcome and guides clinicians to make evidence-based decisions during endodontic practice.

Color Stability and Surface Roughness of Composite submitted to Different Types and Periods of Finishing/Polishing: Physical Properties of Composites.

AIM: The aim of this study was to evaluate the influence of accelerated artificial aging (AAA) on color stability (AE) and surface roughness of composite submitted to different systems and periods of finishing/polishing. MATERIALS AND METHODS: A Teflon matrix was used to fabricate 60 specimens that were separated into four groups, according to the finishing/polishing system: G1: no polishing; G2: abrasive papers; G3: rubber polishing disks; and G4: G2 + G3. Polishing was performed at three different time intervals (n = 6): immediately (Im), 24 hours (24 hours) and 7 days (7 day) after specimen fabrication. Initial color and surface roughness readouts were taken. Afterwards, specimens were submitted to AAA (480 hours) and new readouts were taken. RESULTS: Results demonstrated that G2 (7 day) presented lower AE, statistically different from G1 and G4 (7 days) (two-way analysis of variance (ANOVA), Bonferroni, p < 0.05). CONCLUSION: Regarding roughness, there was no difference among groups and periods. Polishing performed with abrasive papers, 7 days after performing the restoration, promoted less color alteration. CLINICAL SIGNIFICANCE: Most of composite restorations are replaced within a period shorter than 5 years due to esthetic failure, and correct finishing and polishing procedures are fundamental to avoid these problems.

Postoperative pain after endodontic treatment using 8.25% vs 2.5% sodium hypochlorite in necrotic mandibular molars with apical periodontitis: A randomized double-blind clinical trial.

BACKGROUND: This study aimed to evaluate whether the use of 8.25% sodium hypochlorite (NaOCl), compared with the use of 2.5% NaOCl, leads to higher postoperative pain after endodontic treatment. METHODS: A total of 154 patients were randomly assigned into 2 groups: 8.25% and 2.5% NaOCl. A single-visit endodontic treatment was performed using a standard protocol, varying only the NaOCl concentration. Postoperative pain was assessed using the numeric rating scale at multiple times over 30 days. Overall pain scores over time were explored via multilevel mixed-effects negative binomial regression. The need for pain medication was recorded and compared between groups via the Mann-Whitney U test. RESULTS: The use of 8.25% NaOCl increased postoperative pain scores over time by 3.48 times compared with the use of 2.5% NaOCl (incident rate ratio [IRR], 3.48; 95% CI, 1.57 to 7.67). Furthermore, the 8.25% NaOCl group exhibited higher pain incidence than the 2.5% NaOCl group during the 12-hour through 3-day period, with scores at these times ranging from 2.21 (IRR, 2.21; 95% CI, 1.35 to 3.62) through 10.74 (IRR, 10.74; 95% CI, 3.74 to 30.87) higher. No difference was detected in the number of analgesic capsules administered between groups. CONCLUSIONS: The use of 8.25% NaOCl resulted in higher postoperative pain than the use of 2.5% NaOCl, with pain scores increasing by 3.48 times when this solution was used. Furthermore, the 8.25% NaOCl group exhibited higher pain incidence than the 2.5% NaOCl group during the 12-hour through 3-day period. PRACTICAL IMPLICATIONS: The use of 8.25% NaOCl during endodontic treatment can increase postoperative pain significantly. This clinical trial was registered at the Brazilian Registry of Clinical Trials database (RBR-6vq3hc4).

Longer light-curing time decreases the effect of ageing on composite resin hardness used in root reinforcement.

This study evaluated the hardness of a composite resin used for root reinforcement, considering the light-curing time, root canal region and ageing due to long-term storage. Twenty incisor roots were reinforced using composite resin, varying the photopolymerisation time (40 or 120 s). Following fibre post cementation, the roots were transversely sectioned into coronal, middle and apical regions. Composite hardness was measured initially and after 18 months of water storage. Data underwent repeated measures analysis of variance and Tukey's post hoc tests. The factors 'light-curing time', 'root region' and 'ageing' affected the hardness. Significant interactions were observed between 'light-curing time × root region' and 'ageing × light-curing time'. Regardless of time, resin hardness in the apical region was lower. After ageing, hardness in the coronal and middle regions decreased when the light-curing time was 40 s, while no significant effect on hardness was noted with a light-curing time of 120 s.

Do Ultraconservative Access Cavities Hinder Endodontic Reintervention in Mandibular Incisors? A Laboratory Investigation.

This study assessed the influence of the type of endodontic access cavity on endodontic reintervention. Twenty mandibular central incisors were distributed into two groups (n = 10): TradAC group-traditional access cavities and UltraAC.Inc group-ultraconservative access cavities. After endodontic access, the root canals were prepared and obturated by the single cone technique. The filling material was removed with the Reciproc R25 instrument, followed by reinstrumentation with the R40 instrument. Images acquisition of each root canal hemisection was performed in a stereomicroscope to quantify the amount of remaining filling material. The amount of remaining filling material attached to the root canal walls was expressed in square millimeter (mm2). Data were statistically analyzed (one-way ANOVA and post hoc Student's t-tests). There was no statistically significant difference between TradAC and UltraAC.Inc groups (p > 0.05). None of the tested endodontics' access showed root canal walls completely free of filling material. Ultraconservative access cavities in mandibular incisors had no negative impact on the filling material removal.

Did in-between rinsing and agitating with distilled water prevents precipitate formation by the interaction between sodium hypochlorite and chlorhexidine canal irrigants?

The interaction of sodium hypochlorite (NaOCl) and chlorhexidine gluconate (CHX) produces an orange-brown precipitate. The present study evaluated the influence of distilled water (H2 O) in different irrigation protocols designed to prevent the formation of precipitate with NaOCl and CHX. Fifty canine teeth were instrumented and split longitudinally. The canal was examined with a stereomicroscope and photographed by canal-thirds. The tooth halves were repositioned and distributed randomly into five groups, according to the final irrigation protocol (n = 10): G1 (control)-Ethylenediaminetetraacetic acid (EDTA) + NaOCl + CHX, conventional irrigation (CI); G2-EDTA + NaOCl + CHX, activated with passive ultrasonic irrigation (PUI); G3-EDTA (PUI) + NaOCl (PUI) + H2 O (CI) + CHX (PUI); G4-EDTA + NaOCl + H2 O + CHX (PUI); G5-EDTA (PUI) + NaOCl (PUI) + H2 O (continuous ultrasonic irrigation [CUI]) + CHX (PUI). The specimens were evaluated with a stereomicroscope and scanning electron microscope (SEM). Energy dispersive x-ray spectroscopy analysis was performed to identify the elemental profile of the irrigated canal walls. The images were scored according to the extensiveness of precipitate. Data were analyzed (Kruskal-Wallis test, α = 5%). Under the stereomicroscope, G1 had significantly higher scores than all the other groups in all canal-thirds (p < .05). All four experimental groups showed similar scores (p > .05). There were no significant differences in precipitate formation among root-thirds in intragroup analysis (p > .05). Upon SEM examination, overall, only G5 had lower scores than G1 (p < .05). Analysis by canal-thirds showed no significant difference among groups and among canal-thirds in the intragroup analysis (p > .05). G1 showed high Cl peaks. In-between irrigation with H2 O activated by CUI is effective in preventing precipitate formation during canal debridement with NaOCl and CHX. RESEARCH HIGHLIGHTS: Continuous ultrasonic irrigation with distilled water was capable to prevent the precipitate formation. The precipitate can be classified as a chemical smear layer.

Effect of the timing of primary endodontic treatment and dosage of radiation therapy on the filling material removal.

This study investigated the effect of the timing of primary endodontic treatment and dosage of radiotherapy on the remaining filling material (RFM) during endodontic reintervention. 60 single-rooted human mandibular premolars were distributed into five groups (n = 12), according to the timing and dosage of radiation (55Gy or 70Gy): NegativeCG-non-irradiated teeth; Endo-pre-RT55/70-obturation before irradiation (55Gy or 70Gy); Endo-post-RT55/70-obturation and reintervention after irradiation (55Gy or 70Gy). Roots were cleaved and analysed under stereomicroscope and Scanning Electron Microscope to quantify (%) the RFM. Experimental groups had a significantly greater amount (p < 0.05) of RFM in the middle and apical thirds than the control group, except for Endo-pre-RT55 in the middle third (p < 0.0001). The apical third had greater amount of RFM (p < 0.05). Radiation therapy, before and after primary endodontic treatment, increased the amount of RFM, regardless of the dose delivered. When necessary, reintervention preferably must be performed before radiation therapy.

Effect of artificial accelerated aging on the optical properties and monomeric conversion of composites used after expiration date.

This study sought to evaluate how artificial accelerated aging (AAA) affected color stability (ΔE), opacity (ΔOP), and degree of conversion (DOC) for 3 composite materials (Tetric Ceram, Tetric Ceram HB, and Tetric Flow) used both 180 days before and 180 days after their expiration dates. To evaluate the materials' optical properties, 10 specimens of each composite-5 prior to expiration and 5 after the materials' expiration date-were made in a teflon matrix. After polishing, the specimens were submitted to initial color and opacity readings and submitted to AAA for 384 hours; at that point, new readings were taken to determine ΔE and ΔOP. To evaluate monomeric conversion evaluation, 6 specimens from each composite and expiration date-3 prior to AAA and 3 after-were submitted to DOC analysis. Results of the 2-way ANOVA and Bonferroni's tests (P < 0.05) demonstrated that all composites had ΔE values above the clinically acceptable level (ΔE ≥ 3.3). When expiration dates were compared, only Tetric Flow showed a statistically significant difference (P < 0.05). Regardless of the expiration date, ΔOP values for all composites increased after AAA, but not significantly (P > 0.05). The expired Tetric Flow had the highest DOC values (71.42% ± 4.21) before AAA, significantly different than that of the other composites (P > 0.05). It was concluded that both expiration date and AAA affected the properties of the composites tested.

Analysis of physicochemical properties of endodontic sealers containing rhodamine B.

The use of fluorescent dyes in microscopy studies is frequent. Therefore, it is important to investigate whether these compounds may alter the physicochemical properties of materials in which they are incorporated to avoid methodological biases. This study evaluated the physicochemical properties of two endodontic sealers containing dry or diluted rhodamine B. Six groups were evaluated: AH Plus and MTA Fillapex in their original composition and mixed with 0.1% dry or diluted rhodamine. Push-out test was applied to assess the bond strength to root dentin. ANSI-ADA No. 57 and ISO No. 6876:2012 specifications were followed to evaluate flowability, setting time, and solubility of the sealers. pH changes were assessed after 24 h, 7, and 30 days. Intergroup comparisons were analyzed by ANOVA complemented by Tukey's post-hoc test; comparisons among periods were analyzed by Wilcoxon and Friedman tests. The incorporation of dry rhodamine decreased the bond strength and prolonged the setting time of AH Plus. The incorporation of diluted rhodamine decreased the setting time and increased the flowability of MTA Fillapex. Diluted rhodamine promoted pH reduction of AH Plus after 24 h and dry rhodamine after 7 days. Rhodamine incorporation promoted pH reduction after 30 days for MTA Fillapex. Solubility was not affected. In conclusion, the incorporation of diluted rhodamine changed the properties of MTA Fillapex, and the incorporation of dry rhodamine changed the properties of AH Plus. Previous dilution of rhodamine did not severely compromise the physicochemical properties of AH Plus and may be suggested to assess its penetrability.

Impact of Heating Exposure on the Micro-Push-Out Bond Strength of Bioceramic Sealers.

Introduction: The aim of this study was to evaluate the effect of heating of bioceramic and epoxy resin-based sealers on their micro-push-out bond strength (BS) to root canal dentin. Methods: After criterial selection, 30 human teeth were decoronated and 1-mm thick slices (n = 60) were obtained perpendicularly along tooth axis, from cervical and middle root thirds, with a diamond disc attached to a cutting machine. In each slice, three 1.0-mm diameter orifices were made. After rinsing with 17% EDTA and 2.5% NaOCl, each orifice was filled with Bio-C Sealer or BioRoot RCS or AH Plus, according to the manufacturers' instructions. After filling, half of the slices (n = 30) were heated at 100°C for 1 min, and the other half were kept at room temperature. After 7 days-controlled storage, micro-push-out test was performed in a Universal Testing Machine. Failures were analyzed using a stereomicroscope. Statistical analysis was performed with One-Way ANOVA and post hoc Tukey (α = 5%) tests. Results: AH Plus demonstrated higher BS values after heating (p=0.001) when compared to nonheated. The other sealers did not show a statistically significant difference (p > 0.05). When heated, the average BS values for AH Plus were higher than for BioRoot RCS and Bio-C Sealer (p < 0.001). Cohesive failure mode was the most frequent, followed by adhesive and mixed ones. Conclusion: Heating provided a higher push-out BS to root dentin for AH Plus and did not influence BioRoot RCS or Bio-C sealer.

The effects of heating on the physicochemical properties of tricalcium silicate root canal sealers.

This study evaluated the effect of heating on the physicochemical properties and surface changes of tricalcium silicate sealers. Three tricalcium silicate root canal sealers (Bio-C Sealer, BioRoot-RCS, EndoSequence BC Sealer), and one epoxy resin-based sealer (AH Plus; control) were tested. The effect of heating on setting time (ST) and flowability were assessed according to ANSI/ADA 57 and ISO 6876 standards. Solubility and dimensional change (DC) of the set sealers were evaluated at 24 hours and after 30 days; the pH of the water used in the DC testing was also measured. Tests were repeated with heated sealers in an oven at 100 °C for 1 min. SEM and EDS analysis were performed. Data were analyzed using One-Way ANOVA and Tukey post-hoc tests (α=5%). Heating decreased the ST for AH Plus and EndoSequence (p<0.05). Heating reduced flowability (p<0.05) and increased pH for AH Plus (p<0.05). The solubility of Bio-C (dried specimens) was not in accordance with the ANSI/ADA standard. The solubility of EndoSequence was significantly higher (p<0.05) when it was heated and dried after 30 days. DC of Bio-C (24 h and 30 days), BioRoot-RCS (30 days) and AH Plus (24 h and 30 days) were not in accordance with the standards. SEM and EDS analysis showed significant changes in sealer microstructure after heating. In conclusion, heating decreased the ST and increased the solubility of EndoSequence BC sealer. No significant changes in flowability, DC, and pH were identified for all three tricalcium silicate sealers after heat application. However, all sealers had significant surface changes.

Effect of the timing of radiation therapy on the push-out strength of resin cement to root dentine.

This study investigated the effect of radiation timing on the bond strength of resin cement to intraradicular dentine. Fifty human teeth were distributed into 5 groups (n = 10): Control (nonirradiated teeth), Before-RCT (teeth irradiated before root canal treatment), After-CH (teeth irradiated after canal preparation and placement of calcium hydroxide intracanal dressing), After-RCT (teeth irradiated after completion of root canal treatment) and After-FPL (teeth irradiated after luting of a glass fibre post). Each tooth received 70 Gy irradiation. The roots were sectioned for push-out strength testing. After-RCT and After-FPL groups had significantly lower push-out strength than the control at the middle third (p < 0.05). Control and After-CH groups had a higher percentage of cohesive dentine failure. Radiotherapy after root canal obturation and post luting adversely affected the adhesiveness of resin cement to intraradicular dentine. Teeth irradiated before root canal treatment and after placement of calcium hydroxide had the best performance.

Efficacy of disinfection procedures performed prior to regenerative endodontic therapy: An integrative review.

The aim of this integrative review was to identify whether the disinfection procedures performed prior to regenerative endodontic treatment were effective on biofilm removal from the root canals. The research was based on PubMed, Latin American and Caribbean Health Sciences Literature (Lilacs) and Scientific Electronic Library Online (SciELO) databases. Four articles were selected; one of the studies was in vivo and the others ex vivo. Different disinfection procedures were studied, characterised mainly by the use of intracanal medication, highlighting the double antibiotic paste, triple antibiotic paste and calcium hydroxide paste. Disinfection ability was evaluated against Enterococcus faecalis and multispecies biofilms by using the fluorescence technique and colony forming unit counting, for 7 to 21 days. Double antibiotic paste and triple antibiotic paste demonstrated excellent antibiofilm activity, unlike CH paste that showed limited disinfection, even when associated with different antimicrobial agents. Triple antibiotic paste was the most effective medication against biofilm.

Physicochemical properties of a calcium aluminate cement containing nanoparticles of zinc oxide.

Objectives: This study evaluated the effect of different nanoparticulated zinc oxide (nano-ZnO) and conventional-ZnO ratios on the physicochemical properties of calcium aluminate cement (CAC). Materials and Methods: The conventional-ZnO and nano-ZnO were added to the cement powder in the following proportions: G1 (20% conventional-ZnO), G2 (15% conventional-ZnO + 5% nano-ZnO), G3 (12% conventional-ZnO + 3% nano-ZnO) and G4 (10% conventional-ZnO + 5% nano-ZnO). The radiopacity (Rad), setting time (Set), dimensional change (Dc), solubility (Sol), compressive strength (Cst), and pH were evaluated. The nano-ZnO and CAC containing conventional-ZnO were also assessed using scanning electron microscopy, transmission electron microscopy, and energy-dispersive X-ray spectroscopy. Radiopacity data were analyzed by the 1-way analysis of variance (ANOVA) and Bonferroni tests (p < 0.05). The data of the other properties were analyzed by the ANOVA, Tukey, and Fisher tests (p < 0.05). Results: The nano-ZnO and CAC containing conventional-ZnO powders presented particles with few impurities and nanometric and micrometric sizes, respectively. G1 had the highest Rad mean value (p < 0.05). When compared to G1, groups containing nano-ZnO had a significant reduction in the Set (p < 0.05) and lower values of Dc at 24 hours (p < 0.05). The Cst was higher for G4, with a significant difference for the other groups (p < 0.05). The Sol did not present significant differences among groups (p > 0.05). Conclusions: The addition of nano-ZnO to CAC improved its dimensional change, setting time, and compressive strength, which may be promising for the clinical performance of this cement.

Tip and taper compatibility of accessory gutta-percha points with rotary and reciprocating instruments.

Objectives: This study was conducted to evaluate and compare the tip and taper compatibility of accessory gutta-percha points (AGPs) with various rotary and reciprocating instruments. Materials and Methods: Using a profile analyzer, tip and taper measurements were taken of 10 AGPs of each of the 14 models available from Odous de Deus and the 4 models available from Dentsply-Maillefer. Diameter measurements were taken at 1-mm intervals, from 3 mm from the tip (D3) to 16 mm. Results: Based on the mean values obtained, 3-dimensional (3D) models of the AGPs were drawn in Autodesk Fusion 360 and superimposed on 3D models of each instrument selected (Mtwo, Reciproc, RaCe, K3, and ProDesign Logic) to determine the compatibility between the instrument and the AGP. Data corresponding to the tips and tapers of the various AGPs, as well as the tip and taper differences between the AGPs and the instruments, were analyzed using descriptive statistics. The tapers of the AGPs were subject to the American National Standards Institute/American Dental Association No. 57 standard. The Odous de Deus extra-long medium and extra-long extra-medium AGPs were shown to be compatible with Mtwo, K3, and ProDesign Logic instruments with taper 0.06 and tip sizes 25 and 30, while the Dentsply fine and fine medium cones were compatible with Mtwo, RaCe, and K3 instruments with conicity of 0.04 and tip sizes 35 and 40. Conclusions: Both the Odous de Deus and Dentsply commercial brands included 2 AGP models with tip (D3) and taper compatibility with Mtwo, RaCe, K3, and/or Prodesign Logic instruments.

Dental and composite resin discoloration induced by different hydraulic calcium silicate-based cements: two-year in vitro assessment.

Few long-term studies assess the discoloration induced by hydraulic calcium silicate-based cement on dental structures. In addition, as far as we know, no long-term study has assessed the discoloration induced by these cement on composite resin. This in vitro study aimed to assess, during a period of two years, the discoloration potential of different hydraulic calcium silicate-based cements (hCSCs) on the enamel/dentin structure and composite resin restoration. A total of 40 enamel/dentin discs were obtained from bovine incisors, and 40 composite resin discs (10 mm in diameter × 2 mm thick) were fabricated. A 0.8 mm-deep cavity was made in the center of each disc and filled with the following hCSCs (n=10): Original MTA (Angelus); MTA Repair HP (Angelus); NeoMTA Plus (Avalon); and Biodentine (Septodont). An initial color measurement was performed (T0 - baseline). After 7, 15, 30, 45, 90, 300 days, and two years, new color measurements were performed to determine the color (ΔE00), lightness (ΔL'), chroma (ΔC'), hue differences (ΔH'), and whiteness index (WID). For enamel/dentin, the ΔE00 was significant among groups and periods (p<0.05). NeoMTA Plus had the greatest ΔE00. The NeoMTA Plus group had the greatest ΔE00 after two years for composite resin. Significant reduction in lightness was observed for all groups after two years (p<0.05). The most significant WID values were observed after 30 days for Biodentine (enamel/dentin) and MTA Repair HP groups (composite resin) (p<0.05). The hCSCs changed the colorimetric behavior of both substrates, leading to greater darkening over time. The Bi2O3 in the Original MTA seems relevant in the short periods of color change assessment.

Injection of sodium hypochlorite beyond the apical foramen--a case report.

The aim of this study was to report a clinical case of extravasation of 1% sodium hypochlorite into the periapical tissues during endodontic treatment. During apical debridement, absence of reflux of the irrigating solution was observed, followed by root canal hemorrhage. The patient immediately complained of intense pain, and a profuse edema and hyperemia was observed on the left side of her face compatible with extravasation of hypochlorite to the periapex. The patient was treated with ibuprofen 600 mg three times per day for three days, a single dose of dexamethasone 4 mg, amoxicillin 500 mg three times per day for seven days, and a cold compress for two days. Regression of the condition began on the fourth day, and normal tissue aspect and absence of sequelae were observed on the 14th day.