Factors influencing the outcome of nonsurgical root canal treatment and retreatment: A retrospective study.

This study assessed the influence of diverse variables on the outcome of nonsurgical root canal treatment/retreatment. In general, 304 teeth from 218 patients were treated/retreated and the outcome evaluated by the periapical index (PAI). Teeth with apical periodontitis lesions that have not completely healed were classified as success or failure based on lenient and rigid criteria, respectively. Findings were evaluated using a logistic regression analysis. The overall success rates were 74% and 82% using the PAI-rigid and lenient success criteria, respectively. Specifically for treatment, the success rates were 73% (rigid) and 82% (lenient), while for retreatment they were 78% (rigid) and 83% (lenient). The treatment outcome was negatively affected by overextension, presence of preoperative lesion, lesion size >10 mm, and higher number of treatment visits (with no intracanal medication). Regarding retreatment, the chance of success was greater for teeth with adequate coronal restorations.

Anti-Leishmania activity and molecular docking of unusual flavonoids-rich fraction from Arrabidaea brachypoda (Bignoniaceae).

Leishmaniases comprise a group of infectious parasitic diseases caused by various species of Leishmania and are considered a significant public health problem worldwide. Only a few medications, including miltefosine, amphotericin B, and meglumine antimonate, are used in current therapy. These medications are associated with severe side effects, low efficacy, high cost, and the need for hospital support. Additionally, there have been occurrences of drug resistance. Additionally, only a limited number of drugs, such as meglumine antimonate, amphotericin B, and miltefosine, are available, all of which are associated with severe side effects. In this context, the need for new effective drugs with fewer adverse effects is evident. Therefore, this study investigated the anti-Leishmania activity of a dichloromethane fraction (DCMF) extracted from Arrabidaea brachypoda roots. This fraction inhibited the viability of L. infantum, L. braziliensis, and L. Mexicana promastigotes, with IC50 values of 10.13, 11.44, and 11.16 µg/mL, respectively, and against L. infantum amastigotes (IC50 = 4.81 µg/mL). Moreover, the DCMF exhibited moderate cytotoxicity (CC50 = 25.15) towards RAW264.7 macrophages, with a selectivity index (SI) of 5.2. Notably, the DCMF caused damage to the macrophage genome only at 40 µg/mL, which is greater than the IC50 found for all Leishmania species. The results suggest that DCMF demonstrates similar antileishmanial effectiveness to isolated brachydin B, without causing genotoxic effects on mammalian cells. This finding is crucial because the isolation of the compounds relies on several steps and is very costly while obtaining the DCMF fraction is a simple and cost-effective process. Furthermore, In addition, the potential mechanisms of action of brachydins were also investigated. The computational analysis indicates that brachydin compounds bind to the Triosephosphate isomerase (TIM) enzyme via two main mechanisms: destabilizing the interface between the homodimers and interacting with catalytic residues situated at the site of binding. Based on all the results, DCMF exhibits promise as a therapeutic agent for leishmaniasis due to its significantly reduced toxicity in comparison to the adverse effects associated with current reference treatments.

Effects of Calcium Hydroxide Paste in Different Vehicles on Bacterial Reduction during Treatment of Teeth with Apical Periodontitis.

INTRODUCTION: This clinical study evaluated the antibacterial effects of calcium hydroxide associated with different vehicles during the treatment of infected teeth with apical periodontitis. METHODS: Bacteriologic samples were taken from 90 necrotic root canals of teeth with apical periodontitis before (S1) and after preparation with a rotary nickel-titanium instrument system and 2.5% sodium hypochlorite irrigation (S2). The teeth were distributed in 3 groups according to the intracanal medication used, which consisted of a calcium hydroxide paste in glycerin, camphorated paramonochlorophenol/glycerin (CHPG), or 2% chlorhexidine for 1 week, and then another sample was taken (S3). The frequency of bacteria-positive cases and the reduction of bacterial counts were evaluated by quantitative real-time polymerase chain reaction. RESULTS: Substantial intracanal bacterial reduction was observed after preparation in the 3 groups (P < .001). After calcium hydroxide paste in glycerin medication, the number of bacteria-positive cases decreased from 20/29 (69%) to 17/29 (59%); however, the mean bacterial counts increased 8.4% from S2 to S3. Medication with CHPG reduced the number of bacteria-positive cases from 17/29 (59%) to 15/29 (52%), with a significant mean S2-S3 reduction of 71% (P < .05). In the chlorhexidine group, the number of bacteria-positive cases decreased from 21/30 (70%) to 17/30 (57%) after medication, with a mean S2-S3 reduction of 55%, which, however, was not statistically significant (P > .05). Intergroup comparisons showed no significant differences (P > .05). CONCLUSION: Comparison between the 3 calcium hydroxide pastes showed no significant differences in antibacterial effectiveness in the main root canal. However, only the CHPG paste showed a significant reduction in bacterial counts when postpreparation and postmedication samples were compared.

Comparison of some physical properties of finger spreaders made of stainless steel or nickel-titanium alloys.

The purpose of this study was to evaluate the flexibility, shape, and surface finishing of stainless steel (SS) and nickel-titanium (NiTi) finger spreaders as well as to compare the load required to insert these spreaders along a gutta-percha point adapted to the apical segment of curved or straight artificial canals. Instrument flexibility was investigated by using a universal testing machine in the cantilever-flexibility test. Scanning electron microscopy (SEM) was used to examine the shape and surface finishing of different sizes of SS and NiTi finger spreaders. Penetration load was evaluated only for spreaders size C by using the universal testing machine in a compressive test. As for flexibility, the load needed to bend the SS finger spreader sizes A, B, C, and D was approximately 167%, 146%, 102%, and 64% greater than the respective sizes of NiTi finger spreaders. SEM analysis revealed that the instrument tips were always tapered, but with different vertices. NiTi spreaders showed tips with circumferential grooves; whereas, those from SS spreaders exhibited longitudinal grooves. NiTi finger spreaders required a significantly higher penetration load than SS spreaders. This difference was probably related to the different shapes and surface finishing of the instrument tips. Different characteristics of finger spreaders may result in different clinical performance during the lateral compaction technique.

Portuguese Football Federation consensus statement 2020: nutrition and performance in football.

Nutrition is an undeniable part of promoting health and performance among football (soccer) players. Nevertheless, nutritional strategies adopted in elite football can vary significantly depending on culture, habit and practical constraints and might not always be supported by scientific evidence. Therefore, a group of 28 Portuguese experts on sports nutrition, sports science and sports medicine sought to discuss current practices in the elite football landscape and review the existing evidence on nutritional strategies to be applied when supporting football players. Starting from understanding football's physical and physiological demands, five different moments were identified: preparing to play, match-day, recovery after matches, between matches and during injury or rehabilitation periods. When applicable, specificities of nutritional support to young athletes and female players were also addressed. The result is a set of practical recommendations that gathered consensus among involved experts, highlighting carbohydrates periodisation, hydration and conscious use of dietary supplements.

Disinfection and outcome of root canal treatment using single-file or multifile systems and Ca(OH)2 medication.

This clinical study reports on the antibacterial effects and outcome of endodontic treatment using either a single-file or a multifile system, associated with calcium hydroxide interappointment medication. The root canals of single-rooted teeth with apical periodontitis were treated by using either Reciproc or BioRaCe instrument systems, 2.5% NaOCl irrigation, and calcium hydroxide medication. Bacteriological samples taken before preparation and immediately before obturation were evaluated for total bacterial counts by quantitative real-time polymerase chain reaction (qPCR). Patients were followed up and the treatment outcome was assessed by clinical and radiographic criteria. Decreasing lesions were classified as success in a lenient criterion or failure in a rigid one. Bacteria were detected in all initial samples (47 cases) and were significantly reduced after treatment in both groups (p<0.001). In the Reciproc and BioRaCe groups, 7/25 (28%) and 11/22 (50%) root canals yielded negative qPCR results before obturation, respectively (p>0.05). Quantitative bacterial reduction was similar between groups (p>0.05). The success rate in the BioRaCe group was 95.5% and 77% in the loose and rigid criterion, respectively. In the Reciproc group, corresponding figures were 88% and 76%. Differences in outcome were not significant (p>0.05). No diseased case showed negative qPCR results for bacteria. A difference of >1 Log10 counts was observed between healed and diseased cases. Root canal treatments of teeth with apical periodontitis using a single-file or a multifile system for preparation, associated with NaOCl irrigation and calcium hydroxide interappointment medication, showed similar antibacterial effectiveness and success rate.

Transportation assessment in artificial curved canals after instrumentation with Reciproc, Reciproc Blue, and XP-endo Shaper Systems.

AIM: In the present study, we compared the transportation of three different instrumentation systems in different levels of standardized artificial curved canals. METHODS: Sixty epoxy resin blocks containing simulated canals were divided into three groups (n = 20) according to the instrument used for canal preparation: Reciproc (REC), Reciproc Blue (REC Blue), and XP-endo Shaper (XPS). Pre- and post-instrumentation digital images of each specimen were superimposed by Photoshop software to evaluate the different amount of transportation. The Kruskal-Wallis and Wilcoxon were the non-parametric tests applied for the intergroup and intragroup analyses, respectively. The significance level was set at 5%. RESULTS: The XPS showed significantly less canal transportation than REC Blue at five levels (P < 0.05) and significantly less canal transportation at seven evaluated levels when compared with the REC (P < 0.05). REC Blue showed significant less canal transportation than REC at four of the eight evaluated levels (P < 0.05). All evaluated instruments showed a significantly higher amount of resin removal toward the inner wall compared to the outer wall of the curvature (P < 0.001). CONCLUSION: Although the XPS showed significantly less canal transportation than REC and REC Blue, all systems produced transportation from the original canal anatomy.

HDL atheroprotection by aerobic exercise training in type 2 diabetes mellitus.

PURPOSE: In this study we analyzed the role played by aerobic exercise training in the plasma lipoprotein profile, prebeta 1-HDL concentration, and in the in vitro HDL3 ability to remove cholesterol from macrophages and inhibit LDL oxidation in type 2 diabetes mellitus (DM) patients and control subjects, in the fasting and postprandial states. METHODS: Healthy controls (HTC, N = 11; 1 M/10 F) and subjects with type 2 diabetes mellitus (DMT, N = 11; 3M/8F) were engaged in a 4-month aerobic training program, and compared with a group of sedentary subjects with type 2 diabetes mellitus (DMS, N = 10; 4 M/6 F). All groups were submitted to an oral fat load test to analyze all parameters, both at the beginning of the investigation protocol (basal) and at the end of the study period (final). RESULTS: Exercising did not modify body weight, BMI, plasma concentrations of total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides (TG), glucose, insulin, or HOMA-IR, but it reduced the waist circumference. The HDL3 composition did not change, and its ability to remove cell cholesterol was unaltered by aerobic training. In DMT but not in HTC, aerobic training improved 15% the HDL3 protective effect against LDL maximal oxidation rate in the fasting state, and reduced 24% the plasma prebeta 1-HDL concentration in the postprandial state, suggesting an enhanced prebeta 1-HDL conversion into larger, more mature HDL particles. In this regard, regular aerobic exercise enriched HDL2 with TG in the fasting and postprandial states in HTC and in the fasting phase in DMT. CONCLUSION: Our results show that aerobic exercise training in diabetes mellitus improves the HDL efficiency against LDL oxidation and favors HDL maturation. These findings were independent of changes in insulin resistance and of the rise of plasma HDL cholesterol concentration.

Infection Control in Teeth with Apical Periodontitis Using a Triple Antibiotic Solution or Calcium Hydroxide with Chlorhexidine: A Randomized Clinical Trial.

INTRODUCTION: This randomized clinical study compared the antibacterial effectiveness of treatment protocols using either a triple antibiotic solution (1 mg/mL) or calcium hydroxide/chlorhexidine paste as interappointment medication in infected canals of teeth with primary apical periodontitis. METHODS: The root canals of single-rooted teeth with apical periodontitis were prepared by using a reciprocating single-instrument technique with 2.5% sodium hypochlorite irrigation and then medicated for 1 week with either a triple antibiotic solution (minocycline, metronidazole, and ciprofloxacin) at 1 mg/mL (n = 24) or a calcium hydroxide paste in 2% chlorhexidine gluconate (n = 23). Samples were taken from the canal at the baseline (S1), after chemomechanical preparation (S2), and after intracanal medication (S3). DNA extracts from clinical samples were evaluated for total bacterial reduction using a 16S ribosomal RNA gene-based quantitative polymerase chain reaction assay. RESULTS: All S1 samples were positive for the presence of bacteria, and counts were substantially reduced after treatment procedures (P < .01). Bacterial levels in S2 and S3 samples did not significantly differ between groups (P > .05). S2 to S3 reduction was 97% in the antibiotic group and 39% in the calcium hydroxide/chlorhexidine group; only the former reached statistical significance (P < .01). There were significantly more quantitative polymerase chain reaction-negative S3 samples in the antibiotic group than in the calcium hydroxide group (P < .05). CONCLUSIONS: Interappointment medication with a triple antibiotic solution at the concentration of 1 mg/mL significantly improved root canal disinfection, and its effects were at least comparable with the calcium hydroxide/chlorhexidine paste. Effectiveness and easy delivery of the antibiotic solution make it an appropriate medicament as part of a disinfecting protocol for conventional nonsurgical endodontic treatment and possibly regenerative endodontic procedures.

Cyclic fatigue of ProTaper instruments.

The present work evaluated the influence of the curved segment length of artificial root canals (the arc) and the number of cycles necessary to fracture engine-driven nickel-titanium endodontic instruments. ProTaper F3 25-mm files at 250 rpm were used in two artificial canals. The artificial canals were made of stainless steel with an inner diameter of 1.04 mm, a total length of 20 mm, and arc on the ends with a radius of curvature of 6 mm. The arc length of the first tube measured 9.4 mm, and the straight part measured 10.6 mm. The second tube was 14.1 mm long, and the straight part measured 5.9 mm. We determined the fracture surface distances and the number of cycles necessary to induce fatigue fracture in the ProTaper F3 instruments. The fracture surfaces and the helical shaft of the instruments were investigated using a scanning electron microscope. The results indicated that the required number of cycles to cause a fracture was influenced by the canal arc length, the morphology of the fractured surface presented ductile characteristics, and plastic deformation in the helical shaft of the fractured instruments did not occur.

Cleaning and Shaping Oval Canals with 3 Instrumentation Systems: A Correlative Micro-computed Tomographic and Histologic Study.

INTRODUCTION: The present study evaluated the cleaning and shaping ability of 3 instrumentation systems in oval canals of extracted vital teeth using a correlative analytic approach. METHODS: Oval distal canals from 33 freshly extracted mandibular molars with pulp vitality were scanned by micro-computed tomographic (micro-CT) imaging for sample selection. Specimens matched by anatomic similarities were distributed into 3 experimental groups according to the instrument system to be evaluated: the Self-Adjusting File (SAF; ReDentNOVA, Ra'anana, Israel), TRUShape (Dentsply Sirona, Tulsa, OK), and XP-endo Shaper (FKG Dentaire, La Chaux-de-Fonds, Switzerland). The irrigant was 5.25% sodium hypochlorite heated at 37°C. After rescanning with micro-CT imaging, the unprepared surface areas were identified, measured, and then histologically evaluated for the amount of pulp remnants in each root third. RESULTS: When the apical 4-mm canal segment was evaluated, the SAF exhibited significantly less unprepared areas than the XP-endo Shaper (P < .05), and there were no significant differences for the other comparisons (P > .05). Analysis of the full canal length showed no statistically significant differences between the 3 tested systems (P > .05). Likewise, the tested systems did not differ significantly in cleaning the unprepared walls (P > .05). CONCLUSIONS: There was no significant difference in the amount of unprepared surface areas between the 3 instrument systems, except for the comparison between the SAF and XP-endo Shaper in the apical 4-mm segment. None of them prepared 100% of the root canal walls. The cleaning ability of the 3 systems was similar.

Disinfecting Effects of Rotary Instrumentation with Either 2.5% Sodium Hypochlorite or 2% Chlorhexidine as the Main Irrigant: A Randomized Clinical Study.

INTRODUCTION: This randomized clinical study compared the antibacterial effects of irrigation with either 2.5% sodium hypochlorite (NaOCl) or 2% chlorhexidine (CHX) during the preparation of infected root canals with rotary nickel-titanium instruments. METHODS: The root canals of 50 single-rooted teeth with apical periodontitis were prepared by using BioRaCe rotary instruments (FKG Dentaire, La Chaux-de-Fonds, Switzerland) and irrigation with either 2.5% NaOCl (n = 25) or 2% CHX (n = 25). Samples were taken from the canal at baseline (S1) and after (S2) chemomechanical preparation. DNA was extracted from the clinical samples, and the reduction of the levels of total bacteria and streptococci was evaluated by means of a 16S ribosomal RNA gene-based quantitative polymerase chain reaction assay. RESULTS: All S1 samples were positive for the presence of bacteria. After chemomechanical preparation using either 2.5% NaOCl or 2% CHX, 44% and 40% of the root canals still had detectable bacteria, respectively. As for total bacterial counts, a mean number of 3.7 × 10(5) bacterial cell equivalents was present in S1 samples from the NaOCl group, with a substantial reduction in S2 to a mean of 5.49 × 10(2) cell equivalents (P < .001). In the CHX group, a mean bacterial load of 8.77 × 10(4) cell equivalents occurred in S1, with a significant reduction in S2 to a mean of 2.81 × 10(3) cells (P < .001). The differences in both the presence/absence and quantitative data were not statistically significant (P > .05). Both irrigation protocols were highly effective in reducing the levels of Streptococcus species (P < .001). CONCLUSIONS: No significant difference was observed for the clinical antibacterial effectiveness of rotary preparation using either 2.5% NaOCl or 2% CHX as the main irrigant.

Clinical Antibacterial Effectiveness of Root Canal Preparation with Reciprocating Single-instrument or Continuously Rotating Multi-instrument Systems.

INTRODUCTION: This in vivo study compared the antibacterial effectiveness of a reciprocating single-instrument system (Reciproc; VDW, Munich, Germany) and a rotary multi-instrument system (BioRaCe; FKG Dentaire, La Chaux-de-Fonds, Switzerland) during the preparation of infected root canals of teeth with primary apical periodontitis. METHODS: Root canals from single-rooted teeth with necrotic pulps and apical periodontitis were instrumented using either Reciproc (n = 29) or BioRaCe (n = 30) instruments under irrigation with 2.5% sodium hypochlorite. DNA was extracted from samples taken before and after preparation and subjected to quantitative analysis of total bacteria and streptococci by using the quantitative real-time polymerase chain reaction. RESULTS: All initial samples were positive for the presence of bacteria, with median numbers of 7.1 × 10(5) and 1.31 × 10(5) bacterial cells for the Reciproc and BioRaCe groups, respectively. After preparation with Reciproc and BioRaCe, 16 (55%) and 15 (50%) root canals still had detectable bacteria with median counts of 7.05 × 10(2) and 6.03 × 10(1), respectively. Both systems were highly effective in reducing the total bacterial counts (P < .001), and there were no significant differences between them (P > .05). Streptococci were highly frequent, and both systems succeeded in significantly reducing their levels (P < .001). CONCLUSIONS: Both reciprocating single-instrument and rotary multi-instrument systems were highly effective in reducing the counts of total bacteria and streptococci in root canals of teeth with apical periodontitis. Regardless of the system used, approximately one half of the teeth still had detectable bacteria.

Infection Control in Retreatment Cases: In Vivo Antibacterial Effects of 2 Instrumentation Systems.

INTRODUCTION: This in vivo study compared the antibacterial effects of 2 instrumentation systems in root canal-treated teeth with apical periodontitis. METHODS: Forty-eight teeth with a single root and a single canal showing post-treatment apical periodontitis were selected for this study. For retreatment, teeth were randomly divided into 2 groups according to the instrumentation system used: Self-Adjusting File (SAF; ReDent-Nova, Ra'anana, Israel) and Twisted File Adaptive (TFA; SybronEndo, Orange, CA). In both groups, 2.5% sodium hypochlorite was the irrigant. Bacteriological samples were taken before (S1) and after chemomechanical preparation (S2). In the TFA group, passive ultrasonic irrigation (PUI) was performed after instrumentation, and samples were also taken after this supplementary step (S2b). DNA was extracted from the clinical samples and subjected to quantitative real-time polymerase chain reaction to evaluate the levels of total bacteria, streptococci, and Enterococcus faecalis. Statistical analyses from quantitative real-time polymerase chain reaction data were performed within groups using the Wilcoxon matched pairs test and between groups using the Mann-Whitney U test and the Fisher exact test with the significance level set at P < .05. RESULTS: Bacteria were detected in S1 samples from 43 teeth, which were then included in the antibacterial experiment. Both SAF and TFA instrumentation protocols showed a highly significant intracanal bacterial reduction (P < .001). Intergroup quantitative comparisons disclosed no significant differences between TFA with or without PUI and SAF (P > .05). PUI did not result in significant improvement in disinfection (P > .05). CONCLUSIONS: Both instrumentation systems/treatment protocols were highly effective in significantly reducing the intracanal bacterial counts. No significant difference was observed between the 2 systems in disinfecting the canals of teeth with post-treatment apical periodontitis.

Disinfection and outcome of root canal treatment using single-file or multifile systems and Ca(OH)2 medication

Abstract This clinical study reports on the antibacterial effects and outcome of endodontic treatment using either a single-file or a multifile system, associated with calcium hydroxide interappointment medication. The root canals of single-rooted teeth with apical periodontitis were treated by using either Reciproc or BioRaCe instrument systems, 2.5% NaOCl irrigation, and calcium hydroxide medication. Bacteriological samples taken before preparation and immediately before obturation were evaluated for total bacterial counts by quantitative real-time polymerase chain reaction (qPCR). Patients were followed up and the treatment outcome was assessed by clinical and radiographic criteria. Decreasing lesions were classified as success in a lenient criterion or failure in a rigid one. Bacteria were detected in all initial samples (47 cases) and were significantly reduced after treatment in both groups (p<0.001). In the Reciproc and BioRaCe groups, 7/25 (28%) and 11/22 (50%) root canals yielded negative qPCR results before obturation, respectively (p>0.05). Quantitative bacterial reduction was similar between groups (p>0.05). The success rate in the BioRaCe group was 95.5% and 77% in the loose and rigid criterion, respectively. In the Reciproc group, corresponding figures were 88% and 76%. Differences in outcome were not significant (p>0.05). No diseased case showed negative qPCR results for bacteria. A difference of >1 Log10 counts was observed between healed and diseased cases. Root canal treatments of teeth with apical periodontitis using a single-file or a multifile system for preparation, associated with NaOCl irrigation and calcium hydroxide interappointment medication, showed similar antibacterial effectiveness and success rate.

Resumo Este estudo clínico relata os efeitos antibacterianos e o resultado de tratamentos endodônticos usando um sistema de instrumentação de instrumento único ou de múltiplos instrumentos, associado à medicação intracanal com hidróxido de cálcio. Os canais radiculares de 80 dentes unirradiculares com lesão perirradicular foram tratados com os sistemas Reciproc ou BioRaCe, irrigação com NaOCl a 2,5% e medicação com pasta de hidróxido de cálcio por 7 a 10 dias. Amostras bacteriológicas foram colhidas antes do preparo e imediatamente antes da obturação e examinadas quanto à contagem total de bactérias pela reação em cadeia da polimerase em tempo real quantitativa (qPCR). Os pacientes foram acompanhados e o resultado do tratamento foi avaliado por critérios clínicos e radiográficos (índice periapical). Os casos com lesões que diminuíram mas não desapareceram foram classificados como sucesso em um critério leniente ou fracasso em um critério rígido. Quarenta e sete pacientes estavam disponíveis para avaliação bacteriológica e de resultados. Bactérias foram detectadas em todas as amostras iniciais desses casos e foram significativamente reduzidas após o tratamento nos dois grupos (p<0,001). Nos grupos Reciproc e BioRaCe, os canais radiculares apresentaram resultados negativos na qPCR em 7/25 (28%) e 11/22 (50%) casos antes da obturação, respectivamente (p>0,05). A redução bacteriana foi semelhante entre os grupos (p>0,05). O período médio (mediana) de acompanhamento foi de 20,5 (18,5) meses para BioRaCe e 17,4 (18) meses para Reciproc (p>0,05). No grupo BioRaCe, a taxa de sucesso foi de 95,5% e 77% nos critérios leniente e rígido, respectivamente. No grupo Reciproc, os valores correspondentes foram 88% e 76%. As diferenças no resultado não foram estatisticamente significativas (p>0,05). Nenhum caso de doença pós-tratamento mostrou resultados negativos de qPCR para bactérias. Foi observada uma diferença >1 Log10 nas contagens bacterianas entre os casos curados e doentes. O tratamento do canal radicular de dentes com lesão perirradicular utilizando um sistema de instrumento único ou múltiplos no preparo, associado à irrigação com NaOCl e medicação entre consultas com hidróxido de cálcio, mostrou eficácia antibacteriana e taxa de sucesso semelhantes.

[Food phytosterol ester efficiency on the plasma lipid reduction in moderate hypercholesterolemic subjects]. / Eficiência dos Esteres de Fitoesteróis Alimentares na Redução dos Lípides Plasmáticos em Hipercolesterolêmicos Moderados.

OBJECTIVE: This study aimed at relating the pattern of response to dietary plant sterol ester (PSE) treatment of plasma lipids concentrations and apo E polymorphisms. METHODS: Patients (20-60y old: 50 women; 10 men) with primary moderate hypercholesterolemia were fed margarine (20g/d), received no treatment (placebo), and were fed PSE (2.8g/d = 1.68 phytosterols), during 3 periods of 4 weeks each, in a crossover, double-blind study. DNA was extracted from white blood cells for the apo E polymorphisms. RESULTS: PSE treatment significantly lowered TC and LDL-C 10% and 12%, respectively, in relation to the baseline, and 6% and 8% in relation to the placebo phase, but HDL-C and TG levels were not modified. In regard to the apo E genotyping, no significant difference occurred between apo E 3/3 and apo E (3/4). CONCLUSION: Dietary plant sterol ester (PSE) treatment reduced cholesterolemia, and the reduction of LDL-C in absolute values was more pronounced when the initial LDL - C concentration were elevated.

Susceptibility of as-yet-uncultivated and difficult-to-culture bacteria to chemomechanical procedures.

INTRODUCTION: A significant portion of the bacteria taking part of the microbiome associated with apical periodontitis still remain to be cultivated and phenotypically characterized. This molecular study evaluated the prevalence of selected as-yet-uncultivated and difficult-to-culture bacterial taxa in infected root canals and their susceptibility to chemomechanical procedures. METHODS: Root canals of single-rooted teeth with apical periodontitis were prepared using rotary nickel-titanium instruments and 2.5% sodium hypochlorite as the irrigant. DNA extracts from samples taken before (S1) and after (S2) chemomechanical preparation were surveyed for the presence of 7 as-yet-uncultivated phylotypes and 1 difficult-to-culture species using end-point polymerase chain reaction. Samples were also subjected to quantitative analysis of total bacteria and levels of the 2 most prevalent taxa. RESULTS: Bacteroidaceae sp. HOT-272 (24%) and Fretibacterium fastidiosum (20%) were the most prevalent taxa in S1. Their mean counts in S1 were 8.25 × 10(3) and 2.13 × 10(3) rRNA gene copies, corresponding to 0.18% and 0.55% of the total bacteria. Chemomechanical debridement promoted a highly statistically significant reduction in total bacterial counts (P < .001), but 64% of the canals were still positive for bacterial presence. Of the target taxa, only Bacteroidaceae sp. HOT-272 and F. fastidiosum were detected in S2 (each one in 1 sample). The reduction in counts of both taxa was also highly significant (P < .001). CONCLUSIONS: Findings confirmed that several as-yet-uncultivated and difficult-to-grow bacterial taxa can participate in the microbiome associated with apical periodontitis. Two of them were found in relatively high prevalence but rarely as a dominant species. Chemomechanical procedures were highly effective in completely eliminating these taxa or at least substantially reducing their numbers.

A periodontite apical como fator de risco às manifestações sistêmicas: uma perspectiva histórica atualizada / Apical periodontitisas a risk factor to systemic manifestations: a updated historical perspective

Objetivo: O objetivo deste trabalho foi revisar a literatura científica pertinente, dando enfoque ao tratamento endodôntico e dentes portadores de necrose pulpar associados à periodontite apical como fator de risco às manifestações sistêmicas, desde a teoria da infecção focal até os dias atuais. Metodologia: Empregou-se fontes de catalogação bibliográfica identificadas eletronicamente pelo MEDLINE, até setembro de 2018. Os artigos relacionados pela busca eletrônica foram selecionados, por três revisores independentes, avaliando os critérios de inclusão e exclusão. Resultados: A busca apresentou 107 artigos, sendo que destes, 17 estudos satisfizeram os critérios de inclusão, o que possibilitou a análise dos dados. Conclusão: Muitos dos preceitos da teoria da infecção focal estão sendo reerguidos por pesquisas que mostram cada vez mais a existência de associações entre patologias endodônticas e sistêmicas.

Objective: The aim of this work was to review the pertinent scientific literature, focusing on endodontic treatment and teeth with pulp necrosis associated with apical periodontitis as a risk factor for systemic manifestations, from the focal infection theory to the present day. Methodology: The sources of bibliographic cataloging electronically identified by MEDLINE were used until September 2018. Articles related to the electronic search were selected by three independent reviewers, evaluating the inclusion and exclusion criteria. Results: The search presented 107 articles, of which, 17 studies met the inclusion criteria, which made it possible to analyze the data. Conclusion: Many of the precepts of the focal infection theory are being reinstated by research that increasingly shows the existence of associations between endodontic and systemic pathologies.

Antibiofilm and antibacterial activities of farnesol and xylitol as potential endodontic irrigants.

This study investigated the antibiofilm and antibacterial effects of farnesol and xylitol in a series of experiments in order to evaluate their potential use as root canal irrigants. The following substances were tested: 0.2% farnesol; 5% and 20% xylitol; 0.2% farnesol plus 20% xylitol; and saline (control). For comparison with an established endodontic irrigant, 2.5% NaOCl was included in each test. Three experiments were conducted: the crystal violet assay, to evaluate the effects on the biofilm biomass; the dentin disinfection test, to evaluate the effects on bacterial viability in biofilms; and the root canal disinfection test, to simulate the use in the root canal environment. Farnesol was the most effective substance in reducing the biofilm biomass, followed by 20% xylitol. All substances affected bacterial viability in biofilms; farnesol showed the best results followed by the farnesol/xylitol combination. Irrigation with all substances significantly reduced the bacterial load (p<0.001), but only the farnesol/xylitol combination was significantly more effective than saline (p=0.02). NaOCl was more effective than any other substance tested in the three experiments (p<0.001). The findings demonstrated that farnesol affected both the biofilm biomass and the viability of cells in the biofilm, while 20% xylitol affected only the biofilm biomass. Although not more effective than NaOCl, the combination of these two antibiofilm substances has potential to be used in endodontics in certain situations.

Correlative bacteriologic and micro-computed tomographic analysis of mandibular molar mesial canals prepared by self-adjusting file, reciproc, and twisted file systems.

INTRODUCTION: This ex vivo study evaluated the disinfecting and shaping ability of 3 protocols used in the preparation of mesial root canals of mandibular molars by means of correlative bacteriologic and micro-computed tomographic (µµCT) analysis. METHODS: The mesial canals of extracted mandibular molars were contaminated with Enterococcus faecalis for 30 days and assigned to 3 groups based on their anatomic configuration as determined by µCT analysis according to the preparation technique (Self-Adjusting File [ReDent-Nova, Ra'anana, Israel], Reciproc [VDW, Munich, Germany], and Twisted File [SybronEndo, Orange, CA]). In all groups, 2.5% NaOCl was the irrigant. Canal samples were taken before (S1) and after instrumentation (S2), and bacterial quantification was performed using culture. Next, mesial roots were subjected to additional µCT analysis in order to evaluate shaping of the canals. RESULTS: All instrumentation protocols promoted a highly significant intracanal bacterial reduction (P < .001). Intergroup quantitative and qualitative comparisons disclosed no significant differences between groups (P > .05). As for shaping, no statistical difference was observed between the techniques regarding the mean percentage of volume increase, the surface area increase, the unprepared surface area, and the relative unprepared surface area (P > .05). Correlative analysis showed no statistically significant relationship between bacterial reduction and the mean percentage increase of the analyzed parameters (P > .05). CONCLUSIONS: The 3 instrumentation systems have similar disinfecting and shaping performance in the preparation of mesial canals of mandibular molars.