AH Plus extrusion into periapical tissue: literature review of main related properties and report of clinical cases

The sealers were developed for filling of root canals. Due to their physicochemical and technical properties used for obturation, often, extrusion is observed through apical constriction and occasionally by lateral and secondary canals. Objective: To review the literature on important properties to be considered in AH Plus sealer extrusion and report a case series of this sealer extrusion. Literature review: Articles evaluating the cytotoxicity and biocompatibility properties, besides flow and solubility were selected. Case report: In the presented cases, endodontic treatment was performed with rotary instrumentation and irrigation with 2.5% NaOCl. Obturation employed visual, tactile, and radiographic proof of gutta-percha main cone, and different obturation techniques. There were no reports of pain during and after endodontic treatment. Conclusion: AH Plus has adequate properties for a filling material and causes no major damage to the periapical tissues due to its little cytotoxic

In vitro evaluation of the presence of apical deviation with employment of automated handpieces with continuous and alternate motion for root canal preparation

O presente trabalho avaliou, in vitro, a presença de desvio apical no preparo de canais radiculares em raízes mésio-vestibulares de molares superiores humanos utilizando-se de peças automatizadas de giro contínuo, sistema Pow R (Moyco Union Broach) e giro alternado, sistema M4 (Kerr - USA). A análise da presença de desvios apicais foi realizada por meio de radiografias obtidas na plataforma radiográfica confeccionada para o experimento. Os resultados mostraram não haver diferença estatisticamente significante quanto à avaliação da presença de desvio entre os dois sistemas. Não houve correlação entre o grau de curvatura das raízes e o grau de desvio apical, no sistema de giro contínuo. No entanto, o sistema de giro alternado apresentou diferença estatística de correlação direta e grau médio.The present study conducted an in vitro evaluation of the presence of apical deviation on the root canal preparation of the mesiobuccal roots of human maxillary molars employing automated handpieces with continuous motion, the Pow R system (Moyco Union Broach), and alternate motion, the M4 system (Kerr). Analysis of the presence of apical deviation was carried out by means of radiographs obtained on a radiographic desk fabricated for the study. The results demonstrated the lack of statistically significant differences between the two systems as to the evaluation of the presence of apical deviation. There was no correlation between the degree of curvature of the roots and the degree of apical deviation for the continuous motion system. However, there was a statistic difference for the alternate motion system, with a direct correlation of moderate degree

Deslocamento apical produzido por instrumentos de níquel-titânio acionados a motor e limas de aço inoxidável

The aim of this study was to evaluate the apical displacement produced by different rotary nickel-titanium instruments, testing the hypothesis that rotary systems with nickel-titanium instruments produce lower mean values of apical displacement than stainless steel hand instruments. A total of 100 maxillary permanent first molars were selected for the study. The mesiobuccal roots were sectioned at the top cervical third and embedded in blocks of self-curing resin. The specimens were randomly divided into 5 groups and the root canals were prepared using the following nickel-titanium instruments: Group 1 - Quantec system 2000 (Analytic Endodontics, Mexico); Group 2 - Pro-File T.0.04 (Dentsply/Maillefer, Switzerland); Group 3 - Pro-File Series 29 T.0.04 (Dentsply Tulsa, Switzerland); Group 4 - Pow-R T.0.02 (Moyco-Union Broach, USA). Specimens in Group 5 were prepared using stainless steel hand instruments Flexofile (Dentsply/Maillefer, Switzerland). All root canals were previously submitted to cervical preparation using Orifice Shaper instruments #1, 2, 3 and 4 (Dentsply/Maillefer, Switzerland). After odontometry, the remaining root canal was shaped employing increasingly larger instruments, so that the final instrument corresponded to Quantec #9, Pro-File Series 29 #6, and #35 for the other groups. Specimens in Groups 1 to 4 were prepared using an electric handpiece with 16:1 reduction at 350 rpm. The specimens in Group 5 were manually prepared. Apical displacement was measured and recorded by means of radiographic superimposition on a specific desk. Statistical analysis (ANOVA) of the results revealed that all groups presented apical displacements. Considering only the nickel-titanium instruments, Group 4 showed the lowest mean value while Groups 2 and 3 produced the highest mean apical displacement values (pO objetivo deste trabalho foi avaliar o deslocamento apical produzido por diferentes instrumentos de níquel-titânio acionadas a motor testando a hipótese de que os sistemas rotatórios que usam instrumentos de níquel-titânio produzem valores médios de deslocamento apical menores que as limas manuais de aço inox. Foram utilizados 100 primeiros molares permanentes superiores, cujas raízes mesiovestibulares foram separadas e incluídas em blocos de resina autopolimerizável. Os corpos de prova foram divididos aleatoriamente em 5 grupos e os canais radiculares preparados com instrumentos de níquel-titânio: Grupo 1 - sistema Quantec 2000 (Analytic Endodontics, México); Grupo 2 - Pro-File T.0.04 (Dentsply/Maillefer, Suíça); Grupo 3 - Pro-File Série 29 T.0.04 (Dentsply Tulsa, Suíça); Grupo 4 - Pow-R T.0.02 (Moyco-Union Broach, EUA); e Grupo 5 (limas manuais) - limas manuais de aço inox Flexofile (Dentsply/Maillefer, Suíça). Todos os canais mesiovestibulares foram submetidos a um preparo cervical prévio utilizando-se instrumentos Orifice Shaper números 1, 2, 3 e 4 (Dentsply/Maillefer, Suíça). Realizada a odontometria, o restante do canal radicular foi modelado a partir dos instrumentos do menor para o maior calibre de tal ordem que o instrumento final de preparo correspondeu ao número 9 para o Quantec, número 06 para o Pro-File Série 29 e o número 35 para os demais grupos. Nos grupos de 1 a 4 foi utilizado motor elétrico com contra-ângulo de redução de 16:1 numa velocidade de 350 rpm. No grupo 5 o preparo foi realizado manualmente. A análise dos resultados (ANOVA), obtidos pela sobreposição radiográfica numa plataforma especifica, demonstraram que todos os grupos apresentaram deslocamentos apicais, sendo que o menor valor médio foi verificado no grupo 4 e os maiores valores médios foram observados nos grupos 2 e 3 (

Análise histológica da biocompatibilidade de três diferentes cimentos obturadores a base de hidróxido de cálcio

OBJECTIVE: To histologically evaluate the behavior of the subcutaneous tissue of rats after placement of polyethylene tubes filled with calcium hydroxide-based root canal sealers (SealapexTM, ApexitTM e Sealer 26TM). STUDY DESIGN: The study employed 60 rats, which were divided into eight groups, being four experimental groups with 10 rats each, and four control groups with five rats. Analysis was conducted at 48 hours, 7, 21 and 60 days. RESULTS: Histological analysis revealed that all sealers were irritant; however, the intensity varied between each sealer and as a function of time. At the initial periods (48 hours and seven days), all materials demonstrated similar outcomes, with inflammatory reaction from severe to moderate, respectively. At the final periods (21 and 60 days), the tissue reactions to the implants containing SealapexTM displayed an active status yet with regression, compared to the ApexitTM and Sealer 26TM. The control groups exhibited less inflammatory cells than the experimental groups, keeping a reaction status with regression. CONCLUSIONS: The results achieved in this study revealed that the SealapexTM sealer was the most compatible, followed by ApexitTM and Sealer 26TM.INTRODUÇÃO: O tratamento endodôntico tem seus procedimentos clínicos fundamentados em conhecimentos básicos, principalmente biológicos, cujo êxito do tratamento depende das condições dos tecidos da região apical e periapical, dos mecanismos de defesa orgânicos e da potencialidade de reparação das células. Diferentes materiais obturadores, com os mais diferentes componentes químicos, têm sido testados em busca de uma substância que tenha propriedades físico-químicas e principalmente biológicas ideais para perfeita vedação do canal radicular. Um fato importante referente aos insucessos nos tratamentos endodônticos diz respeito aos componentes tóxicos dos cimentos obturadores de canal, incluídos com o propósito de neutralizar as falhas de desinfecção durante o preparo do canal. OBJETIVO: Avaliar histologicamente o comportamento tecidual subcutâneo de ratos após implantes de tubos de polietileno preenchidos com cimentos obturadores de canal à base de hidróxido de cálcio (Sealapexâ, Apexitâ e Sealer 26â). MATERIAL E MÉTODO: Foram utilizados para este estudo 60 ratos, os quais foram divididos em oito grupos: quatro grupos experimentais, cada um com 10 ratos, e quatro grupos controle, com cinco ratos. Foram analisados em intervalos de 48 horas, 7, 21 e 60 dias. RESULTADOS: Os resultados da análise histológica mostraram que todos os cimentos foram irritantes, porém em intensidade que variaram entre si e em função do tempo. Nos períodos iniciais (48 horas e sete dias) todos os materiais exibiram resultados próximos, com quadro inflamatório entre severo e moderado, respectivamente. Nos períodos finais (21 e 60 dias), as reações teciduais aos implantes contendo o cimento Sealapexâ apresentaram quadro ativo, mas em fase involutiva, em relação aos cimentos Apexitâ e Sealer 26â. Os grupos controle apresentaram número de células inflamatórias inferior aos grupos experimentais, mantendo quadro reacional em fase involutiva. O método estatístico utilizado foi a análise de variância para que fosse feita uma comparação entre as médias. CONCLUSÕES: Conclui-se que o cimento Sealapexâ foi o mais biocompatível seguido pelo Apexitâ e Sealer 26â

Influência de diferentes métodos de ampliação cervical na determinação do comprimento de trabalho

OBJETIVO: determinar a influência de três sistemas distintos de instrumentos rotatórios para alargamento cervical na determinação do comprimento real de trabalho. MATERIAL E MÉTODOS: Trinta primeiros molares inferiores foram submetidos ao acesso endodôntico convencional e odontometria inicial pelo método visual, utilizando-se para irrigação/aspiração da câmara pulpar o hipoclorito de sódio a 5%. Procedeu-se a ampliação cervical dos canais mésio-vestibulares empregando-se diferentes alargadores cervicais. De acordo com o sistema de ampliação cervical empregado, as 30 amostras foram divididas aleatoriamente em 3 grupos de 10 dentes cada. No Grupo 1 as brocas de Gates-Glidden foram utilizadas para a ampliação cervical; no Grupo 2, Orifice Openers foram empregados; e, no Grupo 3, foi usado o sistema La Axxess. Foram utilizadas em ordem crescente, duas numerações do sistema rotatório correspondente a cada grupo e, após, realizou-se a odontometria final. A leitura das duas tomadas odontométricas foi realizada com paquímetro digital, em milímetros, considerando-se duas casas decimais para averiguar a provável discrepância entre ambas as tomadas. RESULTADOS: a análise de variância (ANOVA) e o teste de Tukey (p£ 0,05) demonstraram diferença estatística entre o Grupo 1 e os Grupos 2 e 3. CONCLUSÕES: todos os grupos apresentaram encurtamento do comprimento de trabalho após alargamento cervical; os grupos preparados com instrumentos La Axxes e Orifice Opener apresentaram os melhores resultados.OBJECTIVE: to investigate the influence of three different rotary systems for cervical flaring on establishment of the real working length. MATERIAL AND METHODS: Thirty mandibular first molars were submitted to conventional endodontic access and initial working length measurement, followed by irrigation/suction of the pulp chamber with 5% sodium hypochlorite. Teeth were randomly divided into 3 groups (n=10) and cervical flaring of the mesiobuccal canals were performed using one of the following instrument systems: Group 1 - Gates-Glidden burs; Group 2 - Orifice Openers; Group 3 - La Axxess system. Two subsequent numbers of instruments of each rotary system were used and the final working length was recorded. A digital calyper was used to record the working length, in millimeters, to investigate a possible discrepancy between initial and final measurements. RESULTS: Analysis of variance (Anova) na Tukey test revealed statistical difference between Group 1 and Groups 2 and 3 (p£ 0.05). CONCLUSIONS: all groups presented shorter working length after cervical flaring; groups prepared with instruments La Axxes and Orifice Opener presented the best results among the systems studied

Regenerative endodontic treatment of teeth with incomplete root formation: a review

Endodontic treatment of teeth with open apex requires a non-conventional approach and the goals new therapies are to allow root’s complete development differently from what happens with traditional apexification technique. Objective: This study aimed to review the literature on the most recent regenerative endodontic procedures. Literature review: Regenerative endodontics goal is to obtain pulp vitality. Some case reports on donor-obtained dental stem cells show promising results. Other types of laboratory-based dental stem cell therapies are under development. Conclusion: Dentin-pulp complex shows regenerative capacity, but the literature lacks evidence to validate the regenerative therapies in endodontic practic

Root Preparation of Deciduous Teeth: Efficacy of WaveOne and ProTaper Systems with and without Passive Ultrasonic Irrigation

Introduction: The aim of this study was to compare root preparation of deciduous teeth with WaveOne Large (WO) and ProTaper F4 (PT) instruments with or without passive ultrasonic irrigation (PUI). Methods and Materials: Forty-eight deciduous teeth were scanned before and after root preparation and divided in four groups (n=12): WO+EDTA (WO); WO+EDTA with PUI (WOPUI); PTF+EDTA (PT); and PT+EDTA with PUI (PTPUI). Root canal enlargement by micro-computed tomography and root canal cleaning by scanning electron microscopy (SEM) were analyzed. Data were submitted to two-way ANOVA and Tukey’s tests to analyze the root canal volume variation, and Kruskal-Wallis followed by Friedman and Wilcoxon tests were used to evaluate the cleaning efficacy. The level of significance was set at 0.05. Results: No significant difference occurred in total volume between groups (P>0.05). On analysis by thirds of the root canal, there was a difference in volume between WO (cervical) compared to WO and PT (apical), and PTPUI (middle and apical) (P<0.05). When cleaning of the thirds within the same group was compared, there was a significant difference in all groups (P<0.05). Among the groups, in the thirds, in the cervical a difference occurred (P=0.028), and the pairwise comparisons indicated statistically difference between WO and PT, and WO and PTPUI (P<0.05). In the pairwise comparisons among thirds, in the groups, difrences occured in all of them when compared the cervical and apical thirds (P<0.05). Conclusion: Passive ultrasonic irrigation has not improved the smear layer removal in deciduous teeth. Despite the differences in performance between WO and PT instruments, both were suitable for preparation of deciduous teeth.Keywords: Deciduous Teeth; Endodontic; Passive Ultrasonic Irrigation; Root Canal Preparation; Ultrasoni

Influence of protaper finishing files and sodium hypochlorite on cleaning and shaping of mandibuldar central incisors - a histological analysis

OBJECTIVE: This study investigated the influence of the last apical instrument of the ProTaper system with and without 2.5% sodium hypochlorite for cleaning mandibular central incisors. MATERIAL AND METHODS: Thirty two mandibular central incisors were divided into six study groups: Group I - F1 instrument with 2.5% sodium hypochlorite; Group II - F1 and F2 with 2.5% sodium hypochlorite; Group III - F1, F2 and F3 with 2.5% sodium hypochlorite; Group IV - F1 with distilled water; Group V - F1 and F2 with distilled water; Group VI - F1, F2 and F3 with distilled water. The two remaining teeth comprised the negative control group. The specimens were prepared following the principles of the technique suggested by the manufacturer and then submitted to histological preparation and morphometric analysis. Data were analyzed statistically by the Kruskal Wallis test at 1% significance level. RESULTS: There was statistically significant difference (

Influencia de la vibración sónica y el tipo de cemento en la fuerza de unión de los postes de fibra de vidrio después del envejecimiento.

Introduction: This study evaluated the influence of sonic vibration and thermocycling on the bond strength of fiberglass posts using conventional dual-cured and self-adhesive resin cements. Material and Methods: Ninety-six single-rooted endodontically treated teeth were divided randomly into eight groups according to the cement used (dual-cured or self-adhesive resin cement), use of sonic vibration during post accommodation, and aging conditions (24h in distilled water or 5,000 thermal cycles). The fiberglass posts (White Post DC1, FGM) were cleaned with alcohol, treated with silane and cemented with dual-cured (Allcem Core, FGM) or with self-adhesive resin cement (seT, SDI). For groups in which sonic vibration was used, the posts were accommodated, and sonic vibration was applied for 10 s using a special tip placed on top of the post (Sonic Smart Device, FGM). Pull-out tests were performed after storage in distilled water for 24h at 37°C or after thermocycling (5000 cycles, at 5°C and 55°C). The results were evaluated using three-way ANOVA and Tukey’s test (?=0.05). Results: Significant differences were not observed between the bond strengths of dual-cured (87.93±41.81 N) and self-adhesive cement (82.53±41.43 N). Bond strength for the sonic vibration groups (100.36±42.35 N) was significantly higher than for groups without sonic vibration (70.13±34.90 N). There were significant differences between specimens subjected to thermocycling (98.33±39.42 N) and those stored for 24h in distilled water (72.16±39.67 N). Conclusion: It can be concluded that both sonic vibration and thermocycling significantly improved bond strength of fiberglass posts with the two evaluated resin cements.Introducción: Este estudio evaluó la influencia de la vibración sónica y el termociclado en la fuerza de unión de los postes de fibra de vidrio utilizando cementos de resina autoadhesivos y de curado dual convencionales Material y Métodos: Se dividieron aleatoriamente noventa y seis dientes tratados endodónticamente de raíz única en ocho grupos según el cemento utilizado (cemento de resina de curado dual o autoadhesivo), el uso de vibración sónica durante la acomodación posterior y las condiciones de envejecimiento (24 horas agua destilada o 5.000 ciclos térmicos). Los postes de fibra de vidrio (White Post DC1, FGM) se limpiaron con alcohol, se trataron con silano y se cementaron con cemento de curado dual (Allcem Core, FGM) o con cemento de resina autoadhesivo (seT, SDI). Para los grupos en los que se utilizó vibración sónica, se acomodaron los postes y se aplicó la vibración sónica durante 10 s utilizando una punta especial colocada en la parte superior del poste (Sonic Smart Device, FGM). Las pruebas de extracción se realizaron después del almacenamiento en agua destilada durante 24 horas a 37ºC o después del termociclado (5000 ciclos, a 5ºC y 55ºC). Los resultados se evaluaron mediante ANOVA de tres vías y la prueba de Tukey (? = 0.05). Resultados: No se observaron diferencias significativas entre las resistencias de adhesión del cemento de curado dual (87,93 ± 41,81 N) y el cemento autoadhesivo (82,53 ± 41,43 N). La fuerza de unión para los grupos de vibración sónica (100,36 ± 42,35 N) fue significativamente mayor que para los grupos sin vibración sónica (70,13 ± 34,90 N). Hubo diferencias significativas entre los especímenes sometidos a termociclado (98,33 ± 39,42 N) y los almacenados durante 24 h en agua destilada (72,16 ± 39,67 N). Conclusión: Se puede concluir que tanto la vibración sónica como el termociclado mejoraron significativamente la fuerza de unión de los postes de fibra de vidrio con los dos cementos de resina evaluados