Effects of Reciproc, ProTaper Next and WaveOne Gold on Root Canal Walls: A Stereomicroscope Analysis

Introduction: The aim of this study was to analyse the potential occurrence of dentinal defects after root canal preparation using three engine-driven instruments. Methods and Materials: Eighty permanent mandibular incisors were selected. Twenty teeth did not undergo preparation, and the remaining teeth were divided into three groups (n=20): Reciproc (REC), ProTaper Next (PTN) and WaveOne Gold (WOG). The samples were dyed with methylene blue, sectioned perpendicularly to the long axis in 3-, 6- and 9-mm slices and were finally observed under a stereomicroscope (under 25×). The absence/presence of dentinal defects was documented by two blind observers. The data were analysed using Pearson’s chi-squared test with a confidence level of 95% (P=0.05). The time to prepare the samples was recorded, and the groups were compared using F-test (ANOVA). Results: The control group did not present any defects, and the differences between the control and experimental groups were statistically significant (P<0.05). WOG, PTN and REC caused microcracks on 60%, 33.33% and 18.33% of the samples, respectively. No significant differences between the groups in the 3-mm sections (P=0.126) were observed. There were significant differences in the 6-mm (P=0.042) and 9-mm sections (P<0.001). When WOG and PTN were used to perform root canal preparation, a significant difference was found in the average time (P=0.047). Conclusion: All the used instruments caused dentinal defects in the root dentin. All the instruments were used to perform the preparation with a similar average time.Keywords: Dentinal Defects; Microcracks; Nickel-Titanium Instruments; Root Canal Preparatio

Bacterial Reduction after Gutta-Percha Removal with Single vs. Multiple Instrument Systems

Introduction: The aim of this study was to evaluate the effectiveness of a reciprocating single-instrument system (Reciproc-REC) compared with combined continuously rotating multiple-instrument systems [D-Race (DR) and BioRace (BR)] in reducing Enterococcus faecalis (E.f.) after gutta-percha removal. Methods and Materials: Forty-six extracted human maxillary incisors were prepared and contaminated with E.f. strain (ATCC 29212) for 30 days. The samples were obturated and randomly divided into two experimental groups for gutta-percha removal (n=23): a REC group (R50) and a DR/BR group (DR1, DR2 and BR6). A standardized irrigation with 0.9% saline solution was performed. Root canal samples were taken with paper points before (S1) and after (S2) the removal of gutta-percha to establish bacterial quantification by culture. The time required for gutta-percha removal was also recorded. Positive and negative control groups (n=6) were used to test bacterial viability and control asepsis, respectively. Data were analysed using t-Student and one-way ANOVA tests (5% margin of error). Results: The mean percentage of bacterial reduction was significantly higher in DR/BR group (84.2%) than in REC group (72.3%) (P<0.05). The mean time for obturation removal was 74.00 sec in REC group and 107.53 sec in DR/BR group (P<0.05). Conclusion: The combined continuously rotating multiple-instrument system was more effective in reducing bacteria after the removal of gutta-percha than the single-instrument system. None of the tested systems was able to completely eliminate root canal infection after gutta-percha removal. Thus, additional techniques should be considered.Keywords: Endodontics; Enterococcus faecalis; Instrumentation; Retreatment; Root Canal Instrumentatio

Photodynamic Therapy as an adjunct in the Treatment of Medication-Related Osteonecrosis of the Jaw: A Case Report

Introduction: Medication-related osteonecrosis of the jaws (MRONJ) corresponds to an adverse effect of the use of drugs such as Bisphosphonates and Denusomab. The management of MRONJ tends to be conservative, through the guidance of oral hygiene, antibiotic therapy and mouthwashes. However, the use of antimicrobial photodynamic therapy (aPDT) has shown promise in the treatment of these injuries. The purpose of this article is to report a case of MRONJ treatment associated with aPDT. Case report: A 75-year-old patient, with a history of breast cancer and use of intravenous Zoledronic Acid, presented with bilateral MRONJ lesions in tuberosity on the right and left sides. Treatment was conservatively instituted with the use of aPDT as an adjuvant. After 12 aPDT sessions, complete regression of the lesion was observed. However, after two weeks, the presence of a new lesion was noted, this time in the anterior region of the maxilla. The same protocol previously established was followed and after two aPDT sessions, the patient returned with complete lesion regression. Conclusion: The use of aPDT may represent an important adjuvant within a set of clinical protocols in the treatment of MRONJ. DOI:10.34172/jlms.2021.1

LASER THERAPY IN THE TREATMENT OF ORAL MUCOSITIS IN ONCOLOGY PATIENTS

The oral mucositis affects between 89% and 97% of the patients that are users of chemotherapy and radiotherapy as treatment for malignant neoplasms, presenting the potential to interfere directly in the patient's well-being. However, the use of low-power laser therapy has proven to be the most appropriate treatment for oral mucositis, acting through photophysical and biochemical processes that increase cellular metabolism, stimulating mitochondrial activity, acting as an analgesic, anti-inflammatory and repairing agent of the mucosal lesion. This study aims to analyze the efficacy of low intensity laser in the prevention and treatment of oral mucositis in patients exposed to radiotherapy and chemotherapy in the head and neck region. This is a descriptive/narrative literature review, in which the SciELO, LILACS, Pubmed and Medline databases were searched. The following descriptors were used: Oral mucositis; Laser therapy; Radiotherapy; Chemotherapy. The studies showed that in most patients who were prophylactically submitted to laser therapy sessions prior to the antineoplastic treatment, there was no development of lesions on the mucosa or when developed, the mucositis was mild, not altering the patient's well-being

Apical Extrusion of Debris Produced during Continuous Rotating and Reciprocating Motion

This study aimed to analyse and compare apical extrusion of debris in canals instrumented with systems used in reciprocating and continuous motion. Sixty mandibular premolars were randomly divided into 3 groups (n=20): the Reciproc (REC), WaveOne (WO), and HyFlex CM (HYF) groups. One Eppendorf tube per tooth was weighed in advance on an analytical balance. The root canals were instrumented according to the manufacturer’s instructions, and standardised irrigation with 2.5% sodium hypochlorite was performed to a total volume of 9 mL. After instrumentation, the teeth were removed from the Eppendorf tubes and incubated at 37°C for 15 days to evaporate the liquid. The tubes were weighed again, and the difference between the initial and final weight was calculated to determine the weight of the debris. The data were statistically analysed using the Shapiro-Wilk, Wilcoxon, and Mann-Whitney tests (α=5%). All systems resulted in the apical extrusion of debris. Reciproc produced significantly more debris than WaveOne (p<0.05), and both systems produced a greater apical extrusion of debris than HyFlex CM (p<0.001). Cross section and motion influenced the results, despite tip standardization

RESIDÊNCIA EM TERAPIA INTENSIVA: O PAPEL DO CIRURGIÃO-DENTISTA NA EQUIPE MULTIPROFISSIONAL E NA ATENÇÃO AO PACIENTE CRÍTICO

A residência multiprofissional consiste em um programa de pós-graduação, regulamentado pela Lei 11.129 de 2005, que tem como o objetivo a formação de profissionais qualificados, nas mais diversas áreas do conhecimento, visando abranger variados espectros da saúde integrativa. A Odontologia, como parte da equipe multiprofissional presente em Unidades de Terapia Intensiva, desenvolve um papel assistencialista, com o intuito de prevenir, diagnosticar e muitas vezes tratar agravos bucais que podem gerar repercussões sistêmicas. O paciente presente em Unidade de Terapia Intensiva pode estar comumente necessitado de uma assistência ventilatória, às vezes através da intubação orotraqueal, o que acarreta corriqueiramente a necessidade de abertura bucal de maneira ininterrupta, podendo ocasionar desidratação da mucosa oral, aumento da saburra lingual e lesões da comissura labial. Além disso, quando associado a quadros de imunodeficiência, aumenta-se a necessidade da avaliação odontológica rotineira a fim de prevenir infecções oportunistas. Entende-se, portanto, a necessidade de programas de pós-graduação em Odontologia do tipo residência profissional com foco em Terapia Intensiva, com o intuito de contribuir com a formação de novos cirurgiões-dentistas intensivistas de modo a agregar na atenção integralizada do paciente crítico e prevenir o aumento da morbidade associada a ambiente hospitalar, como a pneumonia associada à ventilação mecânica

Antibacterial Effect of Photodynamic Therapy on Root Canal Disinfection Combined with Different Irrigation Protocols

Introduction: Photodynamic therapy (PDT) is an emerging alternative therapy to conventional endodontic treatment to optimize bacterial elimination. The aim of this study was to evaluate the in vitro antibacterial effect of PDT combined with different irrigation protocols on root canals inoculated with Enterococcus (E.) faecalis. Methods and Materials: Ninety uni-radicular human premolars were prepared and contaminated with E. faecalis for 4 days. Teeth were randomly divided into six groups: positive control group (C+) consisted of conventional needle irrigation with 2.5% sodium hypochlorite (NaOCl); negative control group (C-) consisted of no treatment after contamination; PDT group as treated with 0.005% methylene blue and diode laser irradiation for 90 sec at wavelength of 660 nm, energy of 9 Joules, power of 100 mW; the fourth group consisted of  NaOCl+PDT, the fifth group were treated with passive ultrasonic irrigation (PUI) with NaOCl+PDT (PUI+PDT); and the final group were treated with XP Endo Finisher with NaOCl+PDT (XP Endo+PDT). The contents of the root canals were collected with sterile absorbent paper points at two times: before and 24 h after decontamination protocols. The number of colony-forming units (CFU) was determined for each root canal. ANOVA and the Tukey test were used, with significance set at 5% (P&lt;0.05). Results: The inhibition percentage ranged from 10.72 (C-) to 100% (XP Endo+PDT), with CFU/mL counts differing among all protocols tested (P&lt;0.05). The different protocols significantly influenced bacterial inhibition (P&lt;0.05). However, the XP Endo+PDT protocol resulted in the highest inhibition percentage (100%), followed by NaOCl+PDT (65.85%). Conclusions: PDT combined with different final irrigation protocols was more effective in inhibiting E. faecalis growth than photodynamic therapy alone. XP Endo was the best irrigation protocol to eradicate this microorganism.Keywords: Biofilm; Endodontics; Enterococcus faecalis; Photodynamic Therap

The impact of the COVID-19 pandemic on dental trauma attendance: a systematic review and meta-analysis

This systematic review and meta-analysis aimed to analyze the impact of the COVID-19 pandemic on dental trauma patient attendance. The study was registered in the PROSPERO system, using the CRD42021288398 protocol. Searching was performed in PubMed, Scopus, Web of Science, Embase, Lilacs, and OpenGrey databases, using the following keywords: “Tooth injuries,” “Dental trauma,” “Traumatic Dental injury,” and “COVID-19". We included observational studies evaluating dental trauma in the context of the COVID-19 pandemic. Quality assessment was performed using the Joanna Briggs Institute Critical Appraisal Checklist for Cross-Sectional Studies. Meta-analysis was performed in RevMan 5.4 software with Odds Ratios as a pooled measure of effect, with a 95% confidence interval, and using random-effects modeling. After applying the eligibility criteria, 32 studies were included for qualitative analysis, in which 10 were used to assess the frequency of dental trauma diagnoses in dental emergencies. Despite the decrease of visits during COVID-19, the analysis revealed no difference between the pandemic and pre-pandemic periods. Regarding the type of dental trauma, two of the studies revealed no differences for the periods before and during the pandemic. This study revealed that the COVID-19 pandemic has not impacted the frequency or type of dental trauma compared to previous periods

ALTERAÇÕES BUCAIS EM PACIENTES EM UNIDADE DE TERAPIA INTENSIVA: ESTUDO RETROSPECTIVO

Os pacientes críticos podem desenvolver alterações bucais decorrentes do uso de medicamentos, associada a alterações sistêmicas e/ ou ao suporte ventilatório e que pode agravar o quadro de saúde geral. Deste modo, o objetivo do presente estudo é identificar os agentes etiológicos e a frequência de alterações bucais dos pacientes internados em Unidade de terapia intensiva (UTI). Trata-se de um estudo retrospectivo, descritivo utilizando prontuário médico e odontológico em pacientes internados em UTI, entre março de 2021 a março de 2022. Foram avaliados 150 pacientes. O sexo masculino (56,0%) foi mais afetado que o feminino (44,0%). A idade dos pacientes variou entre 1 a 98 anos, com média de 65,2 anos. A maioria dos pacientes apresentou alguma alteração bucal (79,4%). As infecções de origem odontogênicas foram as mais prevalentes (42,7%), seguido por distúrbios da produção de saliva (24,6%). Dessa forma, observa-se que as alterações bucais foram prevalentes nos pacientes em UTI, reforçando a importância do cirurgião-dentista compondo a equipe multiprofissional

Histologic evaluation of pulpotomy performed with ethyl-cyanoacrylate and calcium hydroxide Avaliação histológica de pulpotomia realizada com etil-cianoacrilato e com hidróxido de cálcio

The aim of this study was to evaluate histological aspects of the pulp-dentin complex of dogs submitted to pulpotomy and capped with ethyl-cyanoacrylate and calcium hydroxide. Thirty dog teeth were divided into 2 groups of 15 as follows: Group 1 - ethyl-cyanoacrylate; Group 2 - calcium hydroxide. The pulpotomies were carried out following all of the treatment precautions recommended for dogs. After 30 days the specimens were submitted to histological preparation and were then blindly evaluated by a histologist. Data were analyzed statistically by the Fisher exact test, comparing the two groups. After 30 days, the presence of a hard tissue barrier was observed in 83.3% of Group 1, and in 100% of Group 2 (p = 0.478). A continuous hard tissue barrier was observed in 50% of the ethyl-cyanoacrylate group and 75% of the calcium hydroxide group (p = 0.652). It can be concluded that both materials induced hard tissue barrier formation, but Group 2 had a higher percentage than Group 1, with no significant statistical differences; the differences observed between the different barriers (continuous/non-continuous) were not significant between groups and there was no pulpal necrosis in either group.O objetivo do presente estudo foi avaliar o aspecto histológico do complexo dentino-pulpar de cachorros quando capeado após a pulpotomia com etil-cianoacrilato e hidróxido de cálcio. Trinta dentes de cães foram divididos em 2 grupos de 15 da seguinte forma: Grupo 1 - Etil-cianoacrilato; Grupo 2 - Hidróxido de cálcio. A pesquisa foi realizada tomando-se todos os cuidados recomendados para o tratamento com os cães. Após 30 dias do procedimento realizado os espécimes foram submetidos ao preparo histológico e logo após foram avaliados de forma cega por um histologista. Os resultados foram analisados estatisticamente através do Teste Exato de Fisher. No grupo 1, 83,3% e no grupo 2, 100% dos dentes apresentaram a barreira de tecido duro (p = 0,478). A barreira de tecido duro contínua foi observada em 50% dos casos tratados com etil-cianoacrilato e em 75% dos com hidróxido de cálcio (p = 0,652). Pode-se concluir que tanto o grupo 1 como o grupo 2 induziram a formação da barreira de tecido duro, porém o grupo 2 teve um percentual maior do que o grupo 1, não havendo diferença estatisticamente significante; a diferença observada entre as estruturas das barreiras (contínuas e não-contínuas) não foi significante. A necrose pulpar não foi observada em nenhum grupo