Estudio comparativo de la eliminación de debris y smear layer con láser de ND: YAG y ER,CR: YSGG. Análisis in vitro mediante microscopía electrónica de barrido.

Introducción: La tecnología láser en endodoncia tiene un efecto positivo en cuanto a limpieza mecánica y desinfección. En este estudio hemos querido estudiar el efecto de dos tipos de láser, el láser de Nd:YAG y el láser de Er,Cr:YSGG, en la limpieza de las paredes dentinarias y, en concreto, sobre la apertura de los túbulos dentinarios y la presencia o no de debris y barrillo dentinario. Material y Método: Se escogió una muestra de 60 dientes unirradiculares que se dividieron en 5 grupos según el protocolo de irrigación utilizado, utilizando EDTA al 17%, Láser de Nd:YAG, Láser de Er,Cr:YSGG, EDTA al 17% y Láser de Nd:YAG y EDTA al 17% y Láser de Er,Cr:YSGG. Las muestras fueron observadas al microscopio electrónico de barrido para su análisis de presencia de debris y barrillo dentinario en los tercios apical y medio del conducto. Resultados: En el análisis del tercio apical, no se encontraron diferencias estadísticamente significativas al comparar ninguno de los grupos a estudio. En el análisis del tercio medio, encontramos diferencias estadísticamente significativas al comparar el grupo irrigado con EDTA al 17% y el grupo irrigado con Láser de Er,Cr:YSGG, al comparar el grupo irrigado con EDTA al 17% y el grupo irrigado con EDTA al 17% y láser de Er,Cr:YSGG y al compara el grupo irradiado con Láser de Nd:YAG y el grupo irrigado con láser de Er,Cr:YSGG. Conclusiones: En cuanto a la remoción de debris y barrillo dentinario, el láser de Nd:YAG no es eficaz a la hora de eliminar el barrillo dentinario. Sin embargo, el láser de Er,Cr:YSGG sí es eficaz a la hora de eliminar debris ybarrillo dentinario. La combinación del láser de Nd:YAG con EDTA al 17% no mejora la limpieza de la superficie dentinaria. Sin embargo, la combinación del láser de Er,Cr:YSGG y EDTA al 17%, esta combinación resulta en superficies más limpias en el tercio medio, al ser comparadas con el EDTA al 17%, con diferencias estadísticamente significativas

Effectiveness of Nd:YAG Laser on the elimination of debris and Smear Layer : a comparative study with two different irrigation solution: Edta and qmix® in addition to naocl

The aim of this study was to evaluate the effectiveness in dentin debris and smear layer removal from root canal walls using EDTA and QMix® alone and also activated with Nd:YAG laser. 50 single-rooted teeth were instrumented and divided in 5 groups according to irrigation protocol: 17% EDTA, QMix®, Nd:YAG laser alone, and combination of 17% EDTA - Nd:YAG laser and QMix® - Nd:YAG laser. Samples were evaluated using SEM. Statistical analysis was done using Chi-Square Fisher exact test and McNemar test. Dentinal debris analysis showed statistically significant differences when comparing 17% EDTA vs Laser and Laser vs QMix® in combination with Laser at the apical third. The Smear Layer analysis also showed statistically significant differences at the apical third when comparing 17% EDTA vs Laser, QMix® vs QMix® in combination with Laser and Laser vs QMix® in combination with Laser. 17% EDTA was the most efficient irrigant showing the best results. Laser alone was not effective removing either dentinal debris or smear layer

Prevalence of dens invaginatus assessed by CBCT : systematic review and meta-analysis

Dens invaginatus is a developmental dental anomaly resulting from an invagination of dental tissues folding from the outer surface towards dental pulp. The aim of this systematic review and meta-analysis was to determine the prevalence of dens invaginatu

Comparative study of debris and smear layer removal with EDTA and Er,Cr:YSGG laser

Background: To evaluate in vitro , the ability in removing debris and Smear Layer of 17% EDTA and Er,Cr:YSGG laser. Material and Methods: 58 unirradicular teeth were instrumented with MTwo® and divided into 3 groups according to irrigation protocol: 17%EDTA, laser and a combination of 17%EDTA and laser. All samples were analyzed in the apical and middle third with Scanning Electron Microscope. The Chi-cuadrado and McNemar tests were used to determine the statistical analysis and data processing and analysis was performed with the statistical package StatGraphics Centurion XVI. Results: Debris analysis showed statistical significant differences when compared EDTA vs laser and EDTA vs EDTA+laser in the middle third. The Smear Layer removal showed statistical significant differences in the middle third when compared EDTA vs laser and EDTA vs EDTA+laser. Conclusions: Laser showed a greater cleaning capacity than EDTA in the middle third; the cleanliness was even better when combined laser with EDTA, so the effect is accumulative

Smoking and Radiolucent Periapical Lesions in Root Filled Teeth: Systematic Review and Meta-Analysis

Aim: This systematic review and meta-analysis aimed to investigate the association between smoking habits and the prevalence of radiolucent periapical lesions (RPLs) in root-filled teeth (RFT). Methods: The Population, Intervention, Comparison, and Outcome (PICO) question was: in adult patients who have RFT, does the absence or presence of a smoking habit affect the prevalence of RPLs associated with RFT? Systematic MEDLINE/PubMed, Wiley Online Database, Web of Science, Scopus, and PRISMA protocol were used to evaluate and present the results. Studies comparing smokers with control non-smoker subjects, including RFT, and providing data on the prevalence of RFT with RPLs, were included. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system was used for certainty in the evidence. The risk of bias was assessed according to Cochrane Collaboration common scheme for bias and ROBINS-I tool. Cumulative meta-analysis was performed with a random effects model. PROSPERO registration code: CRD42020165279. Results: Four studies reported data on inclusion criteria, representing data from 9257 root-filled teeth—4465 from non-smokers and 4792 from smoker patients. The meta-analysis provided an odds ratio indicating a significant association between smoking and higher prevalence of root filled teeth with radiolucent periapical lesions (OR = 1.16; 95% CI = 1.07–1.26; p = 0.0004). The certainty of the literature assessment was moderate per GRADE. The ROBINS-I tool classified three studies as low risk of bias, and the fourth as moderate risk of bias. Conclusions: Moderate, quality scientific evidence indicates a weak but significant relationship between smoking and the prevalence of RPLs in RFT. Smoking can be considered a negative prognostic factor for the outcome of root canal treatment. Endodontic providers should be aware of the relationship between smoking and persistent apical periodontitis, assessed as RPLs, in RFT

Use of antibiotics by spanish dentists receiving postgraduate training in endodontics

The incidence of endodontic infections is high. The contribution of Endodontics to the global problem of antibiotic resistance could be significant. The ESE, together with the World Health Organization, are promoting the World Antibiotic Awareness Week (13-19 November 2017) to promote the appropriate use of systemic antibiotics in Endodontics. The objective of this study was to determine the prescription pattern of antibiotics in the treatment of endodontic infections of Spanish dentists attending specialization programs in Endodontics. Material and Methods: Dentists from five Spanish endodontic postgraduate programs were requested to answer a one-page questionnaire surveying about antibiotics indications. Seventy-three dentists were required to participate in this investigation, and 67 (91.2%) fulfilled satisfactorily the survey and were included in the study. Data were analyzed using descriptive statistics and chi square test. Results: The average duration of antibiotic therapy was 6.8±1.2 days. All respondents chose amoxicillin as first choice antibiotic in patients with no medical allergies, alone (40%) or associated to clavulanic acid (60%). The first drug of choice for penicillin allergic patients was clindamycin (72%). For cases of irreversible pulpitis, 22% of respondents prescribed antibiotics. For the scenario of a necrotic pulp, symptomatic apical periodontitis and no swelling, 37% prescribed antibiotics. A quarter of dentists prescribed antibiotics for necrotic pulps with asymptomatic apical periodontitis and a sinus tract. Conclusions: The results of this study show that postgraduate training in Endodontics provides greater awareness of the correct indications of antibiotics. Dentists who have received specialized training in Endodontics have a prescription pattern of antibiotics more adjusted to the guidelines recommended by international organizations and by scientific societies. Key words:Antibiotics, apical periodontitis, dental curriculum, endodontic infections, postgraduate endodontic training

Effect of the Nd:YAG laser on sealer penetration into root canal surfaces: a confocal microscope analysis

Objectives: The objective of this in vitro study was to evaluate the use of the Neodymium:Yttrium-Aluminium-Garnet (Nd:YAG) laser as part of the root canal treatment on the penetration of sealer into dentinal tubules. Methods: Eighty extracted lower premolars were randomly assigned to two groups (n = 40 each): Control group (CG), subjected to a conventional protocol of endodontic instrumentation and obturation; and Laser group (LG), in which Nd:YAG laser irradiations were combined with conventional preparation and obturation. Endodonted samples were sectioned at 3 and 5 mm from the apex and observed under a confocal scanning microscope (CLSM). The penetration depth into the dentinal tubules and the extension of the intracanal perimeter infiltrated by sealer were measured. The Student-Newman Keuls test was run for between-group comparisons (α=.05). Results: The depth of sealer penetration into dentinal tubules did not differ among groups. LG samples showed the significantly highest percentage of penetrated perimeter at 3 mm from the root apex. Within each group, the greatest depth of penetration (P=.0001), and the major percentage of penetrated perimeter (P <.001), were recorded at 5 mm. Conclusions: The application of the Nd:YAG laser after instrumentation did not improve the depth of sealer penetration into the dentinal tubules. The laser enlarged the total penetrable perimeter near the ape

Comparison of diode laser - Oral tissue interaction to different wavelengths. In vitro study of porcine periodontal pockets and oral mucosa

[Background] The aim of this in vitro study was to evaluate the effect of diode lasers at different wavelengths and power settings in handmade incisions in periodontal pockets and in oral mucosa of porcine tissue considering thermal damage, necrosis and the affected area of the soft tissue.[Material and Methods] Combining the following laser wavelengths, 445nm, 532nm (KTP), 810nm, 980nm, 1064nm and 1470nm, and a power range from 0.5W to 2.0W in a continuous wave mode (CW), we made hand-made incisions in porcine periodontal pockets and oral mucosa. After histological processing, we measured the area of lost tissue, the area of thermal damage and the area of necrosis. Then, we performed ANOVA to evaluate the difference between groups and two-way ANOVA to identify the influence of the laser-type variables and the power on the results.[Results] We applied an ANOVA test to evaluate the results, where statistical analysis showed clear differences between the 1470nm and 810nm laser groups that refer to thermal damage and necrosis in the periodontal pocket surface. Regarding the oral mucosa surface, the 1064nm laser showed differences in the analysis of lost tissue. According to the applied power, all the variables we studied (lost tissue area, area of thermal damage and necrosis) showed higher values when using a power of 2.0W instead of 0.5W.[Conclusions] According to our results, the 810nm diode laser for oral soft-tissue biopsy using power ranges be-tween 0.5W and 2W would be the best choice to avoid thermal damage in peri-incisional margins

Use of contemporary technologies and new materials in undergraduate Endodontics teaching

Background: This study aims to analyze the use of contemporary technologies and materials in undergraduate endodontic teaching in Spain. Material and Methods: The survey was sent to the undergraduate endodontic programme leads in the 23 Spanish dental schools. The survey asked about the use of magnification, ultrasonic devices, electronic apex locator, rotary instruments, root-filling techniques, and bioceramic cements in the teaching of endodontics. Results: The response rate was 91%, and the final number of schools included in the study was twenty. Only two schools (10%) used magnification (loupes or operative microscope). Five schools (25%) used ultrasonic devices to prepare the access cavity, and four (20%) to activate the irrigation solution. In 14 dental schools (70%) no type of ultrasonic instrument was used. Electronic apex locators in working length determination was used in 19 schools (95%). All schools used rotary instrumentation in the teaching of endodontics, and 45% of schools used reciprocating instruments. Five schools (25%) used warm vertical compaction technique, four (20%) single cone gutta- percha technique, and four (20%) thermoplastic injection techniques. No school used carrier-based gutta-percha. Bioceramic cements were used in 19 of the schools (95%).Conclusions: Spanish dental schools have incorporated some of the new endodontic technologies and materials, including the electronic apex locator, rotary instruments, and the new bioceramic cements; however, the modern root filling techniques, magnification, and ultrasonic instruments are not yet used in most dental schools.Peer reviewe

Biomaterials in periapical regeneration after microsurgical endodontics: A narrative review

Background: The objective of this narrative review was to analyze the available scientific evidence regarding the application of biomaterials in endodontic microsurgery and its influence in post-surgical tissue repair. Material and Methods: The review question was Do biomaterials used in endodontic microsurgery influence post-surgical tissue repair and regeneration? Systematic MEDLINE/PubMed review was used to evaluate and present the results. Results: The search yielded 131 references, 82 of which were selected for full text review after reading the abstracts. After a manual search in the references of the articles selected, 52 references were eliminated. Finally, 30 articles were selected. Conclusions: Bone grafts, membranes and bioceramics, especially MTA, are biomaterials with the ability to stimulate periapical tissue regeneration. This is one of many reason why bioceramics are the best choice as retrograde sealing materials. However, microsurgically treated periapical lesions can heal completely without the need to use bone grafts or membranes. Those techniques are indicated in endodontic microsurgery when additional stimulation of tissue regeneration is required, or when bone collapse needs to be prevented.Peer reviewe