Avaliação, in vivo, da capacidade de selamento de dois cimentos endodônticos em canais radiculares expostos ao meio bucal por 45 e 90 dias

This in vivo study evaluated the sealing ability of a resin-based sealer (AH Plus) and a zinc oxide-eugenol sealer (Endofill) in dogs' teeth, exposed to the oral environment for 45 and 90 days. Forty eight lower incisors from 8 dogs were endodonticaly treated. A stratified randomization determined the sealer use in each root canal. All canals were filled using the lateral condensation technique. The excess filling material at the cervical portion of the root canal was sectioned, leaving a 10-mm obturation length inside the canal. Teeth were provisionally sealed with glass ionomer cement for 24 h and the canals were exposed to the oral environment for either 45 or 90 days. Therefore, the experimental groups were as follows: A45- AH Plus for 45 days; A90- AH Plus for 90 days; E45- Endofill for 45 days; and E90- Endofill for 90 days (n=12). After the experimental period, the dogs were killed and the lower jaw was removed. The incisors were extracted and the roots were covered with two coats of nail varnish. The teeth were immersed in India ink for 96 h and submitted to diaphanization. Dye leakage (in mm) was measured using stereomicroscopy (10x magnification). The results were statistically analyzed using two-way ANOVA and Tukey test for multiple comparisons (á = 0.05). Group E90 (2.03±0.94) showed significantly higher mean leakage value than all other groups (pEste estudo in vivo avaliou a capacidade de selamento de um cimento endodôntico resinoso (AH Plus) e um a base de óxido de zinco eugenol (Endofill), em dentes de cães, expostos ao meio bucal, por 45 e 90 dias. Foi realizado o tratamento endodôntico de 48 incisivos inferiores de 8 cães. Uma randomização estratificada determinou o tipo de cimento a ser usado em cada canal que foram tratados pela técnica de condensação lateral. Após a obturação, o excesso de material obturador, na porção cervical do canal radicular foi seccionado, restando o comprimento de 10 mm no interior do canal radicular. Os dentes foram selados, provisoriamente, com cimento de ionômero de vidro por 24 h. A seguir, o selamento coronário foi removido e os canais ficaram expostos ao meio bucal. Desta forma, delineou-se os seguintes grupos experimentais: A45- AH Plus por 45 dias; A90- AH Plus por 90 dias; E45- Endofill por 45 dias; e E90- Endofill por 90 dias (n=12). Passado o período experimental, os cães foram mortos e as mandíbulas removidas. Realizou-se a exodontia dos incisivos e as suas raízes foram impermeabilizadas com duas camadas de esmalte para unhas. Os dentes foram imersos em tinta nanquim por 96 h. Após realizou-se a diafanização dos espécimes e a infiltração de corante foi medida (em mm) com auxílio de uma lupa esteroscópica, em aumento de 10x. Os resultados foram analisados estatisticamente através da Análise de Variância de dois fatores e Teste de Comparações Múltiplas de Tukey (á = 0.05). O grupo E90 (2.03±0.94) apresentou uma infiltração média significativamente maior do que a ocorrida nos demais grupos (

Uso de biodentine en la resolución de un fracaso en cirugía paraendodóntica

To present a clinical case report of successful endodontic retreatment, in a maxillary first molar, with symptomatic apical periodontitis in the mesiobuccal root that had already undergone endodontic treatment and paraendodontic surgery.Apatient was referred for evaluation of upper right first molarwith swelling, severe pain and sensitivity to percussion and palpation. She reported having undergone endodontic treatment 1 year ago and, 6 months later, when the symptoms returned, a paraendodontic surgery was performed by the same professional. A cone-beam computed tomography (CBCT) was requested and the images showed extensive bone rarefaction associated with the mesiobuccal root, which had the MB1 canal treated and the MB2 canal untreated. The periapical regionof the apices of the distobuccal and palatine roots showed signs of normality, and the treatment plan was established with selective endodontic retreatment only in the mesiobuccal root, with the location and treatment of the MB2 canal and retreatmentof the MB1 canal. Retreatment was performed in 2 sessions with an intracanal dressing with calcium hydroxidepaste. Thecanals were filled with Biodentine (BD, Septodont, Saint Maur de Fossés, France). Clinically, the patient had no further signs or symptoms and tomographic images showed evidence of bone repair after 24 months.Correct planning and execution of all phasesof endodontic retreatment were fundamental for the success of this case report.Apresentar um relato de caso clínico de sucesso no retratamento endodôntico, em um primeiro molar superior, com periodontite apical sintomática na raiz mesiovestibular que jáhavia passado por um tratamento endodôntico e cirurgia paraendodôntica.Umapaciente foi encaminhada para avaliação do dente 16 apresentando edema, dor forte e sensibilidade àpercussão e palpação. Relatou a realização do tratamento endodôntico há1 ano e, 6 meses após, quando o quadro sintomático retornou, foi realizada uma cirurgia paraendodôntica pelo mesmo profissional. Foi solicitada uma tomografia computadorizada de feixe cônico e as imagens mostraram extensa rarefação óssea associada àraizmesiovestibular, que possuía o canal MV1 tratado e o canal MV2 sem tratamento. O contorno dos ápices das raízes distovestibular e palatina apresentavam sinais de normalidade, sendo estabelecido como plano de tratamento, o retratamento endodôntico seletivo apenas na raiz mesiovestibular, com a localização e tratamento do canal MV2 e retratamento do canal MV1. O retratamento foi realizado em 2 sessões com um curativo de demora com hidróxido de cálcio. Os canais foram obturados com o Biodentine (BD, Septodont, Saint Maur de Fossés, France).Clinicamente, a paciente não apresentou mais sinais ou sintomas e as imagens tomográficas mostraram evidências de reparo ósseo após 24 meses. Um correto planejamento e a execução de todas as etapas do retratamento endodôntico foram fundamentais para o êxito do presente relato de caso.Presentar un reporte de caso clínico de retratamiento endodóntico exitoso, en un primer molar superior,con periodontitis apical sintomática en la raíz mesio-vestibular que ya había sido sometido a tratamiento endodóntico y cirugía paraendodóntica. Un paciente fue remitido para evaluación del diente 16 con tumefacción, dolor intenso y sensibilidad a la percusión y palpación. Refiere haber tenido tratamiento de endodoncia durante 1 año y, 6 meses después, cuando reaparecieron los síntomas, se realizó una cirugía de paraendodoncia por el mismo profesional. Se solicitó una tomografía computarizada de haz cónicoy las imágenes mostraron una extensa rarefacción ósea asociada a la raíz mesio-vestibular, que tenía el canal MV1 tratado y el canal MV2 sin tratar. El contorno de los ápices de las raíces disto-vestibulares y palatinas presentaba signos de normalidad, yse estableció el plan de tratamiento con retratamiento endodóntico selectivo solo en la raíz mesio-vestibular, con localización y tratamiento del canal MV2 y retratamiento del canal MV1. El retratamiento se realizó en 2 sesiones con un apósito permanente con hidróxido de calcio. Los canales se rellenaron con Biodentine (BD, Septodont, Saint Maur de Fossés, Francia). Clínicamente, el paciente no presentó más signos ni síntomas y las imágenes tomográficas mostraron evidencia de reparación ósea después de 24 meses. La correcta planificación y ejecución de todas las etapas del retratamiento endodóntico fueron fundamentales para el éxito de este reporte de caso

Radiographic evaluation of furcal perforations sealed with different materials in dogs' teeth

OBJECTIVE: The objective of this work was to evaluate, using radiographic images, the behavior of four materials used to repair root perforations in dogs' teeth. Material and METHODS: Second and third premolars of 6 dogs were used. The 48 teeth were randomly divided into 4 groups (n=12) and the perforations were sealed with one of the following materials: MTA, AH Plus, Vitremer and gutta-percha. Dogs were submitted to general anesthesia, teeth were radiographed and pulp was accessed. Perforations were done, at the maximum curve of the pulp floor, sealed and the accessed coronal cavity was filled with glass ionomer cement (Vidrion R). After 90 days, the dogs were sacrificed and the last x-ray image was taken. Images were analyzed for the presence/absence of periodontal lesions at the perforation region. Data were analyzed statistically by chi-square test at 5% significance level. RESULTS: There were no statistically significant differences (p>0.05) among AH Plus, Vitremer and gutta-percha groups. MTA produced the smallest number of periodontal lesions (

Apically extruded debris in filling removal of curved canals using 3 NiTi systems and hand files

The aim of this study was to assess the amount of apically extruded debris during filling removal with WaveOne Gold (WOG), ProTaper Universal Retreatment (PTR), D-RaCe Retreatment (DRR) or hand files (HF), to compare the working time during filling removal, and to describe failures of NiTi instruments. Forty mesiobuccal roots of maxillary first molars were prepared with WOG Primary, obturated and divided into 4 groups (n=10), according to the instruments used: WOG, PTR, DRR or HF. Distilled water was used as irrigant and the extruded debris were collected in Eppendorf tubes and dried. The amount of extruded debris was determined by subtracting the final from the initial weight. The time of filling removal for each canal was recorded and the instruments used were analyzed pre and post-operatively by SEM. Kruskal-Wallis and Dunn’s test analyzed extruded debris data and ANOVA, followed by Tukey’s test, compared the working time data (α=0.05). Instrument deformation and fracture were described. WOG produced significantly less debris compared with HF and DRR (p0.05). HF, PTR and DRR showed no significant difference (p>0.05). Working time in HF group was significantly higher than others (p<0.05). SEM analyses showed, from the 18 instruments evaluated, 3 fractures and 10 deformations. All instruments tested caused debris extrusion. WOG was associated with less extrusion than DRR and HF. Filling removal with HF was slower than with the other instruments. All NiTi systems presented fracture and deformation

Biological tissue response to a new formulation of a silicone based endodontic sealer

Satisfactory biological behavior is a necessary requirement for clinical application of endodontic materials. In this study, the connective tissue responses to silicone (GuttaFlow 2), epoxy resin (AH Plus) and zinc oxide and eugenol (Endofill) based sealers were compared. Twelve Wistar rats had polyethylene tubes (four per animal) containing one of the tested sealers and empty tubes (negative control) implanted in their subcutaneous tissue. The tubes were randomly placed 2 cm from the spine and at least 2 cm apart from one another. Tissue samples with implants were processed for histological analysis after 7 or 60 days (n=6 animals per period). Inflammatory cells, fibrous condensation and abscess were scored according to their intensity. Friedman, followed by Dunn’s post hoc, was used to compare sealers. Differences between the two experimental periods were verified using Mann-Witney U test (p<0.05). At 7 days, most of the histological parameters showed no significant differences amongst groups. Endofill group scored higher than the others for giant cells (o<0.05) and promoted a greater number of samples presenting abscess formation. GuttaFlow 2 tended to show a less intense inflammatory infiltrate compared to the other materials. At 60 days, there were no significant differences between groups in most of the histological parameters evaluated. However, it was observed that Endofill scored higher for macrophages (p<0.05) compared to the control group, and GuttaFlow 2 tended to present lower scores than the others for neutrophils and abscess. GuttaFlow 2 showed proper biological behavior and should be considered adequate for clinical practice

Análise in vivo do selamento do canal protéico com diferentes materais adesivos

This in vivo study analyzed the sealing ability of two adhesives in post spaces, cyanoacrylate (Super Bonder® - Henkel Loctite Adesivos Ltda., Itapevi, SP, Brazil) and ScotchbondTM Multi-Purpose (3M Dental Products, St. Paul, MN, USA), testing the hypothesis that their use would result in a decreased leakage through the remaining filling material. Forty extracted premolars (80 root canals) of dogs were used. The root canals were cleaned, shaped and filled by the lateral condensation technique using Sealer 26TM. The post space was created removing two thirds of the filling material within the root canal. The canals were randomly divided in three groups, which were treated as follows: Group A received the ScotchbondTM Multi-Purpose adhesive system; for Group B the cyanoacrylate adhesive, Super BonderTM, was employed; and no adhesive was applied into the post space for Group C (control group). A glass ionomer provisional restoration was placed allowing the sealer to set for 72 hours. Then the restoration was removed and the root canal was exposed to the oral environment for 45 days. The dogs were then killed and their jaws were removed. The post spaces were filled with India ink and the teeth were restored for 96 hours. Afterwards, the teeth were extracted and the roots were sectioned at the furcation for allocation to their specific groups. The teeth were turned transparent and the quantitative analysis of leakage was performed using light microscopy. The results showed no significant differences between groups, rejecting the initial hypothesis. Leakage occurred in a great extent in all specimens. Therefore, sealing post spaces with the adhesives used in this study was not an effective method to prevent microleakage.Esse estudo in vivo analisou a capacidade de selamento do canal protético com dois adesivos, o Super Bonder® (Henkel Loctite Adesivos Ltda., Itapevi, SP) e o Scotchbond® Multi-Purpose (3M Dental Products, St. Paul, MN, EUA), testando a hipótese de que a aplicação desses adesivos resulta em menor infiltração de corante no material obturador remanescente. Quarenta dentes pré-molares (80 canais) de cães foram obturados pela técnica da condensação lateral usando o cimento endodôntico Sealer 26®. O canal protético foi preparado removendo-se 2/3 da obturação do canal radicular. Os canais preparados foram distribuídos, aleatoriamente, em três grupos: no grupo A, foi realizado o selamento do canal protético com o adesivo dentinário; no grupo B, esta impermeabilização foi realizada com o Super Bonder®; e no grupo C, controle, não foi aplicado qualquer material às paredes do canal protético. Os dentes foram selados, provisoriamente, com cimento de ionômero de vidro por 72 horas, objetivando a presa do cimento endodôntico. Removido o selamento coronário, os canais ficaram expostos ao meio bucal por 45 dias, quando os cães foram mortos e os maxilares removidos. Tinta nanquim foi colocada no canal protético e os dentes foram selados por 96 horas. Depois de extraídos, os dentes foram seccionados na região da furca e cada raiz alocada em seu respectivo grupo. Feita a diafanização, foi realizada a análise quantitativa da infiltração do corante com lupa esteroscópica. Os resultados mostraram não haver diferenças entre os três grupos experimentais, negando a hipótese inicial. Houve infiltração do corante no remanescente obturador de todas as raízes analisadas

La atención odontológica de urgencia en el sistema de salud pública brasileño : las enseñanzas de la pandemia de COVID-19 para situaciones futuras

This ecological study described the effect of the COVID-19 pandemic and socioeconomic development on the use and profile of urgent dental care (UDC). UDC rates per 100,000 inhabitants before (from March to June 2019) and during (from March to June 2020) the COVID-19 pandemic in 4,062 Brazilian municipalities were compared. Data were collected from official sources. COVID-19 mortality and hospitalization rates were indicative of levels of lockdown and Human Development Index (HDI) indicated socioeconomic development. Multiple logistic regression and relative excess risk due to interaction (RERI) were used for statistical analyses. The Student t-test was used to compare changes in the profile of UDC causes and procedures in the two periods. Lower UDC rates were found in 69.1% of municipalities and were associated with higher HDI (OR = 1.20; 95%CI: 1.01; 1.42). Mortality had OR = 0.88 (95%CI: 0.73; 1.06) for municipalities with HDI 0.70. RERI between HDI and COVID-19 was 0.13 (p 0,70. O RERI entre IDH e COVID-19 foi de 0,13 (p 0,70. El ERR entre el IDH y el COVID-19 fue de 0,13 (p < 0,05). Los municipios con mayor cobertura de atención primaria tuvieron una menor reducción de las tasas de urgencia. Los procedimientos de endodoncia y la causa del dolor dental fueron los factores más frecuentes tanto antes como durante la pandemia. Aumentó el porcentaje de AOU por dolor y daños en los tejidos blandos, así como el sellado temporal y los procedimientos quirúrgicos. Las variables socioeconómicas afectaron a las tasas de AOU durante el periodo más restrictivo de la pandemia de COVID-19 y deberían incluirse en la planificación de las acciones sanitarias en futuras emergencias

Effect of blood contamination on the push-out bond strength of calcium silicate cements

ARTICLE Effect of Blood Contamination on The Push-Out Bond Strength of Calcium Silicate Cements Flavia Kolling Marquezan1 Patricia Maria Poli Kopper1 Angela Isabel dos Santos Dullius2 Diego Machado Ardenghi3 Renata Grazziotin-Soares3 1Department of Conservative Dentistry, UFRGS - Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil 2Department of Statistics, UFSM - Universidade Federal de Santa Maria, Santa Maria, RS, Brazil 3College of Dentistry, University of Saskatchewan, SK, Canada ABSTRACT This study investigated the effect of blood-contamination on the push-out bond strength of BiodentineTM (BD) and MTA Angelus® (MTA-A) to root dentin over time. Twenty-five teeth were sectioned horizontally to obtain 120 root slices. The lumens were filled with MTA-A or BD: 60 for each cement (30 uncontaminated and 30 blood contaminated). Push out bond strength to dentin was assessed at 24 h (n=10), 7 days (n=10) and 28 days (n=10). Failure modes were classified as: cohesive, adhesive or mixed failure. Two-way ANOVA was used to investigate the interaction between blood contamination vs. hydration period. Mann Whitney test compared different materials in each period, and it also compared the contaminated versus uncontaminated material for each period. Friedman, followed by Dunn`s test, compared periods of hydration for each material, regardless of blood contamination. Failure modes were reported descriptively. The interaction hydration period vs. blood contamination was highly significant for MTA-A (P=0.001) and it was not significant for BD (P=0.474). There were no differences between bond strength of uncontaminated and contaminated BD in any of the periods. Bond strength of uncontaminated MTA-A increased at each time of hydration; but it remained stable over time for blood-contaminated samples. BD had higher bond strength than MTA-A in all periods of hydration. Cohesive failure predom

A new in vitro method to evaluate radio-opacity of endodontic sealers

OBJECTIVES: To evaluate a new method for assessing the radio-opacity of endodontic sealers and to compare radio-opacity values with a well-established standard method. METHODS: The sealers evaluated in this study were AH Plus(®) (Dentsply DeTrey GmbH, Konstanz, Germany), Endo CPM Sealer (EGEO SRL, Buenos Aires, Argentina) and MTA Fillapex(®) (Angelus Dental Products Industry S/A, Londrina, Parana, Brazil). Two methods were used to evaluate radio-opacity: (D) standard discs and (S) a tissue simulator. For (D), ten standard discs were prepared for each sealer and were radiographed using Digora(®) phosphor storage plates (Soredex; Orion Corporation, Helsinki, Finland), alongside an aluminium stepwedge. For (S), polyethylene tubes filled with sealer (n = 10 for each) were radiographed inside the simulator as described. The digital images were analysed using Adobe Photoshop(®) software v. 10.0 (Adobe Systems, San Jose, CA). To compare the radio-opacity among the sealers, the data were analysed by ANOVA and Tukey's test, and to compare methods, they were analysed by the Mann–Whitney U test. To compare the data obtained from dentin and sealers in method (S), Student's paired t-test was used (=0.05). RESULTS: In both methods, the sealers showed significant differences, according to the following decreasing order: AH Plus, MTA Fillapex and Endo CPM. In (D), MTA Fillapex and Endo CPM showed less radio-opacity than aluminium. For all of the materials, the radio-opacity was higher in (S) than in (D). Compared with dentin, all of the materials were more radio-opaque. CONCLUSIONS: The comparison of the two assessment methods for sealer radio-opacity testing validated the use of a tissue simulator block