Eficácia do hipoclorito de sódio com surfactante na desinfecção de cones de guta-percha e análise de alterações superficiais em MEV

TCC (graduação) - Universidade Federal de Santa Catarina. Centro de Ciências da Saúde. Odontologia.A desinfecção do sistema de canais radiculares é um dos objetivos a ser alcançado na terapia endodôntica e, para tal, é importante que todas as etapas do tratamento sejam realizadas sob condições assépticas. Os cones de guta-percha utilizados para a obturação dos canais radiculares têm propriedade termoplástica, não podendo passar pelo processo convencional de esterilização. O hipoclorito de sódio (NaOCl) tem sido utilizado para a desinfecção química dos mesmos, porém a eficácia dos compostos com a adição de surfactante ainda não foi totalmente elucidada. O objetivo deste estudo foi avaliar, in vitro, a eficácia do NaOCl a 1% e a 5,25%, sem e com surfactante, na desinfecção química de cones de guta-percha nos tempos de 30 s e 1 min. Adicionalmente, foram avaliadas em MEV as alterações superficiais dos cones de guta-percha após o uso das soluções de NaOCl com ou sem surfactante. Para o estudo, cones de guta-percha com calibre 80 (n = 120) foram desinfectados com NaOCl a 5,25% por 30 min. Posteriormente, foram contaminados (n = 108) com Enteroccocus faecalis e imersos por 30 s (A) ou 1 min (B) (n = 12) nas seguintes soluções: G1A e G1B: NaOCl a 1%; G2A e G2B: NaOCl a 1% com cetrimide 2%; G3A e G3B: NaOCl a 5,25%; G4A e G4B: NaOCl a 5,25% com cetrimide a 2%. O grupo controle positivo foi composto por cones contaminados (n = 12), mas não desinfectados; e o negativo por cones não contaminados (n = 12). Os cones foram inseridos em tubos de ensaio contendo TSB fresco, incubados em estufa a 37º C e avaliados quanto à alteração de turbidez após 24 h. Outros 10 cones de guta-percha (n = 2) foram analisados em MEV, a fim de avaliar alterações de superfície após o uso de cada solução testada por 1 min. Foi possível observar que o NaOCl a 1%, sem ou com surfactante, não foi eficaz na desinfecção dos cones de guta-percha no tempo de 30 s, ao passo que o NaOCl a 5,25% foi eficaz neste tempo, independente da presença do surfactante; todas as soluções foram eficazes no tempo de 1 min. Na análise em MEV, observou-se que o tratamento dos cones com NaOCl a 1% e a 5,25% resultou na formação de estruturas cristalinas cúbicas na superfície, compatíveis com cristais de cloreto de sódio residuais da solução, e que essas eram maiores e em maior quantidade quando na concentração de 5,25%. O uso do surfactante pareceu inibir a deposição desses cristais quando associado ao NaOCl a 1%. Foi possível concluir que o NaOCl a 1% foi eficaz na desinfecção de cones de guta-percha no tempo de 1 min, ao passo que o NaOCl a 5,25% foi eficaz nos dois tempos avaliados, independente da presença do surfactante. O uso de soluções de NaOCl resultou na formação de cristais de cloreto de sódio na superfície dos cones, em menor quantidade quando foi utilizada a solução de NaOCl a 1% associada ao surfactante.The root canal system disinfection is one of the endodontic therapy objectives and, for this purpose, it is important that every stage of the treatment to be done under aseptic conditions. The gutta-percha cones used to the root canal filling have a thermoplastic property and cannot pass through the regular sterilization process. Sodium hypochlorite (NaOCl) has been used for chemical disinfection of the gutta-percha cones; however, the efficiency of this compound with surfactant has not been completely clarified yet. The objective of this study was to evaluate, in vitro, the efficiency of NaOCl at 1% and 5,25% with and without the surfactant, on the chemical disinfection of the gutta-percha cones at the run time of 30 s and 1 min. In addition, the surface alterations of the gutta-percha cones after the use of the solutions were evaluated in SEM. For this study, size 80 (n = 120) gutta-percha cones were disinfected with NaOCl at 5,25% for 30 min. Subsequently, the cones were infected (n = 108) with Enteroccocus faecalis and immersed for 30 s (A) or 1 min (B) on the following solutions (n = 12): G1A and G1B: NaOCl at 1%; G2A and G2B: NaOCl at 1% with 2% cetrimide; G3A and G3B: NaOCl at 5,25%; G4A and G4B: NaOCl at 5,25% with 2% cetrimide. The positive control group was made by infected cones (n = 12), but not disinfected, and the negative control group by non-infected cones (n = 12). The gutta-percha cones were inserted in test tubes containing fresh TSB, incubated and evaluated regarding the turbidity alteration after 24 hours. Other 10 gutta-percha cones (n = 2) were analysed in SEM, in order to evaluate surface alterations thereupon the use of every tested solution after 1 min. It could be observed that NaOCl at 1%, with or without surfactant, was not effective in the disinfection at the time of 30 s, while NaOCl at 5,25% was. Independently of the surfactant’s presence, all the solutions were effective when immersed for 1 min. In the SEM analysis, it was observed that the cones treatment with NaOCl at 1% and at 5,25% resulted in the formation of surface’s crystalline cubic structures, compatible with the solution’s residual sodium chlorite crystals and, which were bigger and in greater quantity at the 5,25% concentration. The usage of surfactant seemed to inhibit the deposition of these crystals when associated to NaOCl at 1%. It could be concluded that NaOCl at 1% was effective on the gutta-percha cones disinfection by the time of 1 min, while NaOCl at 5,25% was also effective by the time of 30 s, independently if the surfactant was present. The usage of NaOCl solutions resulted in the formation of sodium chloride crystals on cones surface, less visible when used the NaOCl at 1% surfactant’s associated solution

Prevalence of oral injuries and salivary changes in patients with chronic renal failure on hemodialysis: systematic review and meta-analysis

The objective of this study was to evaluate whether individuals with chronic renal failure (CRF) undergoing hemodialysis treatment have more salivary and oral mucosa alterations when compared to healthy individuals, through a systematic review followed by meta-analysis. A systematic literature review was performed, evaluating randomized clinical trials found in the Proquest, Embase, Scopus, Cochrane Library, Web of Science, Lilacs and Pubmed databases, using MeSH terms and other keywords. Initially, 40 articles were included in the study and, after reading the complete articles, only 15 clinical trials that analyzed oral lesions and salivary changes in patients with CRF undergoing hemodialysis treatment were eligible. Most of the clinical studies included were cross-sectional and composed of a study group and a control group. The mean age of participants in the study group was 50.19 years and in the control group, 48.95 years. The most common oral alterations found in the CRF group in relation to the control group were xerostomia, uremic breath, dysgeusia, coated tongue, gingival bleeding and pale mucosa. The salivary flow of patients with CRF was 46.6% lower than the control group. The salivary pH in the study group was also more alkaline when compared to the control group. Greater amounts of urea, phosphate, C-reactive protein and total proteins were found in the saliva of individuals with CRF. Individuals with CRF undergoing hemodialysis are more prone to changes in both the quantity and quality of saliva, as well as having a greater amount of oral changes

Os efeitos da força ortodôntica na polpa dentária: uma análise sistemática das alterações histomorfológicas, clínicas e radiográficas

Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Odontologia, Florianópolis, 2021.Introdução: A força ortodôntica desencadeia uma sequência de respostas biológicas no complexo dentário que podem afetar o tecido pulpar. É fundamental para o cirurgião-dentista conhecer tais alterações para que a mecânica ortodôntica seja realizada de forma segura e precisa. Objetivo: Revisar sistematicamente a literatura acerca dos efeitos da aplicação da força ortodôntica na polpa dentária, a fim de identificar alterações histomorfológicas, clínicas e radiográficas. Método: Em setembro de 2020, dois revisores pesquisaram a literatura de forma abrangente e sistemática nas seguintes bases de dados: Latin American and Caribbean Health Sciences (LILACS), EMBASE, Cochrane Library, MEDLINE PubMed, Scopus, e Web of Science; uma busca adicional foi realizada na literatura cinzenta, incluindo as bases eletrônicas Google Scholar, Open Grey, e ProQuest teses e dissertações. De acordo com o acrônico PICOS (População, Intervenção, Comparação, Resultados e Estudos), foram incluídos nas revisões sistemáticas ensaios clínicos randomizados (ECRs) e estudos observacionais que avaliaram alterações histomorfológicas, clínicas e radiográficas da polpa dentária após aplicação de força ortodôntica. Foram excluídos estudos em dentes com rizogênese incompleta ou traumatizados, séries ou relatos de casos, revisões, estudos laboratoriais, em animais ou que não investigaram a associação entre a força ortodôntica e a ocorrência de alterações pulpares. A avaliação do risco de viés dos estudos observacionais foi realizada através da escala de Newcastle-Ottawa; e para os ECRs, através da ferramenta Cochrane Risk-of-Bias 2.0 (RoB 2). A qualidade geral da evidência foi avaliada pela ferramenta GRADE. Resultados: Cinquenta estudos observacionais e sete ECRs foram incluídos nas revisões sistemáticas. Na análise histomorfológica do tecido pulpar após a aplicação da força ortodôntica, destacaram-se alterações na arquitetura tecidual, no padrão celular, na angiogênese, na deposição de tecidos duros, e a presença de infiltrado inflamatório crônico. Além disso, alterações nos níveis de expressão de quatorze fatores teciduais pulpares foram encontrados. Dentre os achados clínicos, a aplicação da força ortodôntica pareceu promover aumento da intensidade da resposta sensitiva da polpa aos testes elétrico e térmicos (frio e quente), e diminuição do fluxo sanguíneo pulpar. Alterações no volume interno da cavidade pulpar e aumento da incidência de cálculos pulpares foram os achados radiográficos observados. Devido ao grande número de estudos observacionais, ao tamanho amostral e às inconsistências na avaliação e apresentação dos resultados, a maioria dos estudos apresentou moderado risco de viés. A qualidade geral da evidência para todos os desfechos foi classificada como muito baixa. Conclusão: Embora os artigos incluídos sugiram que a força ortodôntica pareceu promover diversas alterações na polpa dentária, não se pode afirmar que tais alterações sejam realmente devidas ao movimento ortodôntico, pois o nível geral de evidência obtido a partir dos estudos primários foi muito baixo. Portanto, mais estudos clínicos com amostras maiores e métodos padronizados são necessários para obter conclusões mais robustas.Abstract: Introduction: Orthodontic force triggers a sequence of biological responses in the dental complex that can affect the dental pulp. It is crucial for the clinician to know these changes so that orthodontic mechanics can be performed accurately and safely. Objective: To systematically review the literature on the effects of the application of orthodontic force on the dental pulp, in order to identify histomorphological, clinical and radiographic changes. Method: In September 2020, two reviewers comprehensively and systematically searched the literature in the following databases: Latin American and Caribbean Health Sciences (LILACS), EMBASE, Cochrane Library, MEDLINE PubMed, Scopus, and Web of Science; an additional search was performed in the grey literature, including the electronic bases Google Scholar, Open Gray, and ProQuest theses and dissertations. According to the PICOS acronym (Population, Intervention, Comparison, Outcomes, and Studies), randomized clinical trials (RCTs) and observational studies that evaluated histomorphological, clinical and radiographic changes in the dental pulp after orthodontic force application were included. Studies in open apex or traumatized teeth, case series or reports, reviews, laboratory-based or animal studies, and studies that did not investigate the association between orthodontic force and dental pulp changes were excluded. The risk of bias assessment for observational studies was performed with the Newcastle-Ottawa Scale, and for RCTs with the Cochrane Risk-of-Bias 2.0 (RoB 2) tool. The overall certainty level was evaluated with the GRADE-tool. Results: Fifty observational studies and seven RCTs were included in the systematic review. In the histomorphological analysis of the pulp tissue after orthodontic force application, changes in tissue architecture, in the cellular pattern, in angiogenesis, in the deposition of hard tissues, and the presence of chronic inflammatory infiltrate are highlighted. In addition, changes in the expression levels of fourteen pulpal tissue factors were found. Among the clinical findings, the application of orthodontic force seemed to promote an increase in the pulpal sensitivity clinical response to electrical and thermal tests (cold and hot), and a decrease in pulp blood flow. Changes in the internal volume of the pulp cavity and increased incidence of pulp stones were the radiographic findings observed. Due to the large number of observational studies, the sample size and the inconsistencies in the evaluation and presentation of the results, most studies presented a moderate risk of bias. The overall quality of the evidence for all outcomes was rated as very-low. Conclusion: Although the included articles suggest that the orthodontic force seemed to promote several dental pulp changes, no well-supported conclusion that these effects are actually due to orthodontic movement, since the overall level of evidence obtained from these studies was very-low. Therefore, more clinical studies with larger samples and improved methods are needed to support more robust conclusions

Tissue and serum sclerostin in bone-related lesions: a scoping review

Bone remodeling is extremely necessary for the renewal and maintenance of a healthy skeleton and consists of a process of bone resorption and formation, carried out, respectively, by osteoclasts and osteoblasts. In the coordination of bone remodeling are the osteocytes, and, therefore, the focus on markers related to the regulation of osteocyte activities can be clinically useful as markers of diagnosis, prognosis or monitoring of bone diseases. Sclerostin has been explored as a new biomarker of bone remodeling produced by osteocytes. Understanding its expression and pathways will potentially help us predict risk groups for bone tumor and tumor-like lesions in early stages. Thus, the clinical utility of this marker as diagnostic, prognostic, or monitoring tools during treatment still needs to be studied. In view of this, a scoping review is necessary for this matter. Electronic search to identify potentially relevant articles will be conducted in the following databases: Cochrane Library, Embase, Latin American and Caribbean Health Sciences (LILACS), MEDLINE PubMed, Scopus, and Web of Science. A search in grey literature will be conducted through Google Scholar and ProQuest thesis and dissertations databases. Additionally, the reference lists of included studies will be checked to identify potentially relevant articles. Experts in the area will be contacted to retrieve ongoing or not published studies. No time or language restriction will be applied to the search

Laser therapy on regenerative endodontic procedures: A scoping review

Endodontic treatment of teeth with incomplete root formation is a challenge. One of the treatment alternatives is the regenerative endodontic treatment, the formation of a blood clot inside the root canal occurs, which will work as a scaffold with the aim of enabling cell growth. Uses the concept of tissue engineering to restore root canals to a healthy state, allowing for continued development of the root and surrounding tissues. Several protocols have been proposed, without a consensus among authors. The objective of this scope review is to show the general panorama of the use of photodynamic therapies in regenerative endodontic treatment

Does the use of natural products for endodontic therapy in primary teeth have sufficient evidence for clinical practice? : a scoping review

Objectives The use of natural products for pulp therapy has experienced a remarkable advancement in recent years. The aim was to provide a critical appraisal of the safety and efcacy of natural products for endodontic therapy in primary teeth and verify whether their uses in clinical practice have sufcient evidence. Materials and methods Two reviewers searched ten databases (Cochrane, DOSS, Embase, Google Scholar, LILACS, OpenGrey, Proquest, PubMed, Scopus, and Web of Science) until January 2022, identifying references that evaluated the safety and efcacy of the use of natural products for endodontic therapy in primary teeth. Cohort, randomized, and non-randomized clinical trials were included. Results A total of 3583 references were initially identifed. From the 63 studies retrieved for full-text reading, 37 fulflled the selection criteria and were included in the qualitative analysis. The studies investigated 19 natural products for pulpotomy medicament, irrigating solution, intracanal medication, and root canal flling material. Most studies showed similar eficacy of natural products and their control groups; however, many methodological biases and concerns about the safety and eficacy of natural products were identifed, questioning their clinical applicability. Conclusions The included studies provided insufcient evidence to support safe and efective clinical application of natural products for endodontic therapy in primary teeth. Future well-designed studies with representative samples are needed to support the use of natural products for endodontic therapy in primary teeth. Clinical relevance. The use of natural products for endodontic therapy in primary teeth requires caution by clinicians, due to the insufcient available evidence

INFLUENCE OF SODIUM HYPOCHLORITE CONCENTRATION ON PAIN AFTER ENDODONTIC TREATMENT: A SYSTEMATIC REVIEW.

This systematic review (SR) searched the literature to answer whether different concentrations of sodium hypochlorite (NaOCl) used in endodontic treatment interfere with the occurrence of postoperative pain. Two reviewers independently searched the following electronic databases: Cochrane Library, EMBASE, LILACS, MEDLINE (PubMed), Scopus and Web of Science. Additionally, a search was performed in gray literature. It was included randomized clinical studies that evaluated the influence of different concentrations of NaOCl on postoperative pain. Studies that were not randomized clinical trials, or included retreatments, primary teeth or incomplete root formation or e with fractures and resorptions or even studies that did not use NaOCl were excluded. 705 studies were initially identified and, after reading the titles and abstracts, eighteen studies were selected for full reading. After applying the eligibility and exclusion criteria, nine studies were included in this SR. After that, NaOCl concentrations were dichotimized into high concentration (above 3%) and low concentration (between 0.5% and 3%). The risk of bias assessment was performed using the Cochrane Collaboration's Risk-of-Bias Assessment Tool 2.0. The prevalence of postoperative pain was assessed through proportion meta-analysis using the MedCalc software. The overall quality of evidence was assessed using the GRADE tool. In assessing risk of bias, three studies were judged as 'high risk' and one as 'some concerns'. The overall pooled prevalence of postoperative pain was 36.31% for NaOCl at higher concentrations and 45.35% for NaOCl at lower concentrations. After 7 days, none of the participants reported moderate or severe pain