Use of platelet concentrates in oral surgery of patients with osteonecrosis: a scoping review

Abstract The objective of this study was to map, through a scoping review, the evidence available in the literature on the use of platelet concentrates in compromised patients undergoing oral surgeries. Searches were performed in electronic databases for clinical studies with compromised patients undergoing oral surgery who used platelet concentrates. Only studies published in English were included. Two independent researchers carried out the selection of studies. The study design and objective, surgical procedure and platelet concentrate used, systemic involvement, analyzed outcome, and main results were extracted. A descriptive analysis of the data was performed. Twenty-two studies met the eligibility criteria and were included. Case series was the most frequent study design among the included studies (41.0%). In terms of systemic disability, 19 studies reported patients with cancer and related to surgical treatment 16 studies reported patients underwent treatment for osteonecrosis related to the use of the drug. The most used platelet concentrate was pure platelet-rich fibrin (P-PRF). In general, most studies recommend the use of platelet concentrates. Thus, the results of this study suggest that the evidence related to the use of platelet concentrates in compromised patients when undergoing oral surgeries is still initial. Also, most studies assessed the use of platelet concentrates in patients with osteonecrosis.

Resumo O objetivo do estudo foi mapear, através de uma revisão de escopo, as evidências disponíveis na literatura sobre o uso de agregrantes plaquetários em pacientes comprometidos e que realizaram cirurgias odontológicas. Pesquisas foram realizadas em bases de dados por estudos clínicos com pacientes comprometidos que realizaram cirurgia odontológica e usaram agragantes plaquetários. Apenas estudos em inglês foram incluídos. Dois pesquisadores independentes realizaram a seleção dos estudos. Os seguintes dados foram extraídos: desenho do estudo, objetivo, procedimento cirúrgico, agregante plaquetário usado, envolvimento sistêmico, desfecho analisado e principais resultados. Uma análise descritiva dos dados foi realizada. Vinte e dois estudos preencheram os critérios de elegibilidade e foram incluídos. Série de casos foi o desenho de estudo mais frequente entre os estudos incluídos (41,0%). Em relação ao comprometimento sistêmico, 19 estudos reportaram pacientes com câncer e em relação ao tratamento cirúrgico, 16 estudos reportaram pacientes que realizavam tratamento para osteonecrose relacionada ao uso de medicamentos. O agregante mais utilizado foi o plasma rico em fribina (P-PRF). Em geral, maioria dos estudos recomendou o uso dos agregantes plaquetários. Assim, os resultados desse estudo sugerem que a evidência relacionada ao uso de agregantes plaquetários em pacientes comprometidos que realizam cirurgia odontológica é ainda inicial. Ainda, a maioria dos estudos avaliaram o uso de agregantes plaquetários em pacientes com osteonecrose.

Influence of bioceramic intracanal medication on the bond strength of bioceramic root canal sealer

Abstract To investigate the influence of the remaining volume of a new intracanal medication based on bioceramic compounds on the bond strength (BS) and formation of an adhesive interface between calcium silicate-based and epoxy resin-based root canal sealers. For this purpose, the specimens were distributed according to the intracanal medication (n = 26): Bio-C Temp (BCT) and Ultracal XS (UXS). The roots were scanned in microCT, and after 7 days, the medication was removed. Then a new scan was performed to evaluate the volume of medication remaining. Subsequently, 40 specimens were redistributed into 2 subgroups (n = 10) and filled according to the sealer used: AH Plus (AHP) and Bio-C Sealer (BCS), to assess the bond strength by using the push-out test, and the adhesive interface by confocal laser fluorescence microscopy (CLSM) and scanning electron microscopy (SEM). The t test showed a smaller remainder of BCT (1.77 ± 0.86) compared with UXS (10.47 ± 5.78), irrespective of the root third evaluated. The BS showed that teeth with BCT + BCS had higher bond strength values (3.70 ± 1.22) when compared to the other groups: BCT + AHP (2.15 ± 1.07), UXS + BCS (3.18 ± 1.09) and UXS + AHP (2.11 ± 1.02) (p<0.001). The cervical third had higher BS when compared with the middle and apical thirds (p < 0.001), and higher number of adhesive failures. The adhesive interface in SEM and CLSM images showed better adaptation for the association between BCT + BCS. Intracanal medication and silicate-based endodontic sealer appeared to interact chemically by forming a biomineralizing layer, allowing for an increase in the bond strength and forming an adhesive interface between the materials, with no or less gap formation.

Impact of access cavities on root canal preparation, restorative protocol quality, and fracture resistance of teeth

Abstract The survival of endodontically treated teeth depends on the remaining tooth structure. The aim of this study was to evaluate the impact of different access cavities on root canal preparation, restorative protocol, and fracture resistance of endodontically treated teeth. Fifty-six mandibular molars were divided into control (n=8) and experimental (n=16) groups according to access cavity: Traditional, Conservative, and Truss; and redistributed (n=8) according to instrumentation protocols: Reciproc Blue and R-motion. After, teeth were scanned in micro-CT and then filled and redistributed according to composite resin restoration (n=8): Filtek One BulkFill and Filtek Z350. A new micro-CT scan was performed to analyze the restorative material. Then, samples were submitted to fracture resistance testing and the failure pattern was determined. Data were analyzed using paired T-test, ANOVA, Tukey, and chi-square tests (α=0.05). In Truss, R-Motion promoted less transportation in different thirds of root canals. Higher percentages of voids (5.05%) and filling material (11.7%) were observed in Truss. Fracture resistance values were higher for the control group, followed by Truss, Conservative, and Traditional. The predominant failure pattern was type-II. In Truss, reciprocating instruments with smaller taper showed less canal transportation. Also, Truss provided higher values of fracture resistance, although it presented a higher percentage of voids and remaining filling material. Thus, in Truss, reciprocating files with smaller taper showed less canal transportation, and these cavities provided higher values of fracture resistance, although it presented a higher percentage of voids and remaining filling material.

Heat-treated NiTi instruments and final irrigation protocols for biomechanical preparation of flattened canals

Abstract This study evaluate shaping ability of heat-treated NiTi-alloy instruments associated with different final irrigation protocols in flattened root canals. Thirty human mandibular incisors with flattened root canals were divided into 5 groups (n = 10): (XP) Original Protocol XP-endo Shaper; (XP-WT) Original Protocol XP-endo Shaper with working time variation; (XP-K) XP-endo Shaper with kinematics variation; (XP-WTK) XP-endo Shaper with kinematics and working time variations; (Hyflex) Hyflex CM. For the variation in working time protocols the same sample of the XP-endo Shaper groups with and without kinematic variation were used. To evaluate final irrigation protocols, groups 1, 3 and 5 were submitted to 3 protocols: (NI) No irrigation (n = 2); (CI) conventional irrigation (n = 4), and (EndoVac) irrigation (n = 4). The samples were scanned by microcomputed tomography and prepared for scanning electron microscopy evaluation. Quantitative data were evaluated using the parametric ANOVA test, with statistical significance level set at 5%, and qualitative data obtained were compared to establish the agreement between examiners through the Kappa test. It was observed that in the analysis of XP-endo Shaper protocols, the additional working time did not cause difference in any of parameters evaluated (p > 0.05) in relation to time recommended by manufacturer. Compared to Hyflex, XP-K showed highest mean volume increase (p < 0.05) and lowest percentage of untouched walls (p < 0.05). In the qualitative evaluation, final irrigation protocol with EndoVac provided the best cleaning results when associated with XP-K and with Hyflex. Thus, supplementary techniques are effective tools to enhance cleaning and to promote higher touch of walls during root canal preparation.

Influence of anatomical features in the endodontic treatment planning of maxillary anterior teeth

Abstract This study evaluate the maxillary anterior teeth anatomy by micro-computed tomography (μCT), about relevant characteristic for endodontic treatment planning. Fifty maxillary central incisors (MCI), lateral incisors (MLI) and maxillary canines (MC) were scanned using a μCT device. Two and three-dimensional parameters at 1 to 5mm distance to the apical foramen, external anatomic characteristics of the teeth and qualitative analysis of the internal anatomy was performed. The roundness and form factor values revealed a circular canal in the apical third in the MCI and MC, whereas MLI showed flattening in the apical third. The linear regression test indicated a progressive increase in the major/minor diameters in the five mm assessed (p < 0.001). The 3D analysis revealed the greatest volume and surface area in MC. The SMI showed a cylindrical geometry of root canals. All teeth presented Vertucci's type I root canal configuration. A mild curvature was prevalent in the MCI (45%) and a moderate one in the MLI (50%) and MC (50%). Palatal shoulder volume was smaller in the MLI (11.46 ± 3.09) than in the MCI (14.15 ± 3.85) and MC (13.95 ± 2.55). The most common exit of main apical foramen was in a central (22%), distolingual (30%) and mesiobuccal position (28%) for MCI, MLI and MC, respectively. Radicular grooves were observed in 2% of MCI and 4% of MLI. Two and three-dimensional data obtained by μCT allowed to observe morphological characteristics of internal/external anatomy of the maxillary anterior teeth. These characteristics may affect the endodontic treatment planning.

Different biomechanical preparation protocols on the penetration and bond strength of the filling material to dentin

Abstract The aim of this study was to evaluate the influence of different instruments and mechanisms of agitation of the irrigating solution on the penetration by confocal laser scanning microscopy (CLSM), and the bond strength (BS) of the filling material to the dentin by push-out test. Human premolars were distributed in two experimental groups (n=30), according to the instrumentation system: ProTaper Next (PN) or XP-endo Shaper (XS) and three irrigation protocol (n=10): NaviTip (Nv), XP-endo Finisher (XF), passive ultrasonic irrigation/ XP-endo Finisher (PUIXF). The 2.5% NaOCl and 17% EDTA were the irrigating solutions used. The filling was performed using a lateral condensation technique, with AH Plus added to 0.1% rodhamine B. The roots were sectioned, obtaining 2 slices for each third of the root. The first slice was submitted to the sealer penetration analysis and the push-out test. The second slice was submitted to qualitative analysis (SEM) of the union interface. For the penetration (%) Tukey showed that PNXF (82.38±13.48), PNPUIXF (82.48± 12.02), XSXF (82.24±11.28) and XSPUIXP (86.23±10.45) presented the highest values, different (p<0.05) from PNNv (68.29±15.12) and XSNv (71.41±16.50). The BS (MPa) test evidenced that in the cervical third, PNPF (4.92±1.04) and XPSPF (5.03±0.70) obtained the highest values differing from the others groups (p<0.05). CSLM and SEM showed greater penetration of the sealer on the entire length of the root canal when the irrigation solution was stirred. In conclusion that the association PUI and XP-endo Finisher favored the penetration and bond strength of the filling material to the root dentin.

Resumo O objetivo neste estudo foi avaliar a influência de diferentes instrumentos e mecanismos de agitação da solução irrigadora na penetração e resistência de união (RU) do AH Plus à dentina. Pré molares humanos foram distribuídos em dois grupos experimentais (n=30), de acordo com o sistema de instrumentação: ProTaper Next (PN) ou XP-endo Shaper (XS) e de acordo com três protocolos de irrigação (n=10): NaviTip (Nv), XP-endo Finisher (XF), passive ultrasonic irrigation/ XP-endo Finisher (PUIXF). A irrigação do canal radicular foi realizada com NaOCl 2,5% e EDTA 17%. A obturação foi realizada por meio da técnica da condensação lateral, com AH Plus acrescido de rodhamina B 0,1%. As raízes foram seccionadas, obtendo-se 2 slices de 2,0 mm para cada terço radicular. O primeiro slice foi submetido a análise da penetração do cimento e ao teste de push-out e o segundo slice submetido a MEV para análise da interface de união. Para penetração (%) Tukey evidenciou que PNXF (82,38±13,48), PNPUIXF (82,48±12,02), XSXF (82,24±11,28) e XSPUIXF (86,23±10,45) apresentaram os maiores valores, diferentes (p<0,05) de PNC (68,29±15,12) e XPSC (71,41±16,50). Na RU (MPa) foi evidenciado que PNPF (4,92±1,04) e XPSPF (5,03±0,70), no terço cervical, obtiveram os maiores valores diferentes dos demais (p<0,05). MCVL e MEV evidenciaram maior penetração do cimento em toda extensão da parede do canal radicular inclusive nas regiões polares, quando foi realizada a agitação da solução irrigadora. Concluiu-se que a associação PUI e XP-endo Finisher favoreceu a penetração e resistência de união do material obturador à dentina radicular.

Removal of filling material using rotating or reciprocating systems with or without solvent: microCT analysis

Abstract This study evaluated by the efficacy of rotary and reciprocating systems to remove filling material by micro-CT. Sixty human canines were instrumented up to F3 by ProTaper Universal system and filled with AH Plus/ gutta-percha. Specimens were submitted to 1,200 thermal cycles, scanned by microCT SkyScan 1176 and randomly distributed in groups according to the filling material removal protocol (n = 10): ProTaper Universal, ProTaper Universal/xylol, ProTaper Next, ProTaper Next/xylol, Reciproc and Reciproc/xylol. After filling removal, specimens were analyzed by microCT to separately verify the presence of gutta-percha and sealer remnants. The data (mm3) were analyzed by two way ANOVA and Tukey´s test (5%). For the remaining gutta-percha, the use of xylol provided the highest values for Reciproc (7.60 ± 0.73), which was statistically different from the other groups (p < 0.05) that presented lower values and were statistically similar to each other (p > 0.05). For the remaining sealer, xylol provided the highest values (21.25 ± 6.94) different (p < 0.05) from the use of instruments alone (11.47 ± 9.45). ProTaper Next presented the lowest values (8.16 ± 1.37) for the remaining sealer, different (p < 0.05) from that of Reciproc (24.67 ± 6.32). The qualitative analysis revealed that all groups presented some remaining root filling material, with the highest volumes presented by Reciproc and Reciproc/xylol. In conclusion the rotary systems provided greater removal of filling material regardless of the use of xylol. The use of xylol negatively interfered with the action of the reciprocating system in the removal of the gutta-percha and sealer.

Antibacterial Activity of a New Ready-To-Use Calcium Silicate-Based Sealer

Abstract The aim of this study was to evaluate the antibacterial potential of a calcium silicate-based sealer (Bio-C Sealer, Angelus) against common bacteria in primary and secondary endodontic infections. Enterococcus faecalis, Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus and Streptococcus mutans were exposed to fresh Bio-C Sealer for 24 h by the agar diffusion method (n=5). Additionally, the antibacterial activity was investigated against E. faecalis and S. mutans biofilms (48 h old) grown in discs with 4 mm in diameter and 2 mm in height. (n=3) of set discs of Bio-C Sealer (Angelus), EndoFill (Dentsply-Mallefer), Sealer 26 (Dentsply), AH Plus (Dentsply), Sealapex (Sybron-Endo) and EndoSequence BC Sealer (Brasseler). The antibacterial activity was evaluated by colony forming unity (CFU) counting using ImageJ software. Data were compared by one-way ANOVA followed by Holm-Sidak test (a=5%). Fresh Bio-C Sealer exhibited antimicrobial activity against all bacteria evaluated by agar diffusion method, except for S. mutans. Set discs of all endodontic sealers tested showed similar CFU values for E. faecalis (p>0.05). S. mutans in biofilms showed higher susceptibility to EndoFill compared with the other sealers (p<0.05). In conclusion, the results indicate that fresh Bio-C Sealer does not inhibit S. mutans growth, but exhibits antibacterial activity against E. faecalis, S. aureus, P. aeruginosa and E. coli. After setting, the Bio-C Sealer exhibits an antimicrobial potential comparable to that of the other sealers evaluated in E. faecalis biofilm, but lower than that of EndoFill for S. mutans biofilm.

Resumo O objetivo deste estudo foi avaliar o potencial antibacteriano do novo cimento biocerâmico (Bio-C Sealer, Angelus) contra bactérias comuns em infecções endodônticas primárias e secundárias. Culturas de Enterococcus faecalis, Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus e Streptococcus mutans foram expostos a amostras frescas do Bio-C sealer durante 24 h pelo método de difusão em agar (n=5). A atividade antibacteriana de amostras dos cimentos Bio-C Sealer (Angelus), EndoFill (Dentsply-Mallefer), Sealer 26 (Dentsply), AH Plus (Dentsply), Sealapex (Sybron-Endo) e EndoSequence BC Sealer (Brasseler) após a presa também foi investigada em biofilmes de 48 h das bactérias E. faecalis e S. mutans, crescidos em discos com 4 mm de diâmetro e 2 mm de altura. A atividade antibacteriana foi avaliada por contagem das unidades formadoras de colônias (UFC) utilizando o software ImageJ. Os dados foram comparados por ANOVA a um critério seguido pelo pós-teste Holm-Sidak (a=5%). Amostras frescas do Bio-C Sealer exibiram atividade antimicrobiana contra todas as bactérias avaliadas pelo método de difusão em ágar, exceto para S. mutans. A análise da formação de biofilme mostrou que todos os cimentos endodônticos testados apresentaram valores similares de UFC para E. faecalis (p> 0,05), enquanto biofilmes de S. mutans foram mais suscetíveis ao EndoFill em comparação com os demais cimentos (p<0,05). Conclui-se que o cimento Bio-C Sealer fresco exibe atividade antibacteriana para E. faecalis, S. aureus, P. aeruginosa e E. coli, mas não inibe o crescimento de S. mutans. Após a presa, o cimento Bio-C Sealer exibe potencial antimicrobiano similar ao dos demais cimentos avaliados em biofilme de E. faecalis, mas inferior ao do EndoFill para S. mutans.

Green synthesis, characterization and antimicrobial evaluation of silver nanoparticles for an intracanal dressing

Abstract Green chemistry has been applied in different areas due to the growing demands for renewable processes and one of them is nanotechnology. The aim of this study was to characterize a formulation containing silver nanoparticles (AgNPs) produced by a green synthesis and to evaluate its antimicrobial activity. The formulation will be used as an intracanal dressing exploiting the AgNPs' antimicrobial properties, which are crucial to prevent infections and bacterial reinfections that can compromise endodontic treatments. In the green synthesis, silver nitrate was employed as the precursor salt, maltose as a reducing agent, and gelatin as a stabilizing agent. The formulation was prepared mixing 50 % of a liquid containing the AgNPs and 50 % of hydroxyethylcellulose gel at 1.5 % with proper evaluation of the process inherent parameters. Techniques such as molecular absorption spectrometry and dynamic light scattering were used in characterization step. The antimicrobial activity of the AgNPs against Escherichia coli ATCC 25922, Enterococcus faecalis NCTC 775, Pseudomonas aeruginosa ATCC 27853, Staphylococcus aureus ATCC 25923 and Streptococcus mutans ATCC 25175 was verified according to National Comittee for Clinical Laboratory Standards (NCCLS) by determining minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC). The obtained results indicated the formulation containing AgNPs produced by a green synthesis was properly characterized by the selected techniques. Furthermore, the formulation assessment proved that it is suitable for the proposal as well as it has potential to be used as an intracanal dressing since presented antimicrobial activity against all bacterial strains evaluated.

Resumo A química verde tem sido aplicada em diferentes áreas devido à crescente demanda por processos renováveis e uma delas é a nanotecnologia. O objetivo deste estudo foi caracterizar uma formulação contendo nanopartículas de prata (AgNPs) produzidas por meio de síntese verde e avaliar sua atividade antimicrobiana. A formulação será usada como curativo intracanal explorando as propriedades antimicrobianas das AgNPs que são cruciais para prevenir infecções e reinfecções bacterianas que podem comprometer os tratamentos endodônticos. Na síntese verde, nitrato de prata foi empregado como sal precursor, maltose como agente redutor e gelatina como agente estabilizador. A formulação foi preparada misturando-se 50% do líquido contendo as AgNPs e 50% de gel de hidroxietilcelulose a 1,5% com avaliação adequada dos parâmetros inerentes ao processo. Técnicas como espectrometria de absorção molecular e espalhamento dinâmico de luz foram usadas na etapa de caracterização. A atividade antimicrobiana das AgNPs contra Escherichia coli ATCC 25922, Enterococcus faecalis NCTC 775, Pseudomonas aeruginosa ATCC 27853, Staphylococcus aureus ATCC 25923 e Streptococcus mutans ATCC 25175 foi verificada de acordo com o National Comittee for Clinical Laboratory Standards (NCCLS), determinando-se a concentração inibitória mínima (MIC) e a concentração bactericida mínima (MBC). Os resultados obtidos indicaram que a formulação contendo AgNPs produzidas por meio de síntese verde foi devidamente caracterizada pelas técnicas selecionadas. Além disso, a avaliação da formulação provou que ela é adequada para a proposta, bem como tem potencial para ser utilizada como curativo intracanal já que apresentou atividade antimicrobiana contra todas as cepas bacterianas avaliadas.

Implant volume loss, misfit, screw loosening, and stress in custom titanium and zirconia abutments

Abstract The aim of this study was to verify the effect of the implant volume loss, vertical misfit between abutment and prosthetic platform, prosthetic screw loosening torque, and screw stress distribution in titanium and zirconia abutments. Ten CAD/CAM system custom abutments of each material were milled and attached to the titanium implants. The implant volume loss was evaluated by microtomography, the vertical misfit with optical microscopy, and digital torque wrench measured the prosthetic screw loosening. All experimental analyses were performed before and after mechanical cycle (1,000,000 cycles, 100 N/2 Hz). Virtual models of the structures were created for finite element analysis, and the stress on the screw obtained with von Mises procedure. Data were analyzed using an independent t-test, two-way ANOVA for repeated measures, and Tukey's HSD test (a=0.05). There was no significant difference in the implant volume loss for the two abutment materials (p=0.662). Titanium abutments provided higher loosening torque values after mechanical cycling (p<0.001). Lesser marginal misfit was obtained with titanium abutments before and after mechanical cycling (p<0.001). The stress distribution on the screw was similar between abutment materials. In conclusion, CAD/CAM custom titanium abutment reduced the marginal misfit and increased the torque maintenance of prosthetic screws when compared to CAD/CAM custom zirconia abutment.

Resumo O objetivo neste estudo foi verificar o efeito da diminuição de volume do implante, desajuste vertical entre o pilar e plataforma protética, torque de afrouxamento do parafuso protético e distribuição da tensão no parafuso em pilares de titânio e zircônia. Dez pilares personalizados de cada material foram fresados e conectados aos implantes de titânio. A diminuição de volume do implante foi avaliada com microtomografia, o desajuste vertical com microscopia óptica e o torque de afrouxamento do parafuso protético com chave de torque digital. Todas as análises experimentais foram realizadas antes e após aplicação do ciclo mecânico (1.000.000 ciclos, 100 N/2 Hz). Modelos virtuais das estruturas foram criados para análise por elementos finitos e a tensão no parafuso obtida com valores de von Mises. Os dados foram analisados usando teste t independente, análise de varância dois fatores para medidas repetidas e teste de Tukey HSD (a=0,05). Não houve diferença significativa na diminuição de volume do implante para os dois materiais do pilar (p= 0,662). Os pilares de titânio proporcionaram maiores valores de torque de afrouxamento após o ciclo mecânico (p<0,001). O menor desajuste marginal foi obtido com os pilares de titânio antes e após o ciclo mecânico (p<0,001). A distribuição da tensão no parafuso foi similar entre os materiais. Em conclusão, os pilares personalizados de titânio reduziram o desajuste marginal e aumentaram a manutenção do torque dos parafusos protéticos quando comparados aos pilares de zircônia.

A micro-CT evaluation of the performance of rotary and reciprocating single-file systems in shaping ability of curved root canals

Abstract To compare the shaping ability of different single-file systems in the preparation of mesial curved canals of mandibular molars using micro-CT technology. Fifteen mesial roots of mandibular molars with two independent and curved canals (n = 30) were selected, scanned at a resolution of 26.7 μm anatomically matched, and distributed into three groups (n = 10), according to the preparation system: WaveOne 25.08, Reciproc 25.08, and OneShape 25.06. A final micro-CT scanning was performed, data sets were registered with their respective counterparts, and compared regarding the three-dimensional (volume, surface area, and structure model index - SMI) and two-dimensional (perimeter, area, roundness, major and minor diameters) parameters, as well as, canal transportation, using ANOVA and post hoc Tukey tests (α = 5%). Overall, no difference was observed between groups regarding area, perimeter, volume, surface area, and canal transportation (p > 0.05). Within group, no canal transportation was significantly higherobserved in the apical third (0.10 ± 0.05 mm) compared to coronal (0.08±0.040 mm) and middle (0.07 ± 0.03 mm) thirds (p < 0.05). Structure model index (SMI) was statistically higher after preparation with OneShape instrument (0.36 ± 0.26) compared to other systems (p < 0.05). Within the parameters of this study, similar shaping ability was observed in the preparation of mesial curved root canals of mandibular molars with Reciproc, OneShape and WaveOne systems.

Micro-computed tomographic assessment of the variability and morphological features of root canal system and their ramifications

Abstract Objectives This study assessed the incidence and variability features of root canals system (RCS) and their ramifications according to Pucci & Reig (PR) (1944) and the American Association of Endodontists (AAE) (2017) by micro-computed tomography (μCT). Methodology 500 representative extracted human teeth of each tooth group (n=50) (maxillary/mandibular central and lateral incisors, canines, first and second premolars and molars) were scanned by μCT with a resolution of 26.70 μm. The reconstructed cross-sections images and the visualization of the continuous slices in the transversal axis were performed using DataViewer software. RCS were classified according to Pucci & Reig (main canal, collateral canal, lateral canal, secondary canal, accessory canal, intercanal, recurrent canal) and AAE (main canal, accessory canal, lateral canal). The apical deltas were assessed for both classifications. The prevalence of apical deltas was evaluated using the Chi-squared test (p<0.05). Results According to PR, a higher incidence of lateral canals was observed in maxillary canines (10%), central incisors (8%) and first premolars (6%). Using AAE, the highest incidence of lateral canals was observed in the mandibular first premolars (85%), first and second molars (84%), lateral incisors (67%), canines (59%), and in maxillary first premolars (52%). Regarding accessory canals, the PR showed a frequency in 2% of the maxillary lateral incisors and maxillary and mandibular first premolars and 3% of mandibular first and second molars. On the other hand, the AAE showed the highest incidence of accessory canals in 86% of the maxillary first premolars, 71% in mandibular lateral incisors, 69% in mandibular first premolars, 65% in mandibular canines, and 56% in maxillary canines. The PR showed the lowest incidence of apical deltas for all dental groups when compared with AAE (p=0.004). Interestingly, distal canals in maxillary molars showed a significant discrepancy between classifications (p=0.027). Conclusions μCT enabled accurately describing the RC system and related ramifications, adding to the PR and AAE classifications, with some discrepancies reported for maxillary molars. Clinical Relevance This μCT study enabled a thorough description of the variability among root canals and their ramifications, including clinically relevant details on the presence and location of lateral canals and accessories in all human tooth groups, beyond the currently existing classification systems.

Effect of sonic and ultrasonic activation on physicochemical properties of root canal sealers

Abstract Objective: To evaluate the effect of ultrasonic and sonic activation on physicochemical properties of AH Plus, MTA Fillapex, ADSeal, GuttaFlow Bioseal, and GuttaFlow 2 sealers. Methodology: Three experimental groups were formed: no activation (NA), ultrasonic activation (UA), and sonic activation (SA). The sealers were manipulated according to the manufacturers' instructions. A 3-mL syringe was adapted to receive 1 mL of sealer. Activation was performed with a 20/.01 ultrasonic insert (20 s/1W) in the UA group. A size 35.04 sonic tip was used (20 s/10,000 cycles/min-1) in the SA group. The molds for physicochemical analysis were filled and evaluated according to ANSI/ADA specification no. 57: setting time (ST), flow (FL), dimensional change (DC), solubility (SB), and radiopacity (RD). Statistical analysis was performed by Kruskal-Wallis, one-way ANOVA, and Tukey's tests (P<0.05). Results: Regarding ST, only AH Plus and GuttaFlow 2 in the NA group met the ANSI/ADA standards. All FL values were greater than 20 mm in diameter, as determined by ANSI/ADA. The tested sealers and protocols did not comply with the ANSI/ADA standards for DC. As for SB, only MTA Fillapex, regardless of the activation protocol, did not follow the ANSI/ADA standards. All of the investigated sealers, regardless of the activation protocol, presented radiographic density higher than 3 mm Al, as proposed by ANSI/ADA. Conclusions: UA and SA promoted changes in the physicochemical properties of the evaluated root canal sealers, mainly in ST and F. Thus, it is important to evaluate the physicochemical properties of endodontic sealers associated with activation techniques prior to clinical application in order to determine whether the properties follow the parameters set by ANSI/ADA, ensuring safety and quality of root canal filling.

Root canal preparation using micro-computed tomography analysis: a literature review

Abstract: This literature review has critically analyzed the published research related to the biomechanical preparation of root canals with three-dimensional analysis using micro-computed tomography (micro-CT). In December 2017, six databases (PubMed, Cochrane, Web of Science, Embase, Scopus, and Science Direct) were accessed using keywords to find articles including the use of the micro-CT analysis in biomechanical root canal preparation. There were 60 full articles that were selected, which were screened and read by two authors. The research that was reviewed and analyzed included root canal anatomy and sample selection, changes in canal shape and untouched canal areas, canal transportation and centering ability, and kinematics (motion). Of the studies selected, 49.18% discussed anatomical characteristics, with 54.1% of these studies describing mesial roots of mandibular molars with moderate curvature. Only 35% used a stratified distribution based on root canal system morphology and quantitative data obtained by micro-CT. The analysis of canal transportation and centering ability showed that transport values in the apical third exceeded the critical limit of 0.3 mm in mesial roots of mandibular molars with moderate curvature, especially in the groups in which a reciprocating system was used. In relation to kinematics, 91.70% of the reviewed studies evaluated continuous rotating instruments, followed by reciprocating rotation (38.33%), vibratory (15%), and the adaptive kinematics, which was in only 8.33%. The reciprocating kinematics was associated with higher canal decentralization and transportation indexes, as well as a greater capacity for dentin removal and debris accumulation. This literature review showed that the anatomy, the type of design and kinematics of instruments, and the experimental design are factors that directly influence the quality of biomechanical preparation of root canals analyzed in a qualitative and quantitative manner by micro-CT.

Push-out bond strength of different tricalcium silicate-based filling materials to root dentin

Abstract: The aim of this study was to evaluate the bond strength of different triccalcium silicate cements to retrograde cavity using a push out test. Thirty maxillary central incisors were shaped using #80 hand files and sectioned transversally. Root slices were obtained from the apical 4 mm after eliminating the apical extremity. The specimens were embedded in acrylic resin and positioned at 45° to the horizontal plane for preparation of root-end cavities with a diamond ultrasonic retrotip. The samples were divided into three groups according to the root-end filling material (n = 10): MTA Angelus, ProRoot MTA and Biodentine. A gutta-percha cone (#80) was tugged-back at the limit between the canal and the root-end cavity. The root-end cavity was filled and the gutta-percha cone was removed after complete setting of the materials. The specimens were placed in an Instron machine with the root-end filling turned downwards. The push-out shaft was inserted in the space previously occupied by the gutta-percha cone and push out testing was performed at a crosshead speed of 1.0 mm/min. There was no statistically significant difference in resistance to push out by the materials tested (p > 0.01). MTA Angelus and ProRoot MTA showed predominantly mixed failure while Biodentine exhibited mixed and cohesive failures. The tricalcium silicate-based root-end filling materials showed similar bond strength retrograde cavity.

Chlorhexidine and proanthocyanidin enhance the long-term bond strength of resin-based endodontic sealer

Abstract The aim of this study was to evaluate the effects of proanthocyanidin (PA) and chlorhexidine (CHX) on the bond strength (BS), failure pattern, and resin-dentin interface morphology of the endodontic sealers EndoREZ and AH Plus after 24 h and 6 months of water storage. A total of 120 prepared bovine roots were divided into six groups: AH Plus, CHX+AH Plus, PA+AH Plus, EndoREZ, CHX+EndoREZ, and PA+EndoREZ. Dentin was treated for 1 or 5 min with 2% CHX or 15% PA, respectively. Roots were filled and stored in water for 24 h or 6 months (n = 10). Root slices were subjected to push-out test and scanning electron microscopy (SEM). Data were compared using two-way ANOVA and student's t-test (α = 5%). BS decreased over time for AH Plus and untreated EndoREZ (p < 0.05). At 24 h, AH Plus had higher BS than EndoREZ (p < 0.001), with no differences among treatments for both sealers (p > 0.05). At 6 months, EndoREZ had higher BS values for CHX and PA than control (p < 0.05). AH Plus had higher BS than EndoREZ (p < 0.001), while with CHX or PA, similar BS was observed in both sealers (p > 0.05). Cohesive and mixed failures were observed in all groups. SEM revealed sealer tags in the root dentin. In conclusion, BS decreased with time and AH Plus had higher BS than EndoREZ in untreated dentin; however, CHX or PA enhanced long-term BS of EndoREZ. Overall, dentin treatment affected failure pattern and resin-dentin interface morphology, particularly for EndoREZ.

Evaluation of Stress Distribution in Endodontically Weakened Teeth Restored with Different Crown Materials: 3D-FEA Analysis

Abstract This study evaluated the stress distribution in endodontically treated teeth, weakened (W) or not weakened (NW), restored with different materials of prosthetic crown using 3D-FEA. Models of a maxillary canine were constructed based on micro-CT images and divided into the groups: G1 (control) - sound tooth; G2 to G7 - endodontically treated teeth restored with glass fiber post (GFP); which G2 to G4 simulated NW root and G5 to G7 simulated W root. For crown material the teeth were restored with: G2 and G5: metallic coping and ceramic veneering, G3 and G6: zirconia coping and ceramic veneering, G4 and G7: alumina coping and ceramic veneering. Load of 180 N was applied at the incisal third of lingual surface at 45º. Models were supported by the periodontal ligament (x=y=z=0). The von Mises stress (VMS) values were calculated. The W teeth presented higher VMS at coping when compared to NW teeth and group G1 showed lower VMS value. For crown material, for both W or NW teeth, increasing VMS was found at metallic, zirconia and alumina coping, respectively. Metallic coping showed a better performance despite its unfavorable esthetics, suggesting as an appropriate material for prosthetic restoration of endodontically treated teeth.

Resumo Este estudo avaliou a distribuição de tensão em dentes tratados endodonticamente, fragilizados (F) ou não fragilizados (NF), restaurados com diferentes materiais para a coroa protética utilizando 3D-FEA. Modelos de um canino maxilar foram construídos baseados em imagens de micro-CT e divididos em grupos: G1 (controle) - dente hígido; G2 a G7 - dentes tratados endodonticamente com pino de fibra de vidro (PFV), sendo que G2 a G4 simularam raízes NF e G5 a G7 simularam raízes F. Para o material das coroas os dentes foram restaurados com: G2 e G5: coping metálico e revestimento cerâmico, G3 e G6: coping de zirconia e revestimento cerâmico, G4 e G7: coping de alumina e revestimento cerâmico. Carregamento de 180 N foi aplicado na superfície lingual em seu terço incisal com 45 graus de inclinação. Os modelos foram suportados pelo ligamento periodontal (x=y=z=0). Os valores da tensão de von Mises (VMS) foram calculados. Os dentes F apresentaram maiores valores VMS para o coping quando comparados aos dentes NF, sendo que o G1 apresentou menores valores VMS. Para o material das coroas, ambos F ou NF aumentaram VMS no coping metálico, zirconia e alumina, respectivamente. Copings metálicos apresentaram melhor comportamento mecânico apesar de não favorecerem a estética, o que sugere ser um material apropriado para a restauração de dentes tratados endodonticamente.

Micro-CT Evaluation of Root and Canal Morphology of Mandibular First Premolars with Radicular Grooves

Abstract The aim of this study was to evaluate morphological features of 70 single-rooted mandibular first premolars with radicular grooves (RG) using micro-CT technology. Teeth were scanned and evaluated regarding the morphology of the roots and root canals as well as length, depth and percentage frequency location of the RG. Volume, surface area and Structure Model Index (SMI) of the canals were measured for the full root length. Two-dimensional parameters and frequency of canal orifices were evaluated at 1, 2, and 3 mm levels from the apical foramen. The number of accessory canals, the dentinal thickness, and cross-sectional appearance of the canal at different root levels were also recorded. Expression of deep grooves was observed in 21.42% of the sample. Mean lengths of root and RG were 13.43 mm and 8.5 mm, respectively, while depth of the RG ranged from 0.75 to 1.13 mm. Mean canal volume, surface area and SMI were 10.78 mm3, 58.51 mm2, and 2.84, respectively. Apical delta was present in 4.35% of the sample and accessory canals were observed mostly at the middle and apical thirds. Two-dimensional parameters indicated an oval-shaped cross-sectional appearance of the root canal with a high percentage frequency of canal divisions (87.15%). Canal configuration type V (58.57%) was the most prevalent. C-shaped configuration was observed in 13 premolars (18.57%), whereas dentinal thickness ranged from 1.0 to 1.31 mm. Radicular grooves in mandibular first premolars was associated with the occurrence of several anatomical complexities, including C-shaped canals and divisions of the main root canal.

Resumo O objetivo deste estudo foi avaliar a morfologia de 70 pré-molares inferiores com depressões radiculares (DR) usando a microtomografia. Os dentes foram escaneados e avaliados quanto à morfologia das raízes e canais radiculares, bem como o comprimento, profundidade, frequência e localização das DR. O volume, a área de superfície e o Structure Model Index (SMI) dos canais foram mensurados no comprimento total da raiz. Parâmetros bidimensionais e orifícios do canal foram avaliados a 1, 2 e 3 mm do forame apical. O número de canais acessórios, a espessura dentinária e a aparência transversal do canal em diferentes níveis de raiz também foram registrados. A expressão de sulcos profundos foi observada em 21,42% da amostra. Os comprimentos médios de raiz e DR foram de 13,43 mm e 8,5 mm, respectivamente, enquanto a profundidade das DR variou de 0,75 a 1,13 mm. O volume médio do canal, a área superficial e o SMI foram de 10,78 mm3, 58,51 mm2 e 2,84, respectivamente. O delta apical estava presente em 4,35% da amostra e os canais acessórios foram observados principalmente nos terços médio e apical. Os parâmetros bidimensionais indicaram canais radiculares com secção oval e alta frequência de divisões canal principal (87,15%). A configuração Tipo V do canal radicular foi a mais prevalente (58,57%). A presença de canais em forma de C foi observada em 13 pré-molares (18,57%), enquanto a espessura dentinária variou de 1,0 a 1,31 mm. Os sulcos radiculares nos primeiros pré-molares inferiores foram associados à ocorrência de várias complexidades anatômicas, incluindo canais em forma de C e múltiplas divisões do canal principal.

Influence of Root Canal Filling Techniques on Sealer Penetration and Bond Strength to Dentin

Abstract The influence of root canal filling techniques on the penetration of AH Plus into dentinal tubules was evaluated using confocal laser scanning microscopy (CLSM) and the impact on the bond strength of the filling material on the root dentin was evaluated using the push-out test. Roots of the maxillary central incisors (n=40) were prepared with ProTaper Universal and assigned to four groups: lateral condensation, vertical compaction, modified Tagger hybrid and single cone. After root canal filling with gutta-percha and AH Plus, along with the addition of 0.01% fluorescein, the roots were cut into 2-mm slices. CLSM was performed on the first slice of each root third, followed by the push-out test. The second slice was analyzed under SEM. ANOVA demonstrated a statistically significant difference between the root canal filling techniques and the root thirds (p<0.05). For percent penetration, Tukey's test showed that the vertical compaction (91.77±13.51), lateral condensation (89.18±10.91) and modified Tagger hybrid (87.53±15.42) presented the highest values, which significantly differed (p<0.05) from those of the single cone (78.19±22.46). For bond strength (MPa), lateral condensation (3.42±0.54) and vertical compaction (3.47±0.53) had the highest values (p<0.05), while the modified Tagger hybrid (2.19±0.41) and single cone (0.54±0.21) had the lowest. In conclusion, the lateral condensation, vertical compaction and Modified Tagger's hybrid techniques resulted in greater penetration and bond strength to the intra-radicular dentin.

Resumo Avaliou-se a influência da técnica obturadora na penetração do cimento AH Plus nos túbulos dentinários, por meio de microscopia confocal de varredura a laser (MCVL), e o impacto na resistência de união do material obturador à dentina, por meio do teste de push out. Raízes de incisivos centrais superiores (n=40) foram preparadas com ProTaper Universal e distribuídas em 4 grupos: Condensação lateral, Compactação vertical, Híbrida de Tagger Modificada e Cone único. Após obturação com guta percha e AH Plus acrescido de fluoresceína 0,01%, as raízes foram seccionadas em slices de 2,0 mm. O primeiro slice de cada terço foi submetido à MCVL e, posteriormente, ao teste de push out. O segundo slice foi analisado em MEV. ANOVA demonstrou diferença estatisticamente significante para as técnicas obturadoras e terços radiculares (p<0,05). Para o percentual de penetração, Tukey evidenciou que compactação vertical (91,77±13,51), Condensação lateral (89,18±10,91) e Híbrida de Tagger Modificada (87,53±15,42) apresentaram os maiores valores, estatisticamente diferentes (p<0,05) da Cone único (78,19±22,46). Na resistência de união (MPa), Condensação lateral (3,42±0,54) e Compactação vertical (3,47±0,53) obtiveram os maiores valores, diferentes (p<0,05) da Híbrida de Tagger Modificada (2,19±0,41) e da Cone único (0,54±0,21), que teve os menores valores. Concluiu-se que as técnicas obturadoras Condensação lateral, Compactação vertical e Híbrida de Tagger Modificada propiciaram maior penetração e resistência de união à dentina intrarradicular.

Cytotoxicity Evaluation of Root Canal Sealers Using an In Vitro Experimental Model with Roots

Abstract The aim of the present study was to evaluate the cytotoxicity of root canal sealers under conditions closely resembling a clinical reality. A primary human fibroblast cell line was seeded in 24-well acrylic plates with Dulbecco’s modified Eagle’s medium supplemented with 10% serum fetal bovine (SFB) and incubated for 24 h. Root canals from premolars were filled and individually attached to nylon devices to be stabilized in the wells with the already seeded cells. Specimens were divided into groups as follows: Control: gutta-percha cones (GPC); AH Plus+GPC; Sealapex+GPC; MTA Fillapex+GPC and Endofill+GPC. After 24 and 48 h, cell viability and morphology were evaluated by MTT assay and scanning electron microscopy (SEM), respectively. Statistical analysis was performed by Mann-Whitney test, complemented by Kruskal Wallis test (p<0.05). Only Endofill presented cytotoxicity after 24 h. MTA Fillapex and Endofill reduced the production of succinic desidrogenase after 48 h. AH Plus was non-toxic at any time point. SEM showed that the AH Plus and MTA Fillapex groups presented fibroblasts with morphology close to the control group, while the Endofill group presented few cells with thin extensions cells. The present study showed that good results were present in AH Plus and Sealapex, but not the Endofill group after 48 h. The method used enabled evaluation of the cytotoxicity of the studied sealers that diffused through the root apex.

Resumo O objetivo do presente estudo foi avaliar a citotoxicidade dos cimentos dos canais radiculares em condições próximas à realidade clinica. Uma linhagem primária de fibrolastos humanos foi semeada em placas acrílicas de 24-poços com meio de cultura Dulbecco’s modified Eagle’s medium suplementado com 10% de soro fetal bovino e incubados por 24 h. Os canais radiculares de pré-molares foram obturados e individualmente adaptados aos dispositivos de nylon para serem estabilizados nos poços com as células já semeadas. Amostras foram dividas de acordo com os grupos: Controle: cones de gutta-percha (CGP); AH Plus+CGP; Sealapex+CGP; MTA Fillapex+CGP e Endofill+CGP. Após 24 e 48 h, a viabilidade e a morfologia celular foram avaliadas pelo ensaio de MTT e microscopia eletrônica de varredura (MEV), respectivamente. Análises estatísticas foram realizadas pelo teste de Mann-Whitney, complementadas por Kruskal Wallis (p<0,05). Apenas o Endofill apresentou citotoxicidade após 24 h. MTA Fillapex e Endofill reduziram a produção da enzima desidrogenase succinica após 48 h. AH Plus não apresentou toxicidade em nenhum momento. MEV mostrou que os grupos AH Plus e o MTA Fillapex apresentaram fibroblastos com morfologia próxima ao grupo controle, enquanto que o grupo do Endofill apresentou poucas células com finos prolongamentos. O presente estudo demonstrou que resultados satisfatórios foram apresentados nos grupos AH Plus e Sealapex, mas não para o Endofill após 48 h. O método utilizado permitiu avaliar a citotoxicidade dos cimentos que se difundem pelo ápice radicular.