Accuracy of Root ZXII, E-PEX and FIND apex locators in teeth with vital pulp: an in vivo study

Abstract: This research evaluated, in vivo, the accuracy of three electronic apex locators - EALs (Root ZXII, E-PEX and FIND) in teeth with vital pulp submitted to biopulpectomy, preserving the periodontal stump. For this study, 90 single-rooted teeth with extraction indication were selected. After positive pulpal cold sensitivity test, pulp chamber access was performed. The cervical and middle thirds of root canals were instrumented with Reciproc R25, and the K#15 file was used as a standard instrument to determine working length, forming 2 groups: Constriction (insertion of the instrument until the apical constriction limit) and Foramen (insertion of the instrument until the foramen and then repositioning at constriction, without removing the file from the canal). The hand file was stabilized with a light-cured flow resin. After extraction, the samples were analyzed through microCT SkyScan 1272, with CTAN software, which evaluated the proximity between the tip of the file to the apical constriction, providing data for comparative analysis using Kruskal-Wallis and Dunn tests (p<0.05). There was a statistically significant difference in the abilities of the EALs to detect the apical constriction after reaching the foramen with Root ZX II showing higher accuracy (89%). However, there was no difference in the accuracy of the three EALs in detecting the apical constriction without reaching the foramen. Based on the present results, we conclude that EALs may show accurate measures in detecting apical constriction and foramen, even without damaging the periodontal stump in biopulpectomy.

Biocompatibility, biomineralization, and maturation of collagen by rtr®, bioglass and dm bone® materials

Abstract This study evaluated the biocompatibility, biomineralization, and collagen fiber maturation induced by Resorbable Tissue Replacement (RTR®; β-tricalcium phosphate [TCP]), Bioglass (BIOG; bioactive glass), and DM Bone® (DMB; hydroxyapatite and β-TCP) in vivo. Sixty-four polyethylene tubes with or without (control group; CG) materials (n=8/group/period) were randomly implanted in the subcutaneous tissue of 16 male Wistar rats (four per rat), weighting 250 to 280 g. The rats were killed after 7 and 30 days (n=8), and the specimens were removed for analysis of inflammation using hematoxylin-eosin; biomineralization assay using von Kossa (VK) staining and polarized light (PL); and collagen fiber maturation using picrosirius red (PSR). Nonparametric data were statistically analyzed by Kruskal-Wallis and Dunn tests, and parametric data by one-way ANOVA test (p<0.05). At 7 days, all groups induced moderate inflammation (p>0.05). At 30 days, there was mild inflammation in the BIOG and CG, and moderate inflammation in the RTR and DMB groups, with a significant difference between the CG and RTR (p<0.05). The fibrous capsule was thick at 7 days and predominantly thin at 30 days in all groups. All materials exhibited structures that stained positively for VK and PL. Immature collagen fibers were predominant at 7 and 30 days in all groups (p>0.05), although DMB exhibited more mature fibers than BIOG at 30 days (p<0.05). RTR, BIOG, and DMB were biocompatible, inducing inflammation that reduced over time and biomineralization in the subcutaneous tissue of rats. DMB exhibited more mature collagen fibers than BIOG over a longer period.

Resumo Este estudo avaliou a biocompatibilidade, biomineralização e maturação das fibras de colágeno induzidas por Resorbable Tissue Replacement (RTR®; fosfato β-tricálcico [TCP]), Bioglass (BIOG; vidro bioativo) e DM Bone® (DMB; hidroxiapatita e β-TCP) in vivo. Sessenta e quatro tubos de polietileno com ou sem (grupo controle; GC) os materiais (n=8/grupo/período) foram implantados aleatoriamente em tecido subcutâneo de 16 ratos machos Wistar (quatro por rato), pesando entre 250 a 280g. Os ratos foram mortos após 7 e 30 dias (n=8), e as amostras foram removidas para análise da inflamação utilizando hematoxilina-eosina; avaliação da biomineralização utilizando coloração de von Kossa (VK) e luz polarizada (LP); e maturação das fibras colágenas, utilizando picrosirius red (PSR). Os dados não-paramétricos foram analisados pelos testes de Kruskal-Wallis e Dunn, e os paramétricos pelo teste de one-way ANOVA (p<0.05). Aos 7 dias, todos os grupos induziram inflamação moderada (p>0,05). Aos 30 dias, houve inflamação leve nos grupos BIOG e GC, e inflamação moderada nos grupos RTR e DMB, com diferença significativa entre os GC e RTR (p<0,05). A cápsula fibrosa foi espessa aos 7 dias, e predominantemente fina aos 30 dias em todos os grupos. Todos os materiais exibiram estruturas positivas para VK e LP. Fibras colágenas imaturas foram predominantes aos 7 e 30 dias em todos os grupos (p>0,05), embora o DMB exibiu fibras mais maduras do que o BIOG aos 30 dias (p<0,05). RTR, BIOG e DMB foram biocompatíveis, induzindo inflamação que reduziu com o tempo, e biomineralização no tecido subcutâneo de ratos. O DMB exibiu mais fibras colágenas maduras do que o BIOG em período mais longo.

Estudo in vitro da influência de diferentes plugs coronários sobre o remanescente da obturação, após preparo para pino, na retenção de pinos metálicos fundidos / In vitro assessment of the influence of different protection plugs over obturation remnant space, after post preparation, on the retention of cast metal posts

Objetivo: Avaliar a influência de diferentes plugs de proteção, acomodados sobre o remanescente da obturação após preparo para pino, na retenção de pinos metálicos fundidos. Métodos: Cinquenta dentes bovinos foram decoronados, manualmente instrumentados até a lima manual Kerr #80 e obturados. A desobturação parcial de 10mm do conduto foi realizada com uma broca Largo e os grupos foram divididos de acordo com os diferentes materiais utilizados como plugs (n=10): Grupo I (Controle, sem plug); Grupo II (plug de Coltosol®); Grupo III (plug, em consistência de massa, de Sealapex® + óxido de zinco); Grupo IV (plug de etil-cianoacrilato); e Grupo V (plug de fosfato de zinco). Uma camada de 1mm de espessura dos diferentes plugs (Grupos II, III, IV ou V) foi acomodada sobre a obturação remanescente. Os espécimes foram selados e armazenados em 100% de umidade, por 7 dias. Após moldagem do conduto, foram confeccionados pinos metálicos fundidos e cimentados com fosfato de zinco. Os espécimes permaneceram em câmara úmida por 45 dias antes do teste de tração, realizado em uma máquina universal de ensaios. Os valores foram expressos em Mega pascal (MPa) e submetidos aos testes ANOVA e Tukey (p<0,05). Resultados: O etilcianoacrilato diminuiu a retenção dos pinos metálicos fundidos (p<0,01). Não houve diferença entre os outros grupos (p>0,05), semelhante- mente ao controle. Conclusão: A proteção da obturação com plugs confeccionados com etil-cianoacrilato prejudica a retenção de pinos metálicos fundidos cimentados com fosfato de zinco, enquanto Sealapex® acrescido de óxido de zinco, fosfato de zinco endurecido ou Coltosol® não interferem na adesividade (AU).

Reimplante intencional como alternativa ao implante dentário: relato de caso com 10 anos de proservação / Intentional replantation as an alternative to dental implant: a 10-years follow-up case report

Objetivo: apresentar o relato de um caso de tratamento viável para molar inferior permanente endodonticamente tratado que apresentou sintomatologia após 6 meses do tratamento endodôntico. Uma vez que retratamento endodôntico ou cirurgia parendodôntica não eram indicados, o reimplante intencional foi a técnica escolhida. Relato de caso: uma hora antes do procedimento, o paciente fez bochecho com gluconato de clorexidina a 0,12% e foi preparado para cirurgia com anestesia dos nervos alveolar inferior e lingual, realizada com mepivacaína 2% contendo 1:100.000 de adrenalina. O procedimento teve início com extração menos traumática possível, envolvendo-se imediatamente o dente extraído em gaze umedecida com soro fisiológico, enquanto as raízes foram avaliadas para presença de fraturas, seguida da apicectomia. As cavidades foram retroinstrumentadas com broca de alta rotação sob irrigação com soro fisiológico e, para a retro-obturação, foi utilizado agregado de trióxido mineral (MTA) branco. Imediatamente, o dente foi reposicionado no alvéolo e estabilizado por suturas com fio de seda 4-0. Após um ano, o paciente retornou para controle radiográfico e clínico, o qual não revelou mais resposta à percussão vertical. Após 10 anos, a imagem radiográfica mostra reparo apical, sem indícios de reabsorção radicular ou lesão periapical. Conclusão: o exame clínico, associado à ausência dor e mobilidade normal do dente, confirmou o sucesso do tratamento, indicando esse como uma alternativa válida quando o implante não for acessível para o paciente. Essa técnica pode ajudar a restaurar a função de um dente original, em vez de substituí-lo por prótese ou implante dentário (AU).

Objective: This case report shows a successful viable treatment for an endodontically treated permanent mandibular molar which presented clinical symptoms 6 months after the endodontic treatment. Since endodontic retreatment or paraendodontic surgery were not indicated, the chosen technique was intentional replantation. Case Report: One hour before the procedure, the patient rinsed his mouth with chlorhexidine gluconate 0.12%. The patient was prepared for surgery and profound inferior alveolar and lingual nerve block anesthesia was achieved with 2% mepivacaine containing 1/100,000 adrenaline. The procedure started with the least traumatic extraction as possible and immediately wrapping the extracted tooth in physiological saline-moistened gauze, while the roots were evaluated for vertical fractures, followed by apicoectomy. The cavities were retro-prepared with high-speed bur under irrigation with physiological saline and white mineral trioxide aggregate (MTA) was used for retrofilling. Immediately, the tooth was repositioned in the alveolus. Two 4-0 silk sutures were used to suture and stabilize the tooth. After one year, the patient returned for radiographic and clinical control, which revealed no more response to vertical percussion. After 10 years, the images show radiographic apical repair, without evidence of root resorption or periapical lesion. Conclusion: Clinical examination associated with the reported absence of pain and normal mobility confirmed the procedure's success, indicating this treatment as a valid alternative when an implant is not viable. This technique may help restore an original tooth to function instead of replacing it with a prosthetic or a dental implant (AU).

Estudo de novos dispositivos, instrumentos e materiais empregados no tratamento endodôntico / Evaluation of new devices, instruments and materials used in endodontic treatment

Introdução: O tratamento endodôntico visa manter ou restabelecer a saúde do periodonto através do preparo biomecânico, utilizando instrumentos de níqueltitânio automatizados e associados com insertos ultrassônicos para potencializar a ação dos irrigantes. Os materiais empregados na endodontia que permanecerão em contato com tecidos devem apresentar biocompatibilidade e preferencialmente ser biomineralizador, a fim de selar comunicações (fisiológicas/iatrogênicas), isolando o sistema de canais radiculares. Objetivos: 1- Avaliar a resistência à fadiga cíclica das limas reciprocantes Genius e EdgeFile X1 Small, comparados à lima WaveOne Gold Primary; 2- Avaliar a capacidade de limpeza de um inserto ultrassônico de níquel titânio em ativação da irrigação de forma contínua e passiva; 3- Avaliar a biocompatiblidade e biomineralização do cimento reparador MTA Flow. Material e Métodos: Para avaliar a resistência à fadiga cíclica dos sistemas Genius, EdgeFile e WaveOne Gold, 80 instrumentos foram utilizados (n=20), divididos em 4 grupos experimentais: Genius 25.04, Genius 30.04; EdgeFile X1 Small e Wave One Gold Primary, acionados em um canal artificial de aço inoxidável com ângulo de curvatura de 60o e raio de curvatura de 5 mm. O tempo decorrido da ativação do motor foi gravado em um cronômetro digital e parado assim que a fratura foi detectada. O número de ciclos até a falha (NCF) e o tempo para fratura (TF) foram calculados e os comprimentos dos segmentos fraturados medidos. Para avaliar a capacidade de limpeza do inserto ultrassônico, 45 prémolares inferiores, padronizados em 16 mm foram utilizados. A instrumentação foi realizada até lima 50.04 sob irrigação com hipoclorito de sódio e foram divididos em 3 grupos (n = 15) de acordo com a técnica de ativação final da solução irrigadora: irrigação convencional (IC) (passiva com pressão positiva/sucção concomitante) como controle; ativação ultrassônica passiva (PUI) e ativação ultrassônica contínua (CUI) do irrigante. Os três grupos tiveram os protocolos de ativação/irrigação final em soluções de hipoclorito de sódio e EDTA. As amostras foram clivadas, as imagens obtidas com microscopia eletrônica de varredura (MEV) e avaliadas quanto à capacidade de remoção da camada de smear layer no terço cervical, médio e apical, por um sistema de escores. Para análise biológica do material reparador MTA Flow, os materiais MTA Angelus e ProRoot MTA foram utilizados para comparação. Quarenta ratos receberam implantes subcutâneo de tubos de polietileno contendo os 3 materiais e tubo vazio como controle (n=10). Após 7, 15, 30 e 60 dias, os animais foram eutanasiados e os tubos removidos com o tecido conjuntivo circundantes. Infiltrado inflamatório e espessura da cápsula fibrosa foram avaliados histologicamente e indução da mineralização analisada por Von Kossa e sob luz polarizada. Os dados foram analisados com testes estatísticos específicos (p<5%). Resultados: Quanto à fadiga cíclica, os instrumentos EdgeFile X1 Small apresentaram maior resistência (NCF: 6175.74 ± 1608.99; TF: 1058.7 ± 275.82), seguido por ambos instrumentos Genius (p<0.05), de forma significativa comparados ao Waveone Gold Primary. O inserto de NiTi aumentou a limpeza, comparado com IC, principalmente no terço apical e CUI mostrou os melhores resultados (p<0.05). Nos resultados biológicos, MTA Angelus induziu a reação mais leve após 15 dias (p<0.05), seguido do MTA Flow. ProRoot MTA induziu uma inflamação severa no dia 7, reduzindo após 15 dias. Nenhuma diferença foi observada entre os materiais após 30 ou 60 dias (p>0.05). Estruturas coradas por Von Kossa e birrefringentes foram positivas para todos os materiais. Conclusões: 1- Os instrumentos EdgeFile X1 Small demonstraram maior resistência à fadiga cíclica que Genius e WaveOne Gold Primary. Ambos instrumentos Genius apresentaram resistência superior à WaveOne Gold Primary. 2- A ativação final do irrigante com o inserto NiTi melhorou a remoção de smear layer, com protocolo CUI superior à PUI ou IC. 3- O MTA Flow mostrou biocompatibilidade e induziu a biomineralização em todos os períodos observados(AU)

Introduction: The endodontic treatment aims to maintain or restore periodontal health through biomechanical instrumentation with nickel-titanium automatized instruments, associated with an ultrasonic tip to activate the irrigant, enhancing cleanness. Materials used in endodontics that will remain in contact with tissues, should demonstrate properties as biocompatibility and biomineralization ability, in order to seal communications (physiological/iatrogenic) isolating the root canal system. Objectives: 1- Evaluate the cyclic fatigue resistance of reciprocating Genius and EdgeFile X1 Small instruments compared to Waveone Gold Primary instruments; 2- Evaluate the cleaning effectiveness of a nickel-titanium ultrasonic tip in continuous and passive irrigant activation; 3-Evaluate the biocompatibility and biomineralization of MTA Flow repair cement. Materials and Methods: To evaluate the cyclic fatigue resistance of Genius, EdgeFile and WaveOne Gold, 80 instruments were used (n = 20), divided into 4 experimental groups: Genius 25.04, Genius 30.04; EdgeFile X1 Small and Wave One Gold Primary, reciprocating in a stainless steel artificial canal with a 60° angle of curvature and 5mm radius of curvature. The elapsed time of the motor activation was recorded in a digital timer and stopped as soon as the fracture was detected. The number of cycles to fracture (NCF) and time to fracture (TF) were calculated and the fractured segments lengths measured. To evaluate the ultrasonic tip cleanness capacity, forty-five mandibular premolars, standardized at 16 mm were used. The instrumentation was performed until file 50.04 under irrigation with sodium hypochlorite. The specimens were divided into 3 groups (n = 15) according to the final irrigant activation protocol: conventional irrigation (CI) (passive, with positive pressure/simultaneous aspiration) as control; passive ultrasonic irrigant activation (PUI) and continuous ultrasonic irrigant activation (CUI). All groups had the final activation / irrigation protocols with solutions of sodium hypochlorite and EDTA, standardized with same volume. Samples were sodium hypochlorite and EDTA, standardized with same volume. Samples were cleaved and images obtained through scanning electron microscopy (SEM) to assess smear layer removal in the cervical, middle and apical thirds, via a score system. To biologically analyze MTA Flow repair cement, MTA Angelus and ProRoot MTA cements were used as comparison. Forty rats received subcutaneous implants of polyethylene tubes containing the 3 cements and empty tube as control (n = 10). After days 7, 15, 30 and 60, the animals were euthanized and the tubes removed with the surrounding tissues. Inflammatory infiltrate and fibrous capsule thickness were histologically evaluated and mineralization induction assessed by Von Kossa staining and under polarized light. The data were analyzed with specific statistical tests (p<5%). Results: The cyclic fatigue test showed EdgeFile X1 Small with the highest resistance (NCF: 6175.74 ± 1608.99; TF: 1058.7 ± 275.82), followed by both Genius instruments (p<0.05). The nickel-titanium tip enhanced cleanness, compared to CI, mainly in the apical area, whereas CUI showed the best results (p<0.05). In the biological results, MTA Angelus induced the mildest reaction after 7 (p>0.05) and 15 days (p<0.05), followed by MTA Flow. ProRoot MTA induced severe inflammation on day 7, reducing after day 15 (p>0.05). No difference was observed after 30 or 60 days (p>0.05). Von Kossa staining and birefringents structures were positive for all materials. Conclusion: 1- EdgeFile X1 Small instruments demonstrated superior cyclic fatigue resistance than Genius and WaveOne Gold Primary. In addition, both Genius instruments showed superior resistance than WaveOne Gold Primary. 2- The final irrigant activation with the NiTi tip improved smear layer removal, with CUI protocol superior to PUI or CI. 3 - MTA Flow showed biocompatibility and induced biomineralization in all observed periods(AU)

Cleaning effectiveness of a nickel-titanium ultrasonic tip in ultrasonically activated irrigation: a SEM study

Abstract In endodontic treatment, regardless of the instrumentation technique, the presence of a smear layer covering contaminated dentin walls is always a concern. Thus, irrigation plays an essential role in reducing bacterial load. To enhance irrigation effectiveness, different ultrasonic activation methods and the use of different tips have been studied. This study assessed the cleaning capacity of the novel NiTi ultrasonic tip for smear layer removal using ultrasonically activated irrigation (UAI) with passive or continuous ultrasonic irrigation (PUI or CUI, respectively), compared with conventional irrigation. Forty-five single-rooted human mandibular premolars were decoronated to a standardized length of 16 mm. Instrumentation was performed using the Genius system up to size 50.04 and irrigated with 3% NaOCl. The specimens were divided into three groups (n = 15) according to the final irrigation activation technique: conventional irrigation (CI), as control group; PUI; and CUI, following the manufacturer's protocol. The samples were longitudinally cleaved and analyzed under a scanning electron microscope for smear layer removal according to a cleanliness score for the cervical, middle, and apical thirds. Data were evaluated by means of the Kruskal-Wallis and Tukey's tests, with a 5% level of significance. UAI enhanced cleaning compared to conventional irrigation, mainly at the apical third. CUI showed the best results, with statistically significant lower scores than PUI and CI (p < 0.05). Final irrigant activation with the NiTi tip showed better cleaning capacity than conventional irrigation. In addition, CUI resulted in better smear layer removal than PUI.

Tissue reaction to Aroeira (Myracrodruon urundeuva) extracts associated with microorganisms: an in vivo study

Abstract: Based on aroeira's (Myracrodruon urundeuva) antimicrobial activity and a future trend to compose intracanal medication, the aim of this study was to assess in vivo inflamatory tissue response to the extracts by edemogenic and histological analysis containing inactivated facultative and anaerobic microorganisms. For edema quantification, eighteen animals were divided into three groups (n = 3, periods: 3 and 6 hours) and 0.2 mL of 1% Evans blue per 100 g of body weight was injected into the penile vein under general anesthesia. After 30 min the animals received a subcutaneous injection in the dorsal region of aqueous or ethanolic extract of aroeira or saline (control) containing inactivated bacteria. Samples were collected, immersed in formamide for 72h, and evaluated by spectrophotometry (630 m). For histological analysis, polyethylene tubes with the extracts were implanted in the dorsal of 30 male rats. Analysis of the fibrous capsule and inflammatory infiltrate were performed after 7 and 30 days. The aqueous extract group induced less edema in both postoperative periods compared to the other groups, but the differences were not significant (p > 0.05). Tissue repair was significantly better after 30 days than after 7 days (p < 0.01). The aqueous solution showed less inflammatory response than the ethanolic solution (p < 0.05), with tendency for better results than control after 7 days. After 30 days, the response to both extracts was similar to control. The aqueous and ethanolic aroeira extracts containing inactivated microorganisms showed a trend for better results than saline, even when associated with microorganisms, and facilitated the tissue repair process.

Edemogenic test and hydrogen peroxide degradation rate of bleaching gels with different desensitizing agents / Teste edemogênico e taxa de degradação do peróxido de hidrogênio de géis clareadores com diferentes agentes dessensibilizantes

Objective: The at-home bleaching technique leads to the intimate contact of the bleaching gel with gingival tissues, so this study evaluated the immediate inflammatory response, through the edemogenic test, induced by at-home bleaching gels of 10% carbamide peroxide with different desensitizing agents, the quantification of hydrogen peroxide released and bleaching gels pH. Material and Methods: Forty-eight rats were divided into groups (n=12): CTRL-control group, WP-Whiteness Perfect 10% (FGM Produtos Odontológicos, Joinville, SC, Brazil), OPA-Opalescence 10% (Ultradent Products Inc., South Jordan, IT, USA), and PB-Power Bleaching (BM4, Palhoça, SC, Brazil). For the edemogenic test, all rats received an intravenous injection of Evan's Blue; after 30 min, 0.2 mL of each bleaching gels was injected into the subcutaneous tissue of the rats, and the results of the vascular permeability were assessed after 3 and 6h. The amount of HP released and pH of each product was also determined. Data were submitted to statistical test (p <0.05 ). Results: At 3h, the PB showed higher vascular permeability than the other groups. At 6h, the PB produced similar vascular permeability than WHI, and higher than OPA and CTRL groups. The OPA group had a higher vascular permeability at 6h compared to 3h; there is no difference in other groups. The PB group had higher HP concentrations than the other groups. Conclusion: In general, the PB caused a more considerable amount of inflammatory edema and higher amount of HP released. This results suggesting that these bleaching gels cause greater aggression in soft gingival tissues that eventually ends up in contact with bleaching products. (AU)

Objetivo: A técnica de clareamento domiciliar leva ao contato íntimo do gel clareador com tecidos gengivais, assim, este estudo avaliou a resposta inflamatória imediata, através do teste edemogênico, induzido por gel de clareamento caseiro à base de peróxido de carbamida a 10% com diferentes agentes dessensibilizantes, a quantificação de peróxido de hidrogênio liberado e o pH dos géis branqueadores. Material e Métodos: Quarenta e oito ratos foram divididos em 4 grupos (n = 12): grupocontrole CTRL, WP-Whiteness Perfect 10% (FGM Produtos Odontológicos, Joinville, SC, Brasil), OPA-Opalescence 10% (Ultradent Products Inc., South Jordan, IT, EUA) e PB-Power Bleaching (BM4, Palhoça, SC, Brasil). Para o teste edemogênico, todos os ratos receberam uma injeção intravenosa de Evan's Blue; após 30 min, 0,2 mL de cada gel clareador foi injetado no tecido subcutâneo dos ratos, e os resultados da permeabilidade vascular foram avaliados após 3 e 6 horas. A quantidade de HP liberada e o pH de cada produto também foram determinados. Os dados foram submetidos ao teste estatístico (P <0,05). Resultados: Às 3h, o PB apresentou maior permeabilidade vascular que os demais grupos. Às 6h, o PB produziu permeabilidade vascular semelhante ao WHI e maior que os grupos OPA e CTRL. O grupo OPA apresentou maior permeabilidade vascular às 6h em relação às 3h; Não existe essa diferença em outros grupos. O grupo PB apresentou maiores concentrações de HP que os demais grupos. Conclusão: Em geral, o PB causou maior quantidade de edema inflamatório e maior quantidade de HP liberado. Estes resultados sugerem que estes géis branqueadores causam maior agressividade nos tecidos gengivais moles que eventualmente acabam em contato com produtos de branqueamento. (AU)

Mixing failures of endodontic sealers: an in vivo biocompatibility study / Falhas durante espatulação de cimentos endodônticos: um estudo de biocompatibilidade in vivo

Objectives: Evaluate, in vivo, the influence of mixing failures on endodontic sealers. Material and Methods: To alveolus analysis, 80 rats were divided into Sealapex® and AH Plus® groups. Within each group, the sealer was subjected to either partial (incomplete homogenization­ simulating handling failures) or total mixing (complete homogenization) over two periods of 7 and 30 days (n = 20). The maxillary incisor was extracted and a polyethylene tube containing the sealer was inserted. To quantify edema, 40 male rats were divided into four groups (n = 10). The animals received 2% Evans Blue intravenously, and either AH Plus® or Sealapex® was injected subcutaneously. The rats were euthanized after 3 or 6 hours and analyzed in a spectrophotometer (630 ƞm). To analyze the subcutaneous tissue, 20 rats received polyethylene tube implants with the sealers in the dorsal area (n=10), then euthanized after either 7 or 30 days, and inflammation was evaluated according to an inflammatory cells score. Results: In the alveolar 7-day group, control group presented an inflammation score 1, while all other groups presented a score 2, except AH plus® total mix group (3). After 30 days, all groups presented a score 1. The edemogenic test showed less edema in Sealapex® groups (p < 0.5). In subcutaneous 7-day period, all groups presented score 2. In 30 days, all groups revealed score 1, except AH Plus® partial mix group (2). Conclusion: Regarding mixing of the sealers, there were no significant differences among the groups (AU)

Objetivo: Avaliar, in vivo, a influência das falhas de espatulação de cimentos endodônticos. Material e Métodos: Para análise alveolar, 80 ratos foram divididos nos grupos Sealapex® e AH Plus®. Em cada grupo, o cimento foi espatulado de forma parcial (homogeneização incompleta, simulando falhas) ou total (homogeneização completa) em dois períodos de 7 e 30 dias (n=20). O incisivo superior foi extraído e um tubo de polietileno contendo o cimento foi inserido. Para quantificar edema, 40 ratos foram divididos em quatro grupos (n = 10). Os animais receberam Azul de Evans 2% intravenoso, e AH Plus® ou Sealapex® injetados no tecido subcutâneo. Após 3 ou 6 horas foram eutanasiados e analisados em espectrofotômetro (630 ƞm). Para analisar a resposta subcutânea, 20 ratos receberam implantes de tubo de polietileno com os cimentos na região dorsal (n = 10), eutanasiados após 7 ou 30 dias, e a inflamação foi avaliada de acordo com um escore de células inflamatórias. Resultados: Na análise alveolar em 7 dias, o grupo controle apresentou escore 1 de inflamação, enquanto que todos os outros grupos apresentaram 2, com exceção do AH plus® espatulação total (3). Após 30 dias, todos os grupos apresentaram escore 1. O teste edemogênico mostrou menor edema nos grupos Sealapex® (p < 0,5). No período subcutâneo de 7 dias, todos os grupos apresentaram escore 2. Em 30 dias, todos os grupos revelaram escore 1, exceto AH Plus® espatulação parcial (2). Conclusão: Não houve diferença estatística significante entre os cimentos quanto à espatulação. (AU)

The Dynamics of Subcutaneous Tissue Response to Microorganisms Associated with the Extract of Araçá (Psidium cattleianum): An Edemogenic and Microscopic Analysis / A Dinâmica da Resposta do Tecido Subcutâneo para Associação de Microorganismos com o Extrato de Araçá (Psidium cattleianum): Uma Análise Microscópica e Edemogênica

Objective: To evaluate in vivo tissue reaction to the extract of araçá (Psidium cattleianum) associated with inactivated microorganisms. Material and Methods: A 0.1 mL suspension was used containing Porphyromonas gingivalis, Prevotella intermedia, Fusobacterium nucleatum, Enterococcus faecalis, Peptostreptococcus micros, and Porphyromonas endodontalis, which were inactivated by heat and mixed into a 1.0 mL saline (control group), an aqueous solution, or a hydroalcoholic extract of araçá. Eighteen male rats (Rattus norvegiccus) under general anesthesia received 0.2 mL of 1% intravenous Evans blue. Thirty minutes later, 0.1 mL of one of the associations was injected into the animals' dorsal region. The animals were euthanized after 3 and 6 hours, and the materials obtained were placed in formamide for 72 hours then analyzed in a spectrophotometer (λ=630 ηm). For the morphological analysis, 30 rats received polyethylene tubes implants with the extracts or the saline with the associations in the dorsal region and euthanized after 7 and 30 days to be analyzed according to an inflammation cell score. Results: No significant difference (p>0.05) was observed in the edema among groups. The optical microscopy results showed a repair in the 30-day-period, which was higher when compared to the 7-day-period (p< 0.0001). Nevertheless, in the 7-day-period, the hydroalcoholic extract presented a significant response compared to the aqueous extract (p=0.05) and a trend for better results than the control group. Conclusion: The aqueous and hydroalcoholic araçá extracts associated with inactivated microorganisms showed similar responses to control, indicating no interference on the toxic effects of the bacterial components in tissue repair. (AU)

Objetivo: Avaliar in vivo a reação tecidual do extrato de araçá (Psidium cattleianum) associado com microorganismos inativados. Material e Métodos: Uma suspensão de 0.1mL foi usada contendo Porphyromonas gingivalis, Prevotella intermedia, Fusobacterium nucleatum, Enterococcus faecalis, Peptostreptococcus micros e Porphyromonas endodontalis dos quais foram inativos por aquecimento e misturados a 1,0 mL de soro fisiológico (grupo controle), uma solução aquosa ou hidroalcoólica de araçá. Dezoito ratos machos (Rattus norvegiccus) sob anestesia geral receberam 0,2mL de Azul de Evans a 1% intravenoso. Após trinta minutos, 0,1mL de um dos extratos (associado com microorganismos inativos) foi injetado nos animais na região dorsal. Os animais foram eutanasiados após 3 e 6 horas, e os materiais obtidos colocados em formamida por 72 horas para análise em espectrofotômetro (λ=630 ηm). Para análise morfológica, 30 ratos receberam implante subcutâneo de tubo de polietileno com as associações na região dorsal, eutanasiados após 7 e 30 dias para serem analisados de acordo com um escore de células inflamatórias. Resultados: Não houve diferença significativa (p>0,05) no edema entre os grupos. Os resultados obtidos em microscópio óptico apontaram reparo em 30 dias superior ao de 7 dias (p< 0,0001). No período de 7 dias a solução hidroalcoólica apresentou resposta superior a solução aquosa (p=0,05) e uma tendência de melhor resultado que o controle. Conclusão: A solução aquosa e hidroalcoólica de extrato de araçá associadas a microrganismos inativados apresentaram respostas biológicas semelhantes ao controle, indicando que não há interferência sobre os efeitos tóxicos advindos dos componentes bacterianos, no sentido de favorecer o reparo(AU)

Calcium hydroxide associated with a new vehicle: Psidium cattleianum leaf extracts. Tissue response evaluation

Abstract The aim of this study was to evaluate edemogenic activity and subcutaneous inflammatory reaction induced by Psidium cattleianum leaf extracts associated with Ca(OH)2. Thirty male Wistar rats, split equally into three groups [aqueous extract + Ca(OH)2; ethanolic extract + Ca(OH)2; and propylene glycol + Ca(OH)2], were assessed every 3 h or 6 h (five animals in each period). Under general anesthesia, 0.2 mL of 1% Evans blue per 100 g of body weight was injected into the penile vein and each combination to be evaluated was subcutaneously injected into the dorsal region 30 min thereafter. Edemogenic activity was analyzed by spectrophotometry (λ=630 nm). For inflammatory reaction analysis, 50 rats received four polyethylene tubes (three experimental groups) and an empty tube (control group). The assessments were made at 7, 15, 30, 60, and 90 days, followed by hematoxylin-eosin staining and by the assignment of scores for evaluation of tissue response intensity. Ethanolic extract + Ca(OH)2 yielded the largest edemogenic activity at 3 h. Intergroup differences at 6 h were not significant. The histological analysis showed progressive repair over time (p<0.05) and aqueous and ethanolic extracts produced similar responses to those of the control and Ca(OH)2 + propylene glycol groups. Psidium cattleianum leaf extracts used as Ca(OH)2 vehicles evoked similar tissue response when compared to Ca(OH)2 associated with propylene glycol.

Biocompatibility and biomineralization assessment of bioceramic-, epoxy-, and calcium hydroxide-based sealers

Abstract Obturation of the root canal system aims to fill empty spaces, promoting hermetic sealing and preventing bacterial activity in periapical tissues. This should provide optimal conditions for repair, stimulating the process of biomineralization. An endodontic sealer should be biocompatible once it is in direct contact with periapical tissues. The aim of this study was to evaluate the rat subcutaneous tissue response to implanted polyethylene tubes filled with Smartpaste Bio, Acroseal, and Sealapex and investigate mineralization ability of these endodontic sealers. Forty Wistar rats were assigned to the three sealers groups and control group, (n = 10 animals/group) and received subcutaneous implants containing the test sealers, and the control group were implanted with empty tubes. After days 7, 15, 30, and 60, animals were euthanized and polyethylene tubes were removed with the surrounding tissues. Inflammatory infiltrate and thickness of the fibrous capsule were histologically evaluated. Mineralization was analyzed by Von Kossa staining and polarized light. Data were tabulated and analyzed via Kruskal-Wallis and Dunn's test. All tested materials induced a moderate inflammatory reaction in the initial periods. Smartpaste Bio induced the mildest inflammatory reactions after day 15. No difference was observed among groups after days 30 or 60. Von Kossa-positive staining and birefringent structures observed under polarized light revealed a larger mineralization area in Sealapex-treated animals followed by Smartpaste Bio-treated animals. At the end of the experiment, all tested sealers were found to be biocompatible. All sealers induced biomineralization, except Acroseal, which induced a mild tissue reaction.

Avaliação da resposta tecidual e capacidade de mineralização de cimentos que contém compostos biocerâmicos, resinosos e com hidróxido de cálcio / Biocompatibility and biomineralization assessment of bioceramic, epoxy- resin based and calcium hydroxide root canal sealers

A obturação ideal é uma combinação de um cimento com um material sólido, geralmente guta percha, que corrobora com o escoamento do cimento fluido, espalhando-o e preenchendo possíveis espaços vazios. Em virtude da possibilidade de contato direto com os tecidos periapicais, estes cimentos devem ser biocompatíveis e, se possível, estimular a mineralização para proporcionar selamento apical. Com o objetivo de avaliar, in vivo, a resposta tecidual e a capacidade de mineralização dos cimentos endodônticos Smartpaste® Bio, Sealapex® e Acroseal®, foi realizado implante subcutâneo em 40 ratos Wistar e adotados os períodos experimentais de 7, 15, 30 e 60 dias (10 animais por período de tempo). Cada animal recebeu quatro implantes, três tubos de polietileno com os cimentos a serem testados e um tubo vazio como controle. Após cada período pós-operatório, os animais foram eutanasiados e os tubos de polietileno, juntamente com o tecido circunjacente foram removidos e fixados. Para a análise histológica da espessura da cápsula fibrosa, infiltrado inflamatório e mineralização as peças foram incluídas em historresina, e coradas em HE, Von Kossa ou permaneceram sem coloração para a luz polarizada. Os resultados foram submetidos ao teste de Kruskal Wallis e Dunn (p<0,05). Resultados: Todos os cimentos produziram reação inflamatória moderada nos períodos iniciais. O Smartpaste Bio® apresentou a menor reação inflamatória aos 15 dias (p<0,05). O Sealapex® induziu maior mineralização, seguido do Smartpaste Bio®. O Acroseal® não apresentou indução de mineralização. Conclusão: Ao final do experimento, todos os cimentos testados apresentaram compatibilidade tecidual. Com exceção do Acroseal, todos induziram mineralização.

The cleaning and shaping of root canals is essential to achieve biological and mechanical goals in the endodontic treatment, providing the appropriate conical shape for subsequent obturation. The optimal obturation is a combination of a sealer with a central core, usually gutta percha, spreading and filling possible gaps. Once there is a direct contact with periapical tissue, the sealer should be biocompatible and, if possible, stimulate mineralization to perform an apical sealing. In order to evaluate in vivo biological response and tissue mineralization capacity of the endodontic sealers Smartpaste Bio® Sealapex® and Acroseal®, subcutaneous implants in 40 Wistar rats were performed. Analisys were at 7, 15, 30 and 60 days experimental periods (10 animals for each time period). Each animal received four implants, three polyethylene tubes with the sealers in test and one empty tube as control. After each post-operative period animals were euthanized and the polyethylene tubes, along with surrounding tissue were removed and fixed. In order to histologically analysis fibrous capsule thickness, inflammatory infiltrate and mineralization, the pieces were included in historesin and stained in HE, Von Kossa or remained without staining for observation under polarized light. The results were statistically analyzed by Kruskal-Wallis and Dunn (p<0,05). Results: All sealers promoted moderate inflammatory reaction at initial periods. Smartpaste Bio® presented the lowest inflammatory reaction at 15 days period (p<0.05). Sealapex® induced higher mineralization, followed by Smartpaste Bio®. Acroseal® showed no mineralization areas. Conclusion: At the end of the experiment, all tested sealers presented biocompatibility. With exception of Acroseal, all induced biomineralization.