ARE CALCIUM SILICATE SEALERS LESS CYTOTOXIC AND GENOTOXIC THAN EPOXY RESIN SEALERS? A SYSTEMATIC REVIEW OF IN VITRO STUDIES

Aims: This systematic review aimed to evaluate whether calcium silicate-based sealers are less cytotoxicity and genotoxicity than epoxy resin-based sealers. Materials and Methods: Systematic searches were conducted for studies published up to September 27th, 2022, without restriction for language or year of publication, in the following databases: MEDLINE/PubMed, Scopus, Web of Science and Grey Literature Report. Only in vitrostudies that evaluated the cytotoxicity or genotoxicity of calcium silicate and epoxy resin-based sealers were included. The quality assessment was performed. Results: After duplicate removal and eligibility criteria assessment, a total of thirty-four studies were included. Twenty-eight studies had a low risk of bias, and six studies had amoderate risk of bias. In general, calcium silicate-based sealers had a lower cytotoxic and genotoxic potential than epoxy-resin based sealers.Conclusions: Based on the findings from in vitrostudies, calcium silicate-based sealers are less cytotoxic andgenotoxic than epoxy resin-based sealers

POSTOPERATIVE PAIN INCIDENCE AND INTENSITY FOLLOWING ROOT CANAL OBTURATION WITH BIOCERAMIC AND OTHER SEALERS: A SYSTEMATIC REVIEW WITH META-ANALYSIS

Aims: To investigate whether bioceramicsealers induce a lower incidence and intensity of postoperative pain compared to other sealers. Materials and Methods: Six electronic databases were searched for studies published up to April 2022, following the PICOS strategy: (P) adult patients undergoing root canal treatment or retreatment; (I) root canal filling using bioceramic sealer; (C) root canal filling using other types of sealers; (O) Primary: postoperative pain incidence and/or intensity; Secondary: number of medication intake; (S) randomizedclinical trials. Risk of bias assessment was performed with the revised Cochrane risk of bias tools for randomized trials (RoB 2). Overall certainty of evidence was assessed through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. Results: Ten studies were included. Eight studies had a low risk of bias, and two had some concerns risk. Meta-analyses showed no differences regarding postoperative pain intensity and incidence between bioceramic sealers and AH Plus. Number of medication intake seemed to be associated to the preoperative diagnosis. Zinc oxide-eugenol sealer demonstrated an intense postoperative pain compared to bioceramic sealers and AH Plus. GRADE analysis showed a low certainty of evidence for all outcomes. Conclusions: There seem to be no differences between bioceramic sealers and AH Plus regarding postoperative pain intensity and incidence. Number of medication intake seem to be associated to the preoperative diagnosis. Zinc oxide-eugenol evoked a more pronounced postoperative pain.

Does the ultrasonic activation of calcium silicate-based sealers affect their physicochemical properties?

Abstract This study aimed to evaluate the influence of ultrasonic activation (UA) on the physicochemical properties of hydraulic calcium silicate-based sealers. Nine experimental conditions were created based on the hydraulic calcium silicate-based sealers (Bio-C Sealer, Sealer Plus BC and Bio Root RCS) and the ultrasonic activation (no activation [NA], 10 seconds, and 20 seconds). Then the experimental groups were BC-NA, BC-10, BC-20, SPBC-NA, SPBC-10, SPBC-20, BR-NA, BR-10, and BR-20. Activation was performed with an ultrasonic insert 20/.01. The mold for the physicochemical analysis was filled and evaluated according to the ANSI/ADA specification nº. 57: initial and final setting time, flow, radiopacity and solubility. Tests were also performed to evaluate pH and calcium ion release with experimental periods of 1, 24, 72, and 168 hours with a pH meter and colorimetric spectrophotometer. Data were analyzed by one-way analysis of variance and post-hoc Tukey tests. The significance level was set at 5%. The time of UA progressively delayed the initial setting time for all hydraulic calcium silicate-based sealers (p < 0.05). Twenty seconds of UA increased the mean flow values of Sealer Plus BC and Bio-C Sealer compared to NA (p < 0.05). UA did not influence the radiopacity and solubility of the tested sealers (p > 0.05). UA for 20 seconds enhanced the pH levels and the calcium ion release of Sealer Plus BC and Bio-C Sealer at 168h (p < 0.05). UA for twenty seconds interferes with some physicochemical properties of hydraulic calcium silicate-based sealers.

Resumo Este estudo teve como objetivo avaliar a influência da ativação ultrassônica nas propriedades físico-químicas de cimentos de silicato de cálcio. Nove condições experimentais foram criadas com base nos cimentos de silicato de cálcio (Bio-C Sealer, Sealer Plus BC e Bio Root RCS) e na ativação ultrassônica (sem ativação [SA], 10 segundos e 20 segundos). Os grupos experimentais foram BC-SA, BC-10, BC-20, SPBC-SA, SPBC-10, SPBC-20, BR-SA, BR-10 e BR-20. A ativação foi realizada com um inserto ultrassônico 20/.01. O molde para a análise físico-química foi preenchido e avaliado de acordo com a especificação ANSI/ADA nº. 57: tempo de presa inicial e final, escoamento, radiopacidade e solubilidade. Também foram realizados testes para avaliação de pH e liberação de íons cálcio com períodos experimentais de 1, 24, 72 e 168 horas com pHmetro e espectrofotômetro colorimétrico. Os dados foram analisados por análise de variância one-way e testes post-hoc de Tukey. O nível de significância foi estabelecido em 5%. O tempo de AU aumentou progressivamente o tempo de presa inicial para todos os cimentos de silicato de cálcio (p < 0,05). Vinte segundos de AU aumentaram os valores médios de escoamento de Sealer Plus BC e Bio-C Sealer em comparação com SA (P < 0,05). A AU não influenciou a radiopacidade e a solubilidade dos cimentos testados (P > 0,05). AU por 20 segundos aumentou os níveis de pH e a liberação de íons cálcio de Sealer Plus BC e Bio-C Sealer em 168h (P < 0,05). AU por vinte segundos interfere em algumas propriedades físico-químicas dos cimentos de silicato de cálcio.

Assessment of quality of life in total edentulous patients rehabilitated with implants and fixed prosthesis

Aim: Tooth loss is very prevalent in Brazil, reflecting high demand for dental services, especially those related to oral rehabilitation. This study aimed to assess the quality of life in total edentulous patients rehabilitated with implants and fixed prosthesis. Methods: Thirty-two patients were evaluated before and after rehabilitation with dental implants and fixed prosthesis using the OHIP-14 questionnaire and the Visual Analogue Scale (VAS) after 6 months follow-up. Results:OHIP-14 revealed a significant improvement after treatment in all seven parameters and in the global score (P < 0.001). VAS presented positive results related to patient satisfaction regarding oral rehabilitation, except for the hygiene of the fixed dentures. Conclusion: At the end of this study, OHIP-14 scores decreased by 50% in most of the questions raised, and VAS presented positive results, except for hygiene of the fixed dentures, presenting an improvement in the quality of life of total edentulous patients after rehabilitation with implants and fixed prosthesis

Evaluation of the dentinal tubule penetration of an endodontic bioceramic sealer after three final irrigation protocols

Introduction: This study aimed to evaluate the dentinal tubule penetration of an endodontic bioceramic sealer, Sealer Plus BC, after three final irrigation protocols. Methods: Thirty distobuccal roots of maxillary molars were selected. Root canal preparation was performed up to an #40.06 instrument (X1 Blue) under 2.5% sodium hypochlorite irrigation. Specimens were randomly divided into three groups (n=10), according to the final irrigation protocol: G-NaOCl (2.5% sodium hypochlorite + PUI), G-SS (0.9% saline solution + PUI) and G-H20 (Deionized water + PUI). After final irrigation protocols, all specimens were irrigated with phosphate buffer solution. Root canal obturation was performed using the single cone technique and Sealer Plus BC, stained with a specific fluorophore. Specimens were transversely sectioned and each root third was evaluated in a confocal scanning laser microscopy. Images obtained were analyzed for sealer penetration in the dentinal tubules. Results: Dentinal tubule penetration of Sealer Plus BC was not observed in any root third, regardless of the final irrigation protocol investigated. Conclusions: Sealer Plus BC dentinal tubule penetration was not observed after none of the protocols tested. Dentinal tubule penetrability of Sealer Plus BC may be related to other factors rather than the final irrigation protocol.

Successful revascularization procedure in an immature permanent necrotic second lower molar: a case report with 4. 5- years follow- up

Background: Infection control is mandatory for revascularization procedures, enabling to eliminate patient's clinical symptoms and signs. Despite presenting a complex morphology when compared to anterior teeth, if a strict disinfection protocol is adopted and the revascularization procedure's biological principles are followed, the therapy can be successful in molar teeth. Methods: This case report aims to present a clinical case of successful revascularization in an immature permanent necrotic second lower molar. Clinical decisions and explanations regarding possible mechanisms related to the treatment's success in a tooth with complex morphology are discussed. Results: Revascularization procedures were performed on a 12-year-old male patient diagnosed with symptomatic periapical periodontitis in a tooth 37. The case highlights the need for infection control and biological principles that surrounds the success of this therapy. Follow-up times presented in this case were six months, 1, 2, 4 and 4.5-years, respectively. Continued root development was observed, and the tooth remains intact and without symptoms. Conclusion: The association of infection control and the biological principles of revascularization procedures allow the maintenance and continuation of tooth development, even when these present complex morphologies.

Evaluation of the impact of pain from dental urgencies on the patients' oral health- related quality of life: a cross- sectional study

Background. This cross-sectional study aimed to evaluate the impact of pain from dental urgencies on the oral health-related quality of life (OHRQoL). Methods. A sample of sixty-eight patients seeking urgent attention to a primary health unit were included. Clinical diagnosis and sociodemographic data were assessed, dental pain measured by visual analog scale (VAS) and numerical pain rating scale (NPRS). The Oral Health Impact Profile-14 (OHIP-14) instrument was used to measure the OHRQoL. Associations were analyzed using the Student t-test, except for types of urgencies, that were evaluated with one-way analysis of variance (ANOVA) test. Results. The most prevalent urgency type was of endodontic origin (81%). There was no difference between pain and other variables. The type of tooth showed significant differences in OHIP-14 scores. Conclusion. Dental urgencies were associated with a high level of pain and impacted negatively on the patients' OHRQoL. The type of tooth had a positive association the OHRQoL measures.