Quando um remanescente de guta-percha é decisivo na identificação humana: relato de caso pericial / When gutta-percha residual is decisive in human identification: case report

A Odontologia Legal é a especialidade responsável por esclarecer demandas administrativas ou judiciais provenientes de diferentes esferas. Na esfera criminal, o processo de identificação humana engloba um conjunto de procedimentos que visam individualizar uma pessoa e, em diversas situações, a Odontologia Legal se destaca como um importante método de identificação humana. O objetivo desse trabalho foi apresentar um relato de caso em que a presença de um remanescente de guta-percha foi decisiva no processo de identificação humana. Após exame necroscópico em um cadáver e com a entrega do prontuário odontológico, foi realizada a comparação das informações recebidas do suspeito com aquelas coletadas no exame post mortem. Por meio dessa comparação, verificou-se que havia pontos coincidentes que permitiram que a identificação positiva da vítima fosse estabelecida, especialmente a presença, tanto no exame ante mortem quanto no post mortem, de um remanescente de guta-percha envolto por tecido cicatricial ósseo na região do dente 21. Os materiais dentários utilizados em procedimentos odontológicos, tais como o remanescente de guta-percha neste relato de caso pericial, são extremamente valiosos no processo de identificação humana

Forensic Dentistry is the specialty responsible for clarifying administrative or judicial demands from different spheres. In the criminal sphere, the human identification process encompasses a set of procedures that aim to individualize a person and, in several situations, and Forensic Dentistry stands out as an important method in human identification. The objective was to present a case report in which the presence of a gutta-percha remnant was important in the human identification process. After necroscopic examination and delivery of the dental records, the information received from the suspect was compared with that collected in the post mortem examination. Through this comparison, it was verified that there were coincident points that allowed the positive identification of the victim, especially the presence, both in the ante-mortem and in the post-mortem examination, of a gutta-percha remnant surrounded by bone scar tissue in the tooth region 21. Materials used in dental procedures, such as the gutta-percha remnant in this forensic case report, are extremely valuable in the human identification process

Ability of two reciprocating Nickel-Titanium instruments for guttapercha/ sealer removal in simulated curved root canals / Análisis de la capacidad de dos instrumentos reciprocantes de Niquel-Titanio para la remoción de gutapercha/sellador en conductos curvos simulados

ABSTRACT The aim of this study was to compare the capacity of two reciprocating NiTi instruments in removing gutta-percha/sealer material from simulated curved root canals (SCRC). The time required for filling material removal was also recorded. Twenty SCRCs were divided into two groups of 10 (n=10) samples each. In Group 1, the SCRC were prepared to a R25 Reciproc Blue instrument (RCPB; VDW, Munich, Germany). In Group 2 the SCRC were prepared to a Primary WaveOne Gold instrument (PWOG; Dentsply, Ballaigues, Switzerland). In both groups, the canals were filled with matched-taper single gutta-percha cones and AH Plus sealer. Filling materials were removed with R25 RCPB (Group 1) and PWOG (Group 2). The amount of remaining gutta-percha/sealer was calculated at three predetermined levels of evaluation located at 2, 6 and 10 mm from the WL and expressed in percentages. Canals re-treated with RCPB contained significantly less remaining gutta-percha/sealer compared to canals prepared with PWOG (P=0.02). The RCPB instruments required significantly less time to complete the retreatment procedures (P<0.01). No unwinding or instrument separation was noted. RCPB instruments removed significantly more gutta-percha/sealer from simulated curved root canals than PWOG. However, neither of the tested instruments completely removed all filling materials.

RESUMEN El propósito del presente estudio fue comparar la capacidad de dos instrumentos de NiTi de movimiento reciproco para remover la obturación de gutapercha/sellador durante el retratamiento de conductos curvos simulados (SCRC). El tiempo requerido para la remoción del material fue también registrado. Se utilizaron veinte (n=20) SCRC divididos en dos grupos de diez especimenes (n=10) cada uno. En el Grupo 1 los SCRC se prepararon hasta un instrumento Reciproc Blue R25 (RCPB; VDW, Munich, Germany). En el Grupo 2, los SCRC se prepararon hasta un instrumento WaveOne Gold Primary (PWOG; Dentsply, Ballaigues, Switzerland). En ambos grupos los conductos se obturaron con cono único de gutapercha de conicidad creciente y el sellador AH Plus. La remoción de los materiales de obturación se realizó mediante los instrumentos RCPB R25 (Grupo 1) o PWOG (Grupo 2). La cantidad de gutapercha/sellador remanente se calculó en tres niveles de evaluación predeterminados ubicados a 2, 6 y 10 mm de la LT, y finalmente fue expresada en porcentajes. La cantidad de gutapercha/ sellador remanente en los SCRC retratados con RCPB fue significativamente menor en comparación con los que fueron retratados con PWOG (P=0.02). Los instrumentos RCPB requirieron un tiempo significativamente menor para completar el retratamiento (P<0.01). No se observaron deformaciones o separación de los instrumentos. Los instrumentos RCPB removieron una cantidad significativamente mayor de gutapercha/sellador que los instrumentos PWOG en conductos curvos simulados. Sin embargo, ninguno de los instrumentos ensayados removió completamente los materiales de obturación.

Effectiveness of disinfecting substances of gutta-percha cones / Efetividade de agentes desinfectantes de cones de guta percha

Aim:To demonstrate the effectiveness of disinfecting substances with 2% and 5% Sodium Hypochlorite and 2% Chlorhexidine Gluconate at each of the pre-established times of 0:15 and 0:30 seconds, and 1, 2, 5, and 10 minutes. Methods: This study selected 96 gutta-percha cones that were contaminated with Enterococcus Faecalis, dried and treated with the aforementioned substances and applied at pre-established times. Subsequently, these were transferred to sterile Brain Heart Infusion broth and placed in a bacteriological incubator at 37°C for 24 hours to evaluate microbial growth, as well as in a nutrient agar medium in Petri dishes. Half of the cone was transferred to individual filter paper packages and exposed to the environment in a dental clinic at Universidade José do Rosário Velano, for 7 days, with subsequent evaluation for microbial growth. The bacterial phenotype test was performed using Gram stain and growth in 6.5% saline solution. The results were submitted to statistical analysis using the Kruskal Wallis H test, with a significance level of 5%. Results:The substances were effective at all times tested and individual storage supported disinfection. In the statistics test, the p-value was greater than 0.05, as there was no variability in the data configurations. Conclusion: The disinfection of gutta-percha cones and individual storage was an effective protocol to be adopted with 2% and 5% Sodium Hypochlorite and 2% Chlorhexidine.

Objetivo: Demonstrar a eficácia de substâncias desinfetantes, Hipoclorito de Sódio a 2% e 5% e Gluconato de Clorexidina 2% em cada um dos tempos pré-estabelecidos de 15 e 30 segundos, e 1,2, 5 e 10 minutos.Métodos: Este estudo selecionou 96 cones de guta-percha,contaminados com Enterococcus Faecalis, secos e tratados com as substâncias citadas e aplicadas em tempos pré-estabelecidos. Posteriormente, estes foram transferidos para tubos contendo caldo Infusão Cérebro Coração estéril e colocados estufa bacteriológica a 37°C por 24 horas para avaliar o crescimento microbiano, também verificado em meio ágar nutriente em Placas de Petri. Metade dos cones foram transferidos para embalagens individuais de papel de filtro, e expostas ao ambiente da clínica odontológica da Universidade José do Rosário Velano por 7 dias, com posterior avaliação do crescimento microbiano. O teste do fenótipo bacteriano foi realizado pela coloração de Gram e crescimento em solução salina a 6,5%. Os resultados foram submetidos à análise estatística por meio do Teste H de Kruskal Wallis, com nível de significância de 5%.Resultados: As substâncias foram eficazes em todos os tempos testados e o armazenamento individual favoreceu a desinfecção. No teste estatístico, o valor de p foi maior que 0,05, pois não houve variabilidade nas configurações dos dados.Conclusão: A desinfecção dos cones com Hipoclorito de Sódio 2% e 5% e Clorexidina 2% a partir de 15 segundos, e o armazenamento individual foram protocolos eficazes para serem adotados.

Application of cold flowable gutta-percha in root canal obturation after apexification / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the clinical effect of root canal obturation therapy using cold flowable gutta-percha on young permanent teeth after apexification.@*METHODS@#Ninety cases of young permanent teeth with pulp necrosis or periapical periodontitis treated by apexification were randomly divided into two groups. The cases in each group were divided into single root canal and multiple root canal according to the number of the root canal, and divided into classifications Ⅰ, and Ⅱ/Ⅲ/Ⅳ according to Frank's classification of root development after apexification. Cold flowable gutta-percha and warm gutta-percha obturation techniques were used for root canal obturation of the two groups. The operation time was recorded, and the patients' therapy pain degree was evaluated by visual analog scale (VAS) immediately after operation. Periapical X-ray was performed after operation to evaluate the effect of the root canal filling. The total length of the root was divided into equal three parts on the X-ray film, and three-dimensional tightness of the apical, middle, and coronal region of the root canals were statistically analyzed respectively. Clinical examinations and X-ray examination were performed 6 and 12 months after the operation to evaluate the treatment success rate.@*RESULTS@#The operation time of cold flowable gutta-percha group was significantly lower than that of the control group, which were 51 s and 74 s (P < 0.05); The percentages of pain and discomfort in the two groups were 26.67% and 40.00%, respectively. There were two cases of underfilling and no overfilling in both groups. The percentages of proper filling and tight three-dimensional obturation in the experimental and control groups were 71.11% and 60.00% respectively; and the percentages of tight three-dimensional obturation in the apical third areas were 86.67% and 66.67%, the difference was significant (P < 0.05). There was no significant difference in the three-dimensional tightness between the two groups in the middle and coronal third areas. The percentages of tight three-dimensional obturation in classification Ⅰ groups were 86.67%, 83.33%, 93.33% and 76.67%, 90.00%, 96.67% in experimental and control group, respectively; The percentages of classification Ⅱ/Ⅲ/Ⅳ groups were 86.67%, 86.67%, 100.00% and 46.67%, 86.67%, 100.00%, respectively, and the difference was significant (P < 0.05). There were no apical lesions that occurred in either group during the one-year review period.@*CONCLUSION@#The application of cold flowable gutta-percha on young permanent teeth root canal obturation after apexification can achieve good obturation effect. The root obturation effect in the apical third area is significantly better than that of warm gutta-percha obturation techniques. Cold flowable gutta-percha can shorten the clinical treatment time and ameliorate the patients' therapy comfort.

Cones de guta-percha: propriedades para a clínica endodôntica atual / Gutta-percha cones: properties for current endodontic practice

Objetivo: O objetivo do presente estudo é revisar a literatura sobre os tipos de guta-percha para obturação, as suas formas de apresentação e as características físico-químicas e biológicas do material. Métodos: Artigos publicados entre 1973 e 2016 foram selecionados nas bases de dados PubMed e Science Direct. Foram utilizados como descritores na língua inglesa "gutta-percha and obturation"; "cones of gutta-percha" e "obturation cones and endodontic". Revisão: A guta-percha é um material de origem orgânica que pode ser encontrado em duas formas cristalinas. Encontra-se, geralmente, na forma de cones compostos de guta-percha associada a outras substâncias. A guta-percha é considerada inerte e biocompatível, porque causa pouca reação alérgica e possui biodegradação lenta. Pode sofrer alterações físico-químicas quando utilizada em técnicas de termo-obturação, nas quais as altas temperaturas aceleram a sua degradação, comprometendo a sua função. Além disso, a sua degrada- ção precoce é também afetada pela presença ou ausência de lesões periapicais. Conclusão: Os cones de guta-percha ainda são considerados o material mais adequado e acessível para o preenchimento de canais radiculares (AU).

Objective: The objective of this study was to identify the types of gutta-percha for obturation and their forms of presentation, as well as physical-chemical and biological characteristics of the material. Materials and Methods: Articles were selected from the PubMed and Science Direct databases, published between 1973 and 2016. Were used as descriptors: "gutta-percha and obturation"; "cones of gutta-percha" and "obturation cones and endodontic". Review: Gutta-percha is a material of organic origin, which can be found in two crystalline forms. It is usually found in the form of cones composed of gutta-percha associated with other substances. Gutta-percha is considered inert and biocompatible, because it causes little allergic reaction and slow biodegradation. It can suffer physical-chemical changes when used in thermo-obturation techniques, where the high temperatures accelerate its degradation, compromising its function. In addition, its early degradation is also affected by the presence or absence of periapical lesions. Conclusion: Gutta-percha Cones are still considered the most suitable and accessible material for root canal filling

Capacidad de sellado de los conductos laterales con distintas técnicas de obturación del conducto radicular / Sealing capacity of lateral canals with different root canal obturation techniques

Objetivo: Estimar y comparar la eficacia de diferentes técnicas de obturación para impedir el flujo de colorante a través de los conductos laterales. Materiales y métodos: Se emplearon 50 premolares inferiores extraídos y conservados en formol neutro al 5% hasta el momento de su uso, a los cuales se les realizaron conductos laterales artificiales. Una vez instrumentados los conductos principales, los dientes fueron divididos al azar en 5 grupos (n=10) para ser obturados con cuatro técnicas distintas: A) System B + inyección de gutapercha termoplástica del sistema Elements, Extruder; B) obturadores de Thermafil, ProTaper Universal; C) técnica híbrida y D) obturación con inyección de gutapercha termoplástica del sistema Elements, Extruder. Inmersos en tinta china y diafanizadas las raíces, se evaluó la longitud de penetración de la tinta en los conductos laterales. Se empleó el análisis de la varianza para detectar diferencias significativas (P<0,05) entre los niveles medios de penetración del colorante según las técnicas de obturación y las zonas del diente, y se efectuaron pruebas de rango múltiple (HSD de Tukey) para realizar comparaciones dos a dos, manteniendo fija la tasa de error por familia. Resultados: A la técnica B le correspondió el valor medio más bajo (30,63%) de penetración de tinta china. Los valores medios más elevados (54,52% y 51,74%) correspondieron a las técnicas A y C, respectivamente. Conclusión: Ninguna de las técnicas de obturación del conducto radicular empleadas ha sido capaz de impedir la filtración del colorante en los conductos laterales (AU)

Aim: To estimate and compare the different obturation techniques to avoid the flow of colorant through lateral canals. Materials and methods: 50 extracted lower premolars preserved in 5% neutral formol until the moment of use, had artificial lateral canals made. Once canals were instrumented, the teeth were randomly divided into 5 groups (n=10) to be filled with four different techniques: A) System B + injection of thermoplastic gutta-percha, Elements system, Extruder; B) Thermafil, ProTaper Universal obturators; C) hybrid technique, and D) injection of thermoplastic gutta-percha, Elements system, Extruder. Having immersed the premolars in India ink and diaphanized the roots, the penetration length of the India ink inside the canals was assessed. Analysis of variance was used to detect significant differences (P<0.05) between the mean levels of dye penetration according to the filling techniques and tooth areas, and multiple range tests (Tukey's HSD) were performed for two-to-two comparisons, keeping the error rate per family fixed. Results: Technique B had the lowest mean value (30.63%) of penetration. The highest mean values (54.52% and 51.74%) corresponded to techniques A and C, respectively. Conclusion: No obturation technique of the root canal used was able to avoid filtration of colourant in the lateral canals (AU)

Estudio tridimensional de reabsorciones internas obturadas con gutapercha inyectable o cono único de gutapercha más sellador biocerámico / Three-dimensional study of internal resorptions obturated with injected gutta-percha or single guttapercha cone and bioceramic sealer

Objetivo: Evaluar ex vivo, mediante reconstrucción tridimensional con tomografía computarizada de haz cónico, la presencia de vacíos, el volumen y la adaptación de la obturación a las paredes de conductos con reabsorciones dentinarias internas simuladas empleando gutapercha inyectable o cono único de gutapercha más sellador biocerámico. Materiales y métodos: Se utilizaron 10 incisivos centrales superiores humanos extraídos, en cada uno de los cuales se talló una reabsorción artificial para su obturación. La muestra fue sometida, de manera sucesiva, a dos condiciones experimentales diferentes: grupo 1, gutapercha inyectable con sistema EQ-V Master; grupo 2, cono de gutapercha más sellador biocerámico BioRoot RCS. Luego, se realizaron tomografías computarizadas de haz cónico y se hizo el estudio tridimensional. A continuación, se utilizó un programa para identificar los vacíos en la obturación y analizar cuantitativamente el volumen y la superficie cubierta por la obturación en los tercios coronario, medio (ampolla) y apical. Los datos fueron evaluados con la prueba de Wilcoxon (P<0,05). Resultados: El volumen de obturación y la superficie dentinaria en contacto con la obturación fueron similares para las dos técnicas empleadas. Las diferencias entre ambos grupos no fueron estadísticamente significativas (P>0,05). Conclusión: Aunque se observaron vacíos con ambas técnicas (en contacto con la superficie dentinaria cuando se empleó gutapercha inyectable, y en el interior de la obturación cuando se usó cono único de gutapercha más sellador BioRoot RCS), las dos rellenaron adecuadamente las reabsorciones simuladas (AU)

Aim: Ex vivo, tridimensional evaluation with cone beam computed tomography (CBCT), of the presence of voids, the obturation volume and adaption to the root canal walls with simulated internal root resorption, using injected gutta-percha or bioceramic sealer with single gutta-percha cone. Materials and methods: Ten maxillary extracted central human incisors were used and artificial internal root resorption was created in each one. For the root canal obturation, each tooth was subjected to two different experimental conditions successively, conforming two matched groups: Group I: EQ-V Master injected thermo plasticized gutta-percha system. Group II: gutta- percha point plus BioRoot RCS bioceramic sealer. First, the root canals were filled with injected gutta-percha and then, with the bioceramic sealer. Then the teeth were scanned with CBCT and subsequently a digital three-dimensional reconstruction was performed. The presence of voids, obturation volumne and the dentin wall surface covered by the filling material was quantitative analyzed through a software; at the coronal, middle (blister) and apical thirds. The data was analyzed by using Wilcoxon test (P<0.05). Results: The filling material volume and the dentin wall surface covered by it, was similar in both root canal obturation techniques. There was no significant difference between both groups (P>0.05). Conclusion: Although voids were observed in both groups (when the injected thermo plasticized gutta-percha system was used the voids were at the external surface and when BioRoot RCS + gutta-percha cone was used the voids were into the filling material), the obturation of simulated root canal resorption cavities was similar with both obturation techniques (AU)

Análisis comparativo de la contaminación en barras de gutapercha / Comparative analysis of gutta-percha bar contamination

Se realizó una investigación analítica realizada in vitro en el laboratorio general del Hospital "Carlos Andrade Marín". La población estuvo compuesta por 20 barras de gutapercha marca Meta®Biomed (Korea), distribuidas en cuatro grupos compuestos por 5 barras atendiendo a características preestablecidas en cuanto a realización de termoplastificación y manipulación. Solo el 15% de las muestras se registró indicios de crecimiento bacteriano, de las que el 66,67% pertenecieron al grupo de barras sólidas de gutapercha que fueron manipuladas, estableciéndose diferencias significativas con respecto al resto de los grupos (p≤0.01), según la prueba de T-stu-dents. La mayoría de las muestras no mostró indicios de crecimiento bacteriano. Sin embargo, dos de las tres muestras que manifestaron esa actividad microbiológica pertenecieron al grupo de las barras sólidas de gutapercha que fueron manipuladas.

An in vitro analytical research was carried out in the general laboratory of the "Carlos Andrade Marín" Hospital. The population consisted of 20 bars of Meta®Biomed brand gutta-percha (Korea) distributed in four groups made up of 5 bars according to the pre-established characteristics in terms of thermoplasticization and handling. Only 15% of the selected samples showed signs of bacterial growth, of which 66.67% belonged to the group of solid gutta-percha bars that were manipulated, establishing specific differences with respect to the rest of the groups (p≤0.01), according to the T-students test. Most of the samples have no evidence of bacterial growth. However, two of the three samples that showed this microbiological activity belonged to the group of solid gutta-percha bars that were manipulated

Decontamination of Gutta-percha Cones employed in Endodontics / Descontaminação de cones de guta-percha empregados em endodontia

ABSTRACT The guttapercha cones used in endodontic treatment are produced in aseptic conditions and their composition includes zinc oxide, which is responsible for antibacterial activity. However, there is the possibility of microbial contamination by manipulation, aerosol or during storage. Although several chemical agents have been tested for their decontamination, there is no consensus on the best disinfection protocol to be used. The aim of this study was to evaluate the decontamination of guttapercha cones contaminated with the bacteria Enterococcus faecalis, by using chlorhexidine digluconate (CHX) and sodium hypochlorite (NaClO) at different concentrations for short exposure times. For this purpose, guttapercha cones (size 40) were selected at random from a sealed box and immersed for 1 min in a microbial suspension. Then they were immersed in specific Petri dishes for different groups containing: CHX 2%, NaClO 1% or NaClO 2.5% for 30 s or 1 min, and subsequently placed in tubes containing BHI broth. After incubating the tubes for 48 h, it was observed that 1% and 2.5% NaClO and 2% CHX were effective for decontaminating the cones at those exposure time intervals. Microbial growth was detected in one of the replicates of the group with CHX applied for 30 s. To prevent the possibility of failures at this stage, the exposure time of guttapercha cones to the decontaminating agent should not be reduced.

RESUMO Os cones de gutapercha utilizados no tratamento endodôntico são produzidos em condições assépticas e possuem óxido de zinco em sua composição, responsável pela atividade antibac te riana. No entanto, existe a possibilidade de contaminação microbiana por manipulação, aerossol ou seu armazenamento. Embora vários agentes químicos já tenham sido testados para sua descontaminação, não há consenso sobre o melhor proto colo de desinfecção a ser usado. Nosso objetivo foi avaliar a descontaminação de cones de gutapercha contaminados com a bactéria Enterococcus faecalis, utilizando digluconato de clorexidina (CHX) e hipoclorito de sódio (NaClO) em diferentes concentrações e tempos de exposição curtos. Para esse fim, 40 cones de gutapercha foram selecionados aleatoriamente, de uma caixa selada e imersos por 1 min em uma suspensão microbiana. Em seguida, foram imersos em placas de Petri específicas para diferentes grupos contendo: CHX 2%, NaClO 1% ou 2,5%, nos tempos de exposição de 30s e 1min e subseqüentemente imersos em tubos contendo caldo BHI. Após incubação dos tubos por 48 h, observouse que NaClO 1% e 2,5% e CHX 2% foram eficazes para a descontaminação dos cones nesses intervalos de tempo de exposição. Em uma das réplicas do grupo com CHX aplicado por 30s foi detectado crescimento microbiano. O tempo de exposição dos cones de gutapercha ao agente de desconta minação não deve ser reduzido para evitar a possibilidade de falhas nesse estágio.

Magnitude of beam-hardening artifacts produced by gutta-percha and metal posts on cone-beam computed tomography with varying tube current

PURPOSE: This study was performed to evaluate the magnitude of artifacts produced by gutta-percha and metal posts on cone-beam computed tomography (CBCT) scans obtained with different tube currents and with or without metal artifact reduction (MAR).MATERIALS AND METHODS: A tooth was inserted in a dry human mandible socket, and CBCT scans were acquired after root canal instrumentation, root canal filling, and metal post placement with various tube currents with and without MAR activation. The artifact magnitude was assessed by the standard deviation (SD) of gray values and the contrast-to-noise ratio (CNR) at the various distances from the tooth. Data were compared using multi-way analysis of variance.RESULTS: At all distances, a current of 4 mA was associated with a higher SD and a lower CNR than 8 mA or 10 mA (P<0.05). For the metal posts without MAR, the artifact magnitude as assessed by SD was greatest at 1.5 cm or less (P<0.05). When MAR was applied, SD values for distances 1.5 cm or closer to the tooth were reduced (P<0.05). MAR usage did not influence the magnitude of artifacts in the control and gutta-percha groups (P>0.05).CONCLUSION: Increasing the tube current from 4 mA to 8 mA may reduce the magnitude of artifacts from metal posts. The magnitude of artifacts arising from metal posts was significantly higher at distances of 1.5 cm or less than at greater distances. MAR usage improved image quality near the metal post, but had no significant influence farther than 1.5 cm from the tooth.

Correlação dos diâmetros e conicidades de instrumentos reciprocantes com cones de guta-percha para obturação com cone único / Correlation of the diameters and tapers of reciprocating instruments with gutta-percha points for single-cone root canal filling

Objetivo: o presente estudo teve como objetivo caracterizar as dimensões dos instrumentos Reciproc R25 e X1 Blue File, e dos cones de guta-percha da Mk Life R25, Reciproc R25 e DiaDent R25, para verificar qual cone de guta-percha se adapta melhor no preparo dos instrumentos. Métodos: dez instrumentos Reciproc R25 25/0,08v e X1Blue File 25/0,06; e dez cones de guta-percha Dia- Dent R25, Mk Life R25 e Reciproc R25 foram utilizados. As imagens foram obtidas através de uma lupa estereoscópica com uma câmera digital acoplada. As medidas foram obtidas através do programa TS View. Os diâmetros dos instrumentos e dos cones de guta-percha foram determinados em D0 até D9, com intervalos de medidas de 1,0 mm; e a conicidade foi calculada adotando-se os diâmetros D8 e D1. Os resultados obtidos foram submetidos à análise estatística utilizando o programa Primer of biostatistics versão 6.0. Resultados: apesar da maior conicidade dos instrumentos X1Blue file (0,07mm/mm), não houve diferença estatisticamente significativa entre os instrumentos nos três primeiros milímetros (p > 0,05), o mesmo ocorreu para a conicidade dos cones (p > 0,05). Os cones de guta-percha apresentaram diferença estatisticamente significativa em todos os diâmetros aferidos (p < 0,05). Conclusão: os instrumentos e os cones de guta-percha atenderam à recomendação das respectivas normas ANSI/ADA. O cone de guta-percha que apresentou maior compatibilidade dimensional com os diâmetros dos instrumentos foi o MK life, e VDW foi o que apresentou maior desajuste (AU).

Objective: The aim of this study was to characterize the dimensions of the Reciproc R25 and X1 Blue File instruments and the gutta-percha points of Mk Life R25, Reciproc R25 and DiaDent R25 to verify which gutta-percha point better fits to the instruments preparation. Material and methods: Ten Reciproc R25 25/0.08v and X1Blue File 25/0.06 instruments; and ten DiaDent R25, Mk Life R25 and Reciproc R25 gutta-percha points were used. The images were obtained through a stereomicroscopic with a digital camera coupled. The measurements were obtained through the TS View program. The diameters of instruments and gutta-percha points were determined in D0 through D9 at 1.0 mm intervals, and the taper was calculated by adopting diameters D8 and D1. The results were submitted to statistical analysis using the program Primer of biostatistics version 6.0. Results: Despite the greater taper of the X1Blue file instruments (0.07mm /mm), there was no statistically significant difference between the instruments in the first 3 millimeters (p> 0.05), the same was observed for the tapers of the guta-percha points (p> 0.05). The gutta-percha points presented a statistically significant difference in all measured diameters (p <0.05). Conclusion: Gutta-percha points and instruments have met the recommendations of their respective ANSI/ADA standards. The gutta-percha point that presented greater dimensional compatibility with the diameters of the instruments was the MK life, and VDW presented the greatest mismatch (AU).

Fibra óptica como un material alternativo en la obturación endodóncica: un estudio piloto / Optical fiber as an alternative material in endodontics: a pilot study

La gutapercha es químicamente un polímero a base de isopreno, impermeable, no poroso y radiopaco entre otras características, empleado desde el siglo XIX; sin embargo manifiesta algunos inconvenientes propios del material, lo cual ha dado lugar al nacimiento de otros materiales para mejorar sus propiedades. Recientemente se ha desarrollado y caracterizado un material novedoso a base de fibra óptica recubierta por nano partículas de plata (FONP), propuesto como un material alternativo para la obturación de conductos radiculares. En el presente estudio se seleccionaron 24 dientes para conformar cuatro grupos experimentales comparativos entre la obturación con fibra óptica y con gutapercha, ambos con el sellador AH Plus. Las raíces fueron obturadas en grupos de diez y almacenadas en solución salina a 37 oC. La filtración apical se midió desde el extremo apical de la interfaz del material hasta la extensión más coronal del tinte observado microscópicamente. Se empleó la herramienta de LAS EZ V3.0 (Leica Microsystems, Switzerland), los datos se tabularon y se analizaron. Resultados: Las mediciones de microfiltración a nivel apical e intraconductos manifestaron diferencias en favor de la gutapercha, donde los grupos experimentales manifestaron una filtración promedio correspondiente a 0.872 mm en el grupo de Gutapercha/AH-PLUS y de 2.390 mm con técnica lateral utilizando FONP/AH-PLUS, aun así se evidenció que las propiedades de sellado de la fibra óptica con nanopartículas fueron suficientes para considerarlo como un material de obturación de conductos radiculares dentales como posible sustituto de la gutapercha (AU)

Gutta-percha is chemically an Isoprene-based polymer, impervious, non-porous and radiopaque, among other characteristics, used since the 19th century, it manifests some disadvantages inherent to the material, which has led to the birth of new materials with improved properties. Recently, a novel material based on optical fiber covered by silver nanoparticles (FONP) has been developed, characterized and proposed as an alternative material for root canal obturation. In the present study, 24 teeth were selected and divided into four comparative experimental groups for obturation with fiber optics and gutta-percha, both with the AH Plus sealer. The roots were sealed in groups of ten and stored in saline at 37 oC. Apical filtration test was performed from the apical end of the material interface to the most coronal extension of the dye observed microscopically. The LAS EZ V3.0 tool was used to make the measurements and the data was tabulated and analyzed. Results: Measurements of microfiltration at the apical and intracanal level showed differences in favor of gutta-percha, where the experimental groups showed an average filtration of 0.872 mm in the Gutapercha/AH-PLUS group and 2.390 mm using FONP/AH-PLUS, even so, it was evidenced that the sealing properties of the optical fiber with nanoparticles are sufficient to consider this material as a proper filling material for dental root canals as a substitute for gutta-percha (AU)

Eficacia disolvente y citotoxicidad del aceite de cáscara de limón (Citrus limon) / Solvent efficiency and cytotoxicity of lemon peel oil (Citrus limon)

Objetivo: Evaluar in vitro el efecto disolvente y tóxico del aceite de cáscara de limón (Citrus limon) según tiempo de exposición e identificar sus componentes a través de la cromatografía de gases. Material y métodos: El estudio fue de tipo experimental in vitro. Para determinar el efecto disolvente se utilizaron conos de gutapercha estandarizados de endodoncia número 80 con conicidad 0,02; los disolventes utilizados fueron: xilol, aceite esencial de cáscara de limón y naranja; éstos fueron sumergidos en 2, 5 y 10 minutos (n=8). Se registró el peso antes y después de la inmersión a las sustancias evaluadas para determinar la pérdida de masa. Para evaluar la toxicidad se emplearon Artemias franciscanas a través de la concentración letal media; la cromatografía de gases se utilizó para obtener los componentes de cada aceite. Para comparar el efecto disolvente entre las sustancias se empleó el análisis ANOVA/Tukey. Resultados: No se encontró diferencia significativa para disolver la gutapercha con el aceite esencial de cáscara de limón, de naranja y xilol (p>0.05). El tiempo no tuvo influencia para la disolución de la gutapercha (p>0.05). Todos los aceites fueron tóxicos, a excepción del aceite de limón 25%. Conclusiones: El Limoneno y el D limoneno fueron los componentes con mayor porcentaje en el aceite de limón y de naranja, respectivamente. El aceite de limón podría ser una considerada como alternativa para ser utilizado como disolvente de gutapercha de uso endodóntico, por tener efecto similar que el aceite naranja.

Objective: To evaluate in vitro the solvent and toxic effect of lemon peel oil (Citrus limon) according to exposure time. Its components were identified through gas chromatography. Material and Methods: The study was of experimental type in vitro. To determine the solvent effect, standardized gutta-percha cones of endodontic number 80 with taper 0.02 were used; solvents used were: xylol, lemon and orange peel essential oil; these were immersed in 2, 5 and 10 minutes (n = 8). The weight was recorded before and after the immersion to the substances evaluated to determine the loss of mass. To evaluate the toxicity, Artemias Franciscan were used through the medium lethal concentration; Gas chromatography was used to obtain the components of each oil. The ANOVA / Tukey analysis was used to compare the solvent effect between the substances. Results: No significant difference was found to dissolve the gutta-percha with the lemon, orange and xylol essential oil (p> 0.05). Time did not influence the dissolution of gutta-percha (p> 0.05). All oils were toxic, with the exception of 25% lemon oil. Conclusions: Limonene and D limonene were the components with the highest percentage in lemon and orange oil, respectively. Lemon oil could be considered as an alternative to be used as a gutta-percha solvent for endodontic use, because it has a similar effect as orange oil.

Tratamento não cirúrgico para remoção de instrumento fraturado e guta-percha extravasada, com o uso do Masserann EndoKit / Non-surgical treatment for removing fractured instrument and extravasated gutta-percha, by using the Masserann EndoKit

Objetivo: o objetivo deste artigo é relatar um caso clínico em que um instrumento fraturado e a guta-percha extravasada foram removidos via canal. Relato de caso: paciente do sexo masculino, com 38 anos de idade, foi encaminhado para avaliação do incisivo lateral superior direito (dente #12). O paciente apresentava dor à palpação na região apical e ausência de sintomatologia espontânea. O exame radiográfico revelou a presença de cone de guta-percha extravasado, uma espiral de Lentulo fraturada, além de lesão periapical no dente #12. O retratamento endodôntico foi o procedimento de escolha, na tentativa de remover os dois materiais. A espiral de Lentulo foi removida com Masserann Endokit; e o cone de guta-percha, utilizando limas Hedstroen. Após realizar a instrumentação e o preenchimento do conduto com pasta de hidróxido de cálcio com iodofórmio, constatou- se a presença de reabsorção no terço apical. Depois de dois meses, observou-se redução da lesão; utilizou-se, então, MTA na região da reabsorção, e o conduto foi obturado com cone de guta-percha e cimento endodôntico Sealer 26. Conclusão: controles clínicos e radiográficos foram realizados após dois, quatro e oito anos, demonstrando reparo na região apical e ausência de sintomatologia (AU).

The objective of this article was to report a clinical case of finding a fractured instrument and over-extended guttapercha of a tooth, which were removed via the canal. The patient, a 38-year-old man, was referred for treatment of the right maxillary lateral incisor (tooth 7). The patient presented pain on palpation at the apical level and absence of spontaneous symptomatology. Radiographic examination revealed the presence of a over-extended gutta-percha cone, a fractured Lentulo spiral and periapical lesion in tooth 7. Endodontic retreatment was the chosen procedure in an attempt to remove both materials. The Lentulo spiral was removed by means of the Masserann Endokit, and the gutta-percha cone by using Hedstroen files. While performing instrumentation, and filling the canal with calcium hydroxide with iodoform, the presence of resorption in the apical third was verified. After 2 months, reduction of the lesion was observed, thus MTA was placed in the area of resorption and the remainder of the canal was filled with a gutta-percha cone and Sealer 26 cement. Clinical and radiographic controls performed after 2, 5 and 7 years showed repair of the area and absence of symptomatology (AU).

Rapid chairside disinfection and surface alterations of gutta-percha cones with 1% Alexidine, 2% Chlorhexidine and 525% sodium hypochlorite against Enterococcus faecalis – An in vitro comparative study

Background: During endodontic intervention, major efforts are made to eliminate bacteria from the infected root canal system. Along these lines, keeping up the chain of asepsis is critical to anticipate sterile root canal system. Currently, gutta-percha (GP) is the most commonly used root canal core filling material. Objective: The purpose of this study was to compare the efficacy of 1% Alexidine, 2% Chlorhexidine, 5.25% Sodium Hypochlorite and saline against E.faecalis in disinfecting gutta-percha cones and to analyze the surface topography of gutta-percha cones after the rapid chemical disinfection procedure. Materials and methods: Gutta-percha cones were contaminated with E.faecalis and immersed in 1% ALX, 2% CHX, 5.25% NaOCl and 0.9% saline for 30 and 60 sec. The disinfected cones were immersed in test tubes and incubated at 37°C for 72 hours. Bacterial growth was evaluated by the presence of turbidity in the broth. Results were confirmed by sub culturing the bacterial colony. For topographical examination, the gutta-percha cones were analyzed under Scanning electron microscopy (SEM). Data was statistically analyzed using one way ANOVA. Swati Srivastava. Rapid chairside disinfection and surface alterations of gutta-percha cones with 1% Alexidine, 2% Chlorhexidine and 5.25% sodium hypochlorite against Enterococcus faecalis - An in vitro comparative study. IAIM, 2019; 6(10): 1-7. Page 2 Results: ALX and NaOCl did not show growth of the tested microorganism for any observed period. CHX completely eliminated E. faecalis after 60 sec. Saline showed no antimicrobial activity. The results of SEM showed some deposits after disinfection procedure by NaOCl and CHX test solutions used. Conclusion: ALX and NaOCl were found to be the most efficient disinfecting agent in eliminating E.faecalis at different time intervals tested. The topographical examination revealed that ALX and CHX left little residue than as compared to NaOCl after 1 minute.

Antibiofilm efficacy of 01% Octenidine, SmearOFF, 1% Alexidine and 525% Sodium Hypochlorite against E faecalis biofilm formed on tooth substrate

Context: The present study was aimed to explore new irrigating solutions, which would probably be as effective as sodium hypochlorite. Aims: The aim of this in vitro study was to evaluate the antibacterial effectiveness of 0.1% octenidine, SmearOFF, 1% alexidine and 5.25% sodium hypochlorite against E. faecalis biofilm formed on tooth substrate. Materials and methods: Eighty extracted human teeth were decoronated, biomechanically prepared, vertically sectioned, placed in the tissue culture wells exposing the root canal surface to E. faecalis strain (ATCC 29212) to establish 3-week-old biofilm. At the end of the 3rd week all groups were treated for 10 minutes with 3 ml of test solutions. Samples exposed to 5.25% sodium hypochlorite (NaOCl) were used as control. All the samples were evaluated for E. faecalis growth and number of colony forming units. Statistical analysis was performed by using one-way analysis of variance (ANOVA) to measure the mean values. The intergroup comparison was done by Tukey HSD post hoc test (p<0.05). Results: Maximum inhibition was observed with 0.1% OCT (group 1) followed by NaOCl (group 4) and ALX (group 3). SmearOFF (group 2) showed the least inhibitory effect. NaOCl (group 4) and ALX (group 3) showed no statistically significant difference (p>0.05), whereas all the other inter‐ group differences were statistically significant (p<0.05). Conclusions: 0.1% OCT showed significantly higher antibiofilm effects. No significant differences Swati Srivastava. Antibiofilm efficacy of 0.1% Octenidine, SmearOFF, 1% Alexidine and 5.25% Sodium Hypochlorite against E. faecalis biofilm formed on tooth substrate. IAIM, 2019; 6(11): 1-8. Page 2 were observed between 1% ALX and 5.25% NaOCl. SmearOFF showed significantly lower antibiofilm effects (p<0.05)

Chronic sinusitis of odontogenic origin due to an undiagnosed displaced root fragment in the maxillary sinus and the role of cone beam computed tomography in successful management

Radiographic imaging is an important criteria in diagnosis, treatment planning, and follow-up of an endodontic treatment. When clinicians encounter with diagnostic difficulties and persistent symptoms, the need for advanced diagnostic aids, especially imaging methods, become imperative and essential. This paper reports a case, in which primary endodontic therapy having failed, the patient had persisting symptoms such as pain, swelling, and draining sinus along with signs and symptoms of maxillary sinusitis. Advanced diagnostic aids such as Cone Beam Computed Tomography was useful in accurate identification of the etiology, which was a fractured mesiobuccal root tip of maxillary molar. This is the first reported case, in which the fractured root tip has migrated to the maxillary sinus, during primary endodontic treatment, through the perforated antral floor causing odontogenic sinusitis. The operating microscope helped in the successful completion of endodontic retreatment along with fractured root fragment retrieval.

Effective Debridement And Subsequent Obturation Of Tooth With Morphoanatomic Variations In Non Syndromic Patients– A Series Of 3 Case Reports

Taurodontism is a morphoanatomical anomaly of teeth characterised by enlarged pulp chamber with apically displaced pulp chamber floor and furcation.Endodontic treatment of a taurodont is challenging and requires special handling because of proximity and apical displacement of roots. In performing root canal treatment on such teeth, one should appreciate the complexity of the root canal system, canal obliteration and configuration, and the potential for additional root canal systems. Careful exploration of the grooves between all orifices particularly with magnification, use of ultrasonic irrigation; and a modified filling technique are of particular use. This paper presents three case reports on diagnosis and successful endodontic management of hypertaurodontic teeth, in non-syndromic patients

Evaluación del ajuste apical y la adaptación de los conos de gutapercha ProTaper Next, ProTaper Gold, WaveOne Gold y Reciproc Blue en conductos simulados instrumentados con estos sistemas / Evaluation of the apical tugback and adaptation of ProTaper Next, ProTaper Gold, WaveOne Gold and Reciproc Blue gutta-percha cones in simulated canals prepared with these systems

Objetivo: Evaluar el ajuste y la adaptación apical de los conos de gutapercha de cuatro diferentes sistemas de instrumentación y obturación endodóntica en conductos curvos simulados. Materiales y métodos: Se emplearon 4 Endo Training Blocks (Dentsply Sirona) con conductos curvos simulados, instrumentados hasta el límite de trabajo, fijado en el orificio de salida del conducto. Con ese propósito se empleó un tope metálico confeccionado ad hoc, ajustado en la concavidad de la salida del conducto, a fin de asegurar el límite de la instrumentación en todos los bloques de trabajo. El tope metálico se mantuvo en la posición por medio de una morsa de mesa. Los conductos fueron permeabilizados con una lima tipo K #10 (Dentsply Sirona). A continuación, se procedió con los protocolos de instrumentación de los sistemas por evaluar en cada Endo Training Block. Se emplearon los sistemas ProTaper Next (Dentsply Sirona), ProTaper Gold (Dentsply Sirona), WaveOne Gold (Dentsply Sirona) y Reciproc Blue (VDW) de acuerdo con las especificaciones del fabricante (grupos 1, 2, 3 y 4 respectivamente). Los conductos fueron irrigados con agua destilada a cada cambio de instrumento y al finalizar la preparación, y secados con conos de papel. Luego se evaluaron, en el respectivo Endo Training Block, el ajuste y la adaptación apical a la longitud de trabajo de 10 conos de gutapercha del sistema correspondiente. Para la evaluación del ajuste, se introdujeron los conos de gutapercha en el conducto simulado respectivo y se elevaron ambos hasta 10 cm de altura, manteniéndolos durante 10 segundos. Cuando se conservaban en esa situación, se consideraba que el cono ajustaba; si se desprendían antes de ese lapso, se establecía la falta de ajuste. Así mismo, se constató en cada caso su adaptación apical a la longitud de trabajo con un microscopio clínico operativo a 8,5X. Para la evaluación total se consideraron las siguientes categorías: 1, el cono de gutapercha llegaba a la longitud de trabajo y ajustaba; 2, el cono de gutapercha llegaba a la longitud de trabajo, pero no ajustaba; 3, el cono de gutapercha no llegaba a la longitud de trabajo; y 4, el cono de gutapercha sobrepasaba la longitud de trabajo. Resultados: Entre los grupos 1, 3 y 4 no se observaron variables intrasistemas de ajuste y adaptación apical a la longitud de trabajo. En el grupo 2 sí las hubo, pero la diferencia entre grupos no fue significativa (P>0,05). Conclusiones: De los cuatro sistemas utilizados, en tres de ellos el empleo de un cono único de gutapercha garantizó, en todas las pruebas, la adaptación y el ajuste a la longitud de trabajo (AU)

Aim: To evaluate in the tugback and apical adaptation at the working length of four different mechanized systems gutta-percha cones in simulated curved canals. Materials and methods: Four Endo Training Blocks (Dentsply Sirona) with simulated curved canals were instrumented up to the working length established at the orifice located in the canal exit. A metal stop was adjusted in the concavity present at the exit of the canal to ensure the working length during instrumentation in all blocks. The metal stop was maintained using a table walrus. Canal patency was achieved with a #10 K file (Dentsply Sirona). Then the instrumentation protocols for the different systems were performed in each Endo Training Block. ProTaper Next (Dentsply Sirona), ProTaper Gold (Dentsply Sirona), WaveOne Gold (Dentsply Sirona) and Reciproc Blue (VDW) were used according to the manufacturers' instructions (groups 1, 2, 3 and 4 respectively). The canals were irrigated with distilled water between instruments and at the end of the preparation and dried with paper points. Then, the tugback and the apical adaptation at the working length of 10 gutta-percha cones of each system were evaluated in the corresponding Endo Training Block. For the tugback analysis, the gutta-percha cones were introduced in the respective simulated canal and both were raised up to 10 cm in height, holding them for 10 seconds. If the cones remained intact in their position, it was considered that the cone tugback was appropriate, if the cones were detached, a lack of tugback was considered. Likewise, a clinical operating microscope at 8.5X was used to confirm the apical adaptation to the working length in each case. For the overall evaluation the following categories were considered: 1, the gutta-percha cone reached the working length with tugback; 2, the gutta-percha cone reached the working length without tugback; 3, the gutta-percha cone did not reach the working length; 4, the gutta-percha cone exceeded the working length. Results: In three groups 1, 3 and 4 they were not found intra-systems variables in the tugback at the working length. In one group there were observed intra-systems variables but the differences between groups were not statistically significant (P>0.05) (AU)

Evaluation Of Tensile Strength Of Gutta Percha Cones With Different Disinfectant Solutions - An In Vitro Study

This study was done to evaluate the tensile strength of gutta–percha using 5% sodium hypochlorite(SH), 2% chlorhexidine(CH) and 1% peracetic acid disinfectant solutions. 40 guttapercha cones of size 30(6% taper) were obtained from sealed packs as 4 different groups. Experimental groups were disinfected using 5% sodium hypochlorite, 2% chlorhexidine, 1% peracetic acid respectively except the control group. Then tensile strength of gutta–percha cones were measured using the universal testing machine. The mean tensile strength values for group I, II, III, IV are 7.003MPa, 8.49 MPa, 6.60MPa and 9.45MPa respectively. Results were subjected to statistical analysis one–way analysis of varience test and unpaired ‘t’ test. 1% peracetic acid decreased tensile strength significantly as compared to 5% sodium hypochlorite and 2% chlorhexidine. The result concluded that the least decreased in tensile strength is for chlorhexidine followed by sodium hypochlorite and peracetic acid.