Comparative in vitro analysis of the antifungal activity of different calcium silicate-based endodontic sealers

Aim: This study aimed to perform an in vitro comparative analysis of the antifungal activity of different calcium silicate-based endodontic sealers against three fungal species. Methods: The antifungal properties of three calcium silicate-based sealers were tested: Bio-C Sealer, Cambiar a Sealer Plus BC, and MTA-Fillapex. Two commonly used sealers were used as controls: AH Plus and Endomethasone. An agar diffusion test was performed to analyze the antifungal activity of the sealers against Candida albicans, Candida glabrata, Candida tropicalis, and a mixed microbial culture medium. The results were analyzed using ANOVA (p <0.05). Results: Endomethasone exhibited the highest inhibition against all strains examined, maintaining a consistent level of inhibition throughout 7 days. MTA-Fillapex demonstrated the best performance among the calcium silicate-based sealers for the three fungal species (p < 0.05), maintaining stable values over the 7 days, surpassing that of Endomethasone. Nevertheless, MTA-Fillapex only exhibited antimicrobial effect against the mixed culture for the first 24 hours, and no antimicrobial activity was observed at 48 hours, being surpassed by all tested sealers (p < 0.05). Conclusion: Of all silicate-based sealers tested, only MTA-Fillapex exhibited promising antifungal activity. Nevertheless, care must be taken when extrapolating these results, as MTA-Fillapex exhibited poor antimicrobial activity when tested in mixed microbial cultures

Continuous Wave of Condensation Improves the Filling of Curved Canals: a Micro-CT Study / La condensación de onda contínua mejora el selle de canales curvos: un estudio de micro-CT

Abstract The aim of this study was to compare the filling capacity in curved root canal using a new continuous wave of condensation technique (Termo Pack II, Easy Dental Equipments, Brazil) or lateral compaction. The percentage of voids in the filling of mesial root canals of mandibular molars was assessed by micro-computed tomography (micro-CT). Mesial root canals (n=24) of mandibular molars with a degree of curvature between 20° and 40° were prepared using rotary system (ProDesign Logic, Easy, Brazil) up to #35, .05 taper. The root canals were filled by using the continuous wave of condensation system or lateral compaction and AH Plus sealer (n=12). Scanning at 9 µm was performed after preparation and after filling by using micro-CT SkyScan 1176. The volumetric percentage of filling material and voids (total length and in each root canal third) were calculated. Data were analyzed using ANOVA/ Tukey and Student's t tests (α=0.05). Before the filling techniques, the root canals volume after preparation was similar (p>0.05). The root canals filled by the continuous wave of condensation technique presented the lowest percentage of voids, and the greatest percentage of filling material in total length and thirds (cervical, middle and apical) (p<0.05). Both techniques were not able of completely filling the root canals. The continuous wave of condensation technique Termo Pack II promoted better root canal filling in curved root canals, when compared with lateral compaction.

Resumen El objetivo de este estudio fue comparar la capacidad de obturación en conductos radiculares curvos utilizando una nueva técnica de condensación de onda continua (Termo Pack II, Easy Dental Equipments, Brasil) vs compactación lateral. El porcentaje de brechas en la obturación de los conductos radiculares mesiales de los molares mandibulares se evaluó mediante microtomografía computarizada (micro-CT). Se prepararon conductos radiculares mesiales (n=24) de molares mandibulares con un grado de curvatura entre 20° y 40° utilizando un sistema rotatorio (ProDesign Logic, Easy, Brasil) al #35, conicidad 0,05. Los conductos radiculares se obturaron utilizando un sistema de condensación de onda contínua o compactación lateral y cemento AH Plus (n=12). Se realizó un escaneo de 9 µm después de la preparación y después de la obturación usando el micro-CT SkyScan 1176. Se calculó el porcentaje volumétrico de material de obturación y vacíos (longitud total y en cada tercio del conducto radicular). Los datos se analizaron utilizando las pruebas ANOVA/Tukey y t de Student (α=0,05). Antes de las técnicas de obturación, el volumen de los conductos radiculares después de la preparación fue similar (p>0,05). Los conductos radiculares obturados con la técnica de condensación por onda contínua presentaron el menor porcentaje de vacíos y el mayor porcentaje de material de obturación en longitud total y en tercios (cervical, medio y apical) (p<0,05). Ambas técnicas no fueron capaces de llenar completamente los conductos radiculares. La técnica de condensación de onda contínua Termo Pack II promovió un mejor relleno del conducto radicular en conductos radiculares curvos en comparación con la compactación lateral.

Root filling quality and bond strength of endodontic sealers to human and bovine dentin / Qualidade da obturação e resistência de união de cimentos endodônticos à dentina humana e bovina

Objetivo: Este estudo teve como objetivo comparar a qualidade da obturação e a resistência de união de dois cimentos endodônticos, AH Plus e Bio-C Sealer, em dentes humanos e bovinos. Métodos: Os canais radiculares de 60 dentes unirradiculares [30 humanos (H) e 30 bovinos (B)] foram preparados e obturados por condensação lateral da guta-percha e AH Plus (grupos AP-H e AP-B) ou Bio-C Sealer (grupos BC-H e BC-B). Seis fatias de 1,5 mm de espessura foram obtidas de cada raiz. Os espécimes foram observados em estereomicroscópio para avaliar a qualidade da obturação, considerando possíveis espaços vazios no material obturador. Posteriormente, as fatias radiculares foram avaliadas em termos de resistência de união por push-out e modo de falha. Os dados foram analisados pelos testes de Mann-Whitney e coeficientes de correlação de Spearman (α=5%). Resultados: A qualidade de obturação fornecida por AP e BC foi semelhante em ambos os substratos de dentina. No entanto, ao comparar dentes humanos e bovinos, os escores de espaços vazios foram maiores nas amostras bovinas, para ambos os cimentos. AP teve maior resistência de união à dentina humana e bovina do que BC. No entanto, não houve diferença significativa na resistência de união entre os substratos dentinários, para ambos os cimentos testados. Além disso, houve uma correlação positiva e moderada entre os valores de resistência de união de dentes humanos e bovinos. O modo de falha misto foi o mais prevalente. Conclusão: AP e BC fornecem qualidade de obturação semelhante, mas o primeiro apresenta maiores valores de resistência de união à dentina humana e bovina. A utilização de dentes bovinos como substitutos de amostras humanas parece ser adequada em estudos relacionados à resistência de união, mas não naqueles que testam a qualidade da obturação endodôntica.(AU)

Objective: This study aimed to compare the filling quality and bond strength of two endodontic sealers, AH Plus and Bio-C Sealer, in human and bovine teeth. Methods: The root canals of 60 [30 human (H) and 30 bovine (B)] single-rooted teeth were prepared and filled by lateral condensation of gutta-percha and AH Plus (groups AP-H and AP-B) or Bio-C Sealer (groups BC-H and BC-B). Six 1.5-mm-thick slices were obtained from each root. The specimens were observed under a stereomicroscope to assess filling quality, considering possible voids within the filling material. Subsequently, root slices were evaluated in terms of push-out bond strength and failure mode. Data were analyzed by Mann-Whitney tests and Spearman correlation coefficients (α=5%). Results: The filling quality provided by AP and BC was similar in both dentin substrates. However, when comparing human and bovine teeth, void scores were greater in the bovine samples, for both sealers. AP had higher bond strength to human and bovine dentin than BC. However, there was no significant difference in bond strength between dentin substrates, for both sealers tested. Also, there was a positive and moderate correlation between the bond strength values of human and bovine teeth. The mixed failure mode was the most prevalent. Conclusion: AP and BC provide similar filling quality, but the first presents higher bond strength values to human and bovine dentin. The use of bovine teeth as substitutes for human samples seems adequate in studies related to bond strength, but not in those testing root canal filling quality.(AU)

Pulpectomies with Iodoform Versus Calcium Hydroxide-Based Paste: A Preliminary Randomised Controlled Clinical Trial

ABSTRACT Objective: To compare clinical and radiographical pulpectomy outcomes in primary teeth filled with different pastes. Material and Methods: The sample included thirty-eight teeth indicated for pulpectomy due to irreversible pulp inflammation or necrosis from thirty patients (2 to 9 years old). The first appointment comprised chemomechanical preparation (2.5% sodium hypochlorite), smear layer removal (6% citric acid), intracanal dressing and temporary restoration. Seven days later, teeth were randomly assigned to filling with iodoform (IP) or calcium hydroxide with zinc oxide (CHZO) based pastes and temporarily restored. Final restoration (composite resin) occurred at the 3rd appointment. Data from baseline, 6 and 12 months were analysed using descriptive and inferential statistics (p≤0.05). Results: The overall frequency of success was 63.6% (n=21), with no significant difference between groups (IP=62.5% n=10; CHZO=64.7% n=11, p=0.59). Multiradicular teeth, overfilled canals and teeth whose coronal restoration have been lost were significantly associated with failure (p=0.01, p=0.04 and p<0.001, respectively). Conclusion: After 12 months, both pastes showed similar outcomes and can be used as good options for pulpectomies in primary teeth. Moreover, tooth location, extent of the root canal filling, and integrity of final restoration during the follow-up influenced the outcome of pulpectomies.

Effects of using different root canal sealers and protocols for cleaning intraradicular dentin on the bond strength of a composite resin used to reinforce weakened roots / Efectos del uso de diferentes selladores de conductos radiculares y protocolos para limpiar la dentina intrarradicular sobre la fuerza de unión de una resina compuesta utilizada para reforzar raíces debilitadas

Background: This study evaluated the effects of using different root canal sealers and protocols for cleaning intraradicular dentin on the bond strength of a composite resin used to reinforce weakened roots. Material and Methods: Sixty-four roots of extracted human maxillary canines were weakened, prepared and filled with two different endodontic sealers (Endofill and AH Plus). In half of the sample, set aside for each respective sealer, excess filling material was cleaned. In the other half, the weakened areas were not cleaned, and the excess of sealer was spread on the intraradicular dentin. Intentionally worn areas inside each root were restored with a microhybrid light-cure composite resin (Z100) to reinforce them, with and without acid etching. Prefabricated metal posts were fixed with a dual resin cement (RelyX ARC), and the specimens were submitted to a pull-out test. Statistical analysis was performed by means of Shapiro-Wilk, analysis of variance (one-way ANOVA) and Tukey-Kramer tests (p<0.05). Results: The groups filled with Endofill (GI, GII, GIII, GIV) had the lowest bond strength values, which were similar among each other (p>0.05).The greatest bond strength values were observed in roots filled with AH Plus (GV, GVI, GVII, GVIII), mainly without cleaning of the weakened areas, and followed by acid etching (GVII), and also with cleaning of the weakened areas, however, with no acid etching (GVI) (p<0.05). Conclusion: The greatest bond strength values were observed in roots filled with AH Plus; (1) without cleaning of the weakened areas and with acid etching, and; (2) with cleaning of the weakened areas, but without acid etching.

Antecedentes: este estudio evaluó los efectos del uso de diferentes selladores de conductos radiculares y protocolos para limpiar la dentina intrarradicular sobre la fuerza de unión de una resina compuesta utilizada para reforzar las raíces debilitadas. Material y Métodos: Sesenta y cuatro raíces de caninos maxilares humanos extraídos fueron debilitadas, preparadas y rellenadas con dos selladores endodónticos diferentes (Endofill y AH Plus). En la mitad de la muestra, reservada para cada sellador respectivo, se limpió el exceso de material de relleno. En la otra mitad, las áreas debilitadas no se limpiaron y el exceso de sellador se esparció sobre la dentina intrarradicular. Las áreas desgastadas intencionalmente dentro de cada raíz se restauraron con una resina compuesta fotopolimerizable microhíbrida (Z100) para reforzarlas, con y sin grabado ácido. Los postes metálicos prefabricados se fijaron con un cemento de resina dual (RelyX ARC) y los especímenes se sometieron a una prueba de extracción. El análisis estadístico se realizó mediante Shapiro-Wilk, análisis de varianza (ANOVA de una vía) y pruebas de Tukey-Kramer (p<0,05). Resultados: Los grupos rellenos con Endofill (GI, GII, GIII, GIV) presentaron los valores más bajos de fuerza de unión, los cuales fueron similares entre sí (p>0,05). Los mayores valores de fuerza de unión se observaron en raíces rellenas con AH Plus (GV, GVI, GVII, GVIII), principalmente sin limpieza de las áreas debilitadas, seguido de grabado ácido (GVII), y también con limpieza de las áreas debilitadas aunque sin grabado ácido (GVI) (p<0.05). Conclusión: Los mayores valores de fuerza de unión se observaron en las raíces rellenas con AH Plus; (1) sin limpieza de las áreas debilitadas y con grabado ácido, y; (2) con limpieza de las áreas debilitadas, pero sin grabado ácido.

Does ultrasonic activation improve the bond strength and root canal filling quality of endodontic sealers?

Abstract This study aimed to investigate the effect of ultrasonic activation (UA) of three endodontic sealers on the bond strength to root dentin and root canal filling quality. Ninety six bovine incisors were instrumented and root canal filling was carried out using AH Plus (AP), Sealer Plus (SP), or Sealer Plus BC (BC), with or without UA (n=16/group). Two 1.5-mm slices were obtained from each root third. The first slice was subjected to push-out testing and failure mode analysis, while the second was observed under a stereomicroscope for filling quality assessment. Data were analyzed by Kruskal-Wallis, Mann-Whitney and Friedman tests (α=0.05). SP showed higher bond strength and fewer voids than BC in the apical third and when root thirds data were pooled. SP also had higher bond strength compared with AH Plus in the apical third. UA improved the bond strength when BC was used but did not affect the filling quality of any sealer. There were no significant differences between the ultrasonically activated sealers regarding bond strength and filling quality. When root thirds were compared, the bond strength was similar along the root, but there was a tendency to worsen filling quality, with more voids, in the apical segment. In conclusion, UA was effective in increasing the bond strength of the calcium silicate-based sealer but did not improve its filling quality. For the epoxy resin-based sealers, these properties were not affected by UA.

Resumo Este estudo teve como objetivo investigar o efeito da ativação ultrassônica de três cimentos endodônticos na resistência de união à dentina radicular e na qualidade da obturação do canal radicular. Noventa e seis incisivos bovinos foram instrumentados e a obturação dos canais radiculares foi realizada com AH Plus (AP), Sealer Plus (SP) ou Sealer Plus BC (BC), com ou sem AU (n=16/grupo). Duas fatias de 1,5 mm foram obtidas de cada terço radicular. A primeira fatia foi submetida ao teste push-out e análise de modo de falha, enquanto a segunda foi observada em um estereomicroscópio para avaliação da qualidade da obturação. Os dados foram analisados ​​por testes de Kruskal-Wallis, Mann-Whitney e Friedman (α=0,05). SP mostrou maior resistência de união e menos espaços vazios na massa obturadora do que BC no terço apical e quando os dados dos terços radiculares foram agrupados. SP também apresentou maior resistência de união em comparação ao AH Plus no terço apical. A AU melhorou a resistência de união quando BC foi usado, mas não afetou a qualidade da obturação de nenhum dos cimentos. Não houve diferença significante entre os cimentos ativados por ultrassom em relação à resistência de união e qualidade da obturação. Quando comparados os terços radiculares, a resistência de união foi semelhante ao longo da raiz, mas houve uma tendência de pior qualidade no preenchimento, com mais vazios, no terço apical. Concluindo, a AU foi eficaz em aumentar a resistência de união do cimento à base de silicato de cálcio, mas não melhorou a qualidade da obturação. Para os cimentos à base de resina epóxi, essas propriedades não foram afetadas pela AU.

Synthesis, characterization, and evaluation of nano-hydroxyapatite based experimental calcium silicate cement as a root repair material / Síntesis, caracterización y evaluación de cemento experimental de silicato de calcio a base de nanohidroxiapatita como material de reparación radicular

Introduction: This study aimed to prepare a new root repair material including Portland cement, bismuth oxide, and nano-hydroxyapatite and analyze its physicochemical properties and its effects on the proliferation and differentiation of human dental pulp stem cells (hDPSCs). Material and Methods: Bismuth oxide as a radiopaque component and nano-hydroxyapatite particles were added to white Portland cement at 20% and 5% weight ratio, respectively. Characterization of the prepared cement was done using conventional methods. To examine the bioactivity of this new material, atomic absorption spectroscopy (AAS) was used for the investigation of the rate of calcium ions dissolution in simulated body fluid media. The viability of hDPSCs was assessed by an MTT assay after 1, 3 and 7 days. The odontogenic potential of this substance was evaluated by measuring alkaline phosphatase activity and alizarin red S staining. Results: Based on the bioactivity results, the cement presented high bio-activity, corroborating sufficiently with the calcium release patterns. The cell viability was significantly increased in new root repair material containing hydroxyapatite nanoparticles after 3 and 7 days (p<0.05). Conclusion: Moreover, alkaline phosphatase activity increased over 7 days in all experimental groups. The new cement containing nano-hydroxyapatite particles could be a good root repair material.

Objetivo: Este estudio tuvo como objetivo preparar un nuevo material de reparación de raíces que incluye cemento Portland, óxido de bismuto y nano-hidroxiapatita y analizar sus propiedades fisicoquímicas y sus efectos sobre la proliferación y diferenciación de células madre de pulpa dental humana. Material y Métodos: El óxido de bismuto como compo-nente radiopaco y las partículas de nano-hidroxiapatita se agregaron al cemento Portland blanco en una proporción en peso del 20 % y el 5 %, respectivamente. La caracterización del cemento preparado se realizó utilizando métodos con-vencionales. Para examinar la bioactividad de este nuevo material, se utilizó la espectroscopia de absorción atómica para investigar la velocidad de disolución de los iones de calcio en medio fluido corporal simulado. La viabilidad de las células madre de pulpa dental humana se evaluó mediante un ensayo MTT después de 1, 3 y 7 días. El potencial odontogénico de esta sustancia se evaluó midiendo la actividad de la fosfatasa alcalina y la tinción con rojo de alizarina S.Resultados: Con base en los resultados de bioactividad, el cemento presentó alta bioactividad, corroborando suficientemente con los patrones de liberación de calcio. La viabilidad celular aumentó significativamente en el nuevo material de reparación de raíces que contenía nanopartículas de hidroxiapatita después de 3 y 7 días (p<0,05). Conclusión: Además, la actividad de la fosfatasa alcalina aumentó durante 7 días en todos los grupos experimentales. El nuevo cemento que contiene partículas de nanohidroxiapatita podría ser un buen material de reparación radicular.

Evaluation of in vitro experimental model for analysis of bioceramic sealers

Abstract This study aimed to evaluate physicochemical properties of three ready-to-use calcium silicate-based endodontic sealers: Endosequence BC Sealer, Bio C Sealer, and Sealer Plus BC. Radiopacity was evaluated using specimens of 10 mm in diameter and 1 mm in height, along with an aluminum step wedge. For the flow test, 0.5 mL of each sealer was deposited between glass plates and the mean of the measurement of two diameters was considered the cement flow value. For pH and calcium release, root canals of 30 prototypes of upper incisor acrylic resin teeth were filled with sealer and gutta percha point and then immersed in containers with 13 mL of ultrapure water. Both pH and release of calcium ions (atomic absorption spectrophotometer) were measured at 3, 24, 72, and 168 h. Acrylic resin teeth were scanned by Micro-CT 1174 at the time of pH and calcium ion readings for volumetric change analysis. The data were analyzed by ANOVA, Tukey's, Kruskal-Wallis, and Dunn's tests. Endosequence BC Sealer presented the lowest, and Bio C Sealer the highest volumetric change after 72 h and 168 h (p < 0.05). Endosequence BC Sealer presented higher radiopacity (p < 0.05). All materials showed alkalinization capacity. All of them presented calcium ion release, with a higher value for Sealer Plus BC. All materials presented alkalinization, calcium release capacity, radiopacity, and flow above the minimum values required by the ISO standard. The highest volumetric loss was experienced by Bio C Sealer and the lowest one by Endosequence BC Sealer.

Laboratory study of tissue repair of resin-based endodontic sealers in critical surgical defects

Abstract Filling materials should be restricted to the root canal space. However, sometimes it is impossible to control the apical extrusion, in this case, the fate of the filling material and the result of the treatment will depend on its physicochemical properties and biocompatibility. Objective To evaluate the tissue response and bone repair capacity of endodontic sealers that were implanted in the calvaria of Wistar rats, forming the groups (n=16): AH Plus and Sealer Plus, compared to the clot group. Methodology On days 30 and 60, the animals were euthanized, the calvaria was removed and processed for hematoxylin-eosin, immunohistochemistry for collagen type I, Picrosirus red and microtomographic analysis. Data were subjected to ANOVA and Tuckey tests (p<0.05). Results At 30 days, all groups showed an intense inflammatory reaction (p>0.05). At 60 days, the AH Plus and Sealer Plus maintained an intense inflammatory infiltrate compared to the clot group (p<0.05). We observed immunopositive areas for type I collagen in all groups at 30 days and 60 days (p>0.05). We observed more red collagen fibers for the Sealer Plus compared to the clot group at 30 days (p<0.05). Considering the total fibers, the clot group at 30 days compared to 60 days after surgery showed an increase in the amount of matrix (p<0.05). There were no statistical differences between groups for green and yellow fibers (p>0.05). Regarding morphometric parameters, at 30 days, the newly formed bone volume and number of bone trabeculae were higher in the groups with sealers compared to the clot group (p<0.05). At 60 days, AH Plus and Sealer Plus showed greater bone neoformation compared to the clot group (p<0.05). Conclusions Despite AH Plus and Sealer Plus induced an intense inflammatory reaction, they can be considered biocompatible materials, since they allowed bone repair.

Physicochemical properties and osteoclastogenesis for three premixed calcium silicate-based sealers post set

Abstract: Solubility, pH, ion release, cytotoxicity, and osteoclastogenesis inhibition in bone marrow-derived monocyte macrophages (BMMs) were evaluated in EndoSequence BC Sealer (END), Bio-C Sealer (BC), and Sealer Plus BC (SPBC). pH was determined after immersion of the sealers in deionized water (DW) and Minimum Essential Medium Alpha (α-MEM). Solubility was obtained by mass loss. Ion release was measured by using X-ray fluorescence spectroscopy (XRF). Cytotoxicity was evaluated by MTT assay. Inhibition of osteoclastogenesis was evaluated by tartrate-resistant acid phosphatase (TRAP). Data were analyzed using the t-test, ANOVA and Tukey/Dunnett's post-hoc tests (α = 0.05). END had the highest pH in DW (p < 0.05), and BC, in α-MEM (p < 0.05). Solubility in DW was the lowest for SPBC (p < 0.005). The highest calcium release was observed for BC in DW at 12 h (p < 0.05), and in α-MEM at 12 and 24 h (p < 0.05). The lowest toxicity was detected for END (p < 0.05). BC had the highest inhibitory effect on osteoclasts (p < 0.05). Overall, the highest solubility and pH values were found in DW. However, the calcium silicate-based sealer showed higher solubility than the ISO standards. Calcium release was the highest for BC. END showed the highest cell viability, and BC, the highest osteoclast inhibition.

Physicochemical properties of three bioceramic cements

Abstract: This study aimed to compare the physicochemical properties of MTA Angelus (MTA-A), MTA Repair HP (MTA-HP), and Biodentine (BD). Setting times (n = 7) were determined in accordance with ASTM C266-15. Solubility (n = 11), pH (n = 10), and calcium ion release (n = 10) were evaluated up to 28 days in accordance with ANSI/ADA specification no. 57. Radiopacity was assessed by ANSI/ADA (n = 10) and the tissue simulator method (n = 10). In both methods, the specimens were radiographed using an aluminum stepwedge and the digital radiographs were analyzed in Adobe Photoshop, determining the mean grayscale pixel values of the materials, of the 3-mm aluminum stepwedge, and of the dentin, the latter of which was analyzed on the tissue simulator. The data obtained from each test were statistically analyzed and compared (p < 0.05). MTA-A presented longer final setting time compared with the other materials. There were no significant differences in the mass values of materials during the experiment. All materials presented an alkaline pH. BD promoted greater calcium ion release in most of the experimental periods. All materials presented appropriate radiopacity. BD showed lower radiopacity than MTA-A in the tissue simulator method. All groups presented higher radiopacity in the tissue simulator when compared with the ANSI/ADA method. MTA-A, MTA-HP, and BD showed appropriate physicochemical properties and radiopacity, and were considered suitable to be used in clinical practice.

Comparison between the use of alcohol and chlorhexidine in the intracanal disinfection protocol before the installation of fiberglass pin related to the increase in adhesiveness: a systematic literature review / Comparativo entre o uso de álcool e clorexidina no protocolo de desinfecção intracanal anterior à instalação de pino de fibra de vidro relacionado ao aumento da adesividade: uma revisão sistemática da literatura

ABSTRACT Introduction: Many clinical failures involving the fiberglass post result from the detachment between the retainer, the root canal and the cement. Thus, the connections that cause a probability of these failures are essential for dentistry. Objective: To compare the efficiency of intracanal disinfection between alcohol and chlorhexidine in the context of minimizing fractures. Methods: The present systematic review registered in PROSPERO under the protocol CRD42021233516 based on a Medical Subject Headings strategy: "((Endodontics OR Root Canal Filling Materials OR Dental Materials) AND Chlorhexidine AND Ethanol AND Dental Bonding)" in the search engines PubMed, Scopus, Web of Science, Cochrane Library, Embase and Lilacs. Studies in Portuguese, English or Spanish were included, without restrictions regarding their methodology and year of publication. Articles that did not report an intracanal hygiene protocol before the procedure, without full publication and orthodontic research were excluded. Results: Six studies were selected according to the inclusion and exclusion criteria. In all, chlorhexidine was used for intracanal cleaning, comparing it with the other groups, and in 4 it was compared with alcohol and other groups. Discussion: The articles used different media and storage times and most used bovine teeth. There was no significant difference between any other characteristics regarding the increase in adhesiveness of the set. Conclusion: There is no difference between the use of alcohol or chlorhexidine as a disinfection method. However, a previous protocol must be established for longer treatment longevity.

RESUMO Introdução: Muitas falhas clínicas que envolvem o pino de fibra de vidro decorrem do descolamento entre o retentor, o canal radicular e o cimento. Assim, protocolos que reduzem a probabilidade dessas falhas são essenciais para a odontologia. Objetivo: Comparar a eficiência da desinfecção intracanal entre o álcool e clorexidina no contexto de minimização de fraturas. Métodos: A presente revisão sistemática registrada no PROSPERO sob o protocolo CRD42021233516 usou a estratégia baseada nos Medical Subject Headings: "((Endodontics OR Root Canal Filling Materials OR Dental Materials) AND Chlorhexidine AND Ethanol AND Dental Bonding)" nos buscadores PubMed, Scopus, Web of Science, Cochrane Library, Embase e Lilacs. Foram incluídos estudos em português, inglês ou espanhol, sem restrições quanto a sua metodologia e ano de publicação. Excluiu-se artigos que não relataram um protocolo de higiene intracanal antes do procedimento, sem publicação na íntegra e pesquisas ortodônticas. Resultados: Foram selecionados 6 estudos de acordo com os critérios de inclusão e exclusão. Em todos utilizou-se a clorexidina para limpeza intracanal, comparando com os demais grupos, e em 4 houve a comparação dela com álcool e outros agrupamentos. Discussão: Os artigos utilizaram diferentes meios e tempos de armazenamento e a maioria fez o uso de dentes bovinos. Não verificou-se uma diferença significativa entre quaisquer substâncias quanto ao aumento da adesividade do conjunto. Conclusão: Não existe diferença entre o uso do álcool ou clorexidina como método de desinfecção, entretanto, um protocolo prévio deve ser estabelecido para uma maior longevidade de tratamento.

Physicochemical properties and antimicrobial activity of calcium hydroxide pastes in association with other compounds

Aim: This study aimed to evaluate the pH, Ca2+ release, solubility, and antimicrobial activity of calcium hydroxide (Ca(OH)2) pastes in association with different substances. Methods: Sixty acrylic teeth (n=10) were filled with pastes that associated Ca(OH)2 with the following substances: benzalkonium chloride 5% (G1) and 50% (G2) both in propylene glycol, arnica glycolic extract (G3), green tea glycolic extract (G4), Calen/PMCC™ (G5), and Calen™ (G6). In the group G1 to G4 were used 1g of Ca(OH)2 powder with 0,8g of vehicle. pH and Ca2+ release was measured after 7, 15, and 30 days. For solubility, micro-CT was used immediately and at the periods of 7, 15, and 30 days. For the antimicrobial analysis, a biofilm of E. faecalis was induced in vitro on bovine dentin discs. Live/dead viability dye and confocal scanning microscopy were used. Results: The highest pH values occurred on the first 7 days, and the G6, G1, G3, and G5 presented the highest pH values at this period (P <0.05). Ca2+ release was higher in all groups at 7 days, with the highest values observed in G1, G5, and G6. The volume of all pastes showed no significant difference in the intragroup analysis at 7 and 15 days (P <0.05). G1 and G2 showed the highest antimicrobial action (P <0.05). For the biovolume, there was difference between the G6 and the other groups (P >0.05) with G1 presenting the lowest values. Conclusion: Benzalkonium chloride 5% increases the antimicrobial action of the Ca(OH2), without impairs physicochemical properties

A comparative evaluation of the sealing ability of two calcium silicate based sealers and a resin epoxy-based sealer through scanning electron microscopy and bond strength: an in vitro study

Aim: this study aimed to compare the sealing ability of two types of commercially available calcium silicate bioceramic based root canal sealers and a resin based root canal sealer. Methods: Twenty one single-rooted teeth were used, samples (n= 21) were randomly divided into three groups according to the sealer used (group A; ADSEAL, group B; Wellroot, group C; Ceraseal). Roots were then cleaved longitudinally in the labiolingual direction; all samples were then sectioned at three, six, and nine mm from the root tip. The penetration of sealers into the dentinal tubules was examined at 1000x with a scanning electron microscope. Data were tested for normality using Shapiro Wilk test. ANOVA test was used for analyzing normally distributed data followed by Bonferroni post hoc test for pair-wise comparison. Significance level p≤0.001. Results: groups B and C showed better sealing ability than group A in all the three sections. The coronal section showed higher sealing ability than the middle section followed by the apical section in the three tested groups. Conclusion: it can be concluded that both calcium silicate-based sealers had better sealing ability and higher bond strength than the resin epoxy- based sealer

Retreatment of mesial roots of mandibular molars filled with resin-based and bioceramic sealers

Aim: The aim of this study was to evaluate, by micro-computed tomography (micro-CT) analysis, the remaining filling material during endodontic retreatment performed with Protaper retreatment without solvent. Methods: Forty mandibular molars were divided into two groups (n = 20) according to the sealer used in the obturation: the bioceramic TotalFill BC (TF) or the resin-based AH Plus (AHP). The specimens were scanned before instrumentation, after obturation and after filling removal. Only the mesial roots were analysed. The filling volumes and the remaining filling material were calculated in the entire root canal and in the cervical, middle and apical thirds. Results: The volume of obturation and the volume of remaining filling material in the entire root canal and in the cervical, middle and apical thirds of the canal between the groups were not statistically different (independent t-test, p > 0.05). In the AHP group, there was a higher percentage of remaining filling material in the middle third than in the cervical third (p < 0.05). Conclusion: The filling material could not be entirely removed from any specimen

Spectrophotometric evaluation of coronal discoloration induced by bioceramic root canal filling materials / Evaluación espectrofotométrica de la decoloración coronal inducida por materiales biocerámicos de obturación del conducto radicular

The aim of this study is to evaluate the crown discoloration induced by bioceramic root canal filling materials (OrthoMTA and iRoot SP) compared to AH Plus. Material and Methods: Sixty intact mandibular single rooted premolars were sectioned 2 mm below the cemento-enamel junction, prepared, and randomly assigned into four groups according to the root filling materials: OrthoMTA, iRoot SP, AH Plus and unfilled. Results: Before placement of the materials in the pulp chamber and the coronal third of the root, the spectral reflectance lines of the crowns were recorded by a digital spectrophotometer at baseline, and after filling at 1 week and 1, 3 and 6 months and ∆Ε values were calculated. All materials used induced clinically perceptible crown discoloration (∆Ε>3.7) and no significant difference was detected between these materials (p>0.05). Regardless of the material, discoloration progressed significantly within the three months (p<0.05) however, at 6 months, the discoloration reduced for AH Plus and no further increase for bioceramic materials was detected. Conclusion: Bioceramic root filling materials tested induced clinically perceptible crown discoloration and their application in the esthetic zone should be performed with caution.

Objetivo: El objetivo de este estudio es evaluar la decoloración de la corona inducida por materiales biocerámicos de obturación del conducto radicular (OrthoMTA e iRoot SP) en comparación con AH Plus. Material y Métodos: Se seccionaron sesenta premolares mandibulares de raíz única intactos, 2 mm por debajo de la unión cemento-esmalte, se prepararon y se asignaron al azar en cuatro grupos de acuerdo con los materiales de obturación radicular: OrthoMTA, iRoot SP, AH Plus y sin relleno. Resultados:Antes de la colocación de los materiales en la cámara pulpar y el tercio coronal de la raíz, las líneas de reflectancia espectral de las coronas se registraron con un espectrofotómetro digital al inicio del estudio, y a la semana 1, así como a 1, 3 y 6 meses, y los valores ?? fueron calculados. Todos los materiales utilizados indujeron una decoloración de la corona clínicamente perceptible (??> 3,7) y no se detectaron diferencias significativas entre estos materiales (p> 0,05). Independientemente del material, la decoloración progresó significativamente dentro de los tres meses (p<0.05); sin embargo, a los 6 meses, la decoloración se redujo para AH Plus y no se detectó ningún aumento adicional para los materiales biocerámicos. Conclusiones: Los materiales biocerámicos de obturación radicular probados indujeron una decoloración de la corona clínicamente perceptible y su aplicación en la zona estética debe realizarse con precaución.

Retratamento endodôntico e complementação cirúrgica em dente com fístula persistente: relato de caso / Endodontic retreatment and surgical complementation on a tooth with persistent fistula: case report

Introdução: O preparo químico-mecânico representa uma etapa fundamental, pois promove a antissepsia do complexo sistema de canais radiculares, viabilizando um ambiente biológico favorável para o processo de cura e reparo dos tecidos periapicais. Porém, insucessos podem acontecer em dentes tratados e retratados endodonticamente, sendo a intervenção cirúrgica frequentemente indicada nesses casos. Relato do caso: Paciente do sexo masculino, 32 anos de idade, melanoderma, apresentou-se à clínica-escola de uma faculdade de Odontologia em um município baiano, com queixa principal de "aparecimento de bolha na gengiva e gosto amargo na boca". Ao exame clínico, visualizou-se presença de restauração de resina composta nas faces mesial e palatina, bem como fístula intrabucal ativa na região de fundo de vestíbulo, próximo ao ápice do elemento #22. Por meio de exames clínico e radiográfico, testes de sensibilidade pulpar e rastreamento da fístula, foi estabelecido diagnóstico de tratamento endodôntico concluído, e periapical de abscesso apical crônico. Em seguida, houve indicação de retratamento endodôntico e duas sessões de medicação intracanal com hidróxido de cálcio, seguidas de uma intervenção cirúrgica exploratória. Resultados: O protocolo de tratamento proposto foi eficaz. Constatou-se sucesso clínico, com cicatrização da fístula intrabucal ativa, e radiográfico, com reparação dos tecidos periapicais, além do restabelecimento da estética e função dentária, com acompanhamento de 26 meses. O paciente encontra-se sob acompanhamento semestral. Conclusão: é necessário salientar a relevância de efetuar com segurança um planejamento e prognóstico endodôntico confiável e, igualmente, o acompanhamento do caso, com supervisão clínica e radiográfica periódica (AU).

Introduction: Biological chemical preparation repre- sents a fundamental step, as it promotes asepsis of the complex root canal system, enabling a biological environment favorable to the process of healing and repair of the periapical tissues. However, failures can occur in endodontic treatment and retreatment teeth, where surgical intervention is often indicated in these cases. Description: The patient, a 32-year old man, melanoderma, presented at the school clinic of a School of Dentistry in a city in Bahia, with a chief complaint of "blistering of the gums and bitter taste in the mouth." Clinical examination revealed the presence of composite resin restoration on the mesial and palatine surfaces, and an active intraoral fistula in the vestibular region near the apex of tooth 22. By means of clinical, radiographic, pulp sensitivity tests and sinus tracking, a diagnosis of completed endodontic treatment was established, and periapical diagnosis of a chronic apical abscess. Afterwards, endodontic retreatment was indicated, consisting of two sessions of intracanal medication with calcium hydroxide, followed by an exploratory surgical intervention. Results: The proposed treatment protocol was effective. Clinical and radiographic success with healing of the active intrabuccal fistula and repair of the periapical tissues, as well as reestablishment of esthetics and dental function, was verified, in a period of twenty six months follow-up. At present, the patient is being followed-up semi-annually. Conclusion: it is necessary to emphasize the importance of safely performing reliable endodontic planning and prognosis, as well as follow up of the case, with periodic clinical and radiographic control (AU).

Apical Sealing Efficacy of the Bioceramic Cements Bio Root and MTA Fillapex: An ex vivo Study

ABSTRACT: The aim of this ex vivo study was to compare the ability of the apical sealing bioceramic cements BioRoot™ RCS (Septodont) and MTA-Fillapex (Angelus). One hundred and eighty-four vestibular canals were selected from ninety-two recently extracted maxillary molars. Canals were instrumented with the mechanized system ProTaper Next and obturated using the single cone technique. The sample was randomly divided into two groups (92): Group 1 was obturated with BioRoot ™ RCS, and Group 2 with MTA-Fillapex. Samples were processed for the leakage test by dye penetration and later cut longitudinally. The data obtained were tabulated and analyzed using Stata 15.0. The degree of leakage from BioRoot ™ RCS was 0.03 mm, and MTA-Fillapex was 0.31 mm p (0.00). BioRoot ™ bioceramic presented an adequate apical sealing, while MTA-Fillapex showed an accentuated leakage.

RESUMEN: El objetivo de este studio ex vivo fue comparar la capacidad de sellado apical de dos cementos biocerámicos, el BioRoot™ RCS (Septodont) y MTA-Fillapex (Angelus). 184 conductos vestibulares fueron seleccionados de 92 molares maxilares recientemente extraídos. Los conductos fueron instrumentados con el sistema de instrumentación mecanizado Protaper Next y obturados usando la técnica de cono único. Las muestras fueron divididas aleatoriamente en dos grupos (N 92): Grupo 1 fue obturado con BioRoot™ RCS, y el grupo 2 con MTA-Fillapex. Las muestras fueron procesadas para el test de filtración por penetración de tinción, y luego cortadas de manera longitudinal. Los datos obtenidos fueron tabulados y analizados usando Stata 15.0. El grado de penetración de BioRoot™ RCS fue de 0,03 mm, y de MTA Fillapex fue de 0,31 mm (P 0.00). BioRoot™ RCSpresent un sellado apical adecuado, mientras que MTA Fillapex mostró una filtración mayor.

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)

Micro-push-out bond strength of mineral­based root canal sealer in canals with different tapers / Fuerza de unión por micro-expulsión del sellador de conductos radiculares a base de minerales en conductos con diferentes ahusamientos

Objective: The aim of this study was to assess the micro-push-out bond strength of a mineral-based root canal sealer, BioRoot RCS in canals prepared by K3XF rotary systems of two different tapers. Material and Methods: Eighty caries free maxillary central incisors were used in this study. The samples were allocated into 4 groups (n=20) according to the root canal sealer and taper of the rotary instruments. The samples were obturated using single cone obturation technique. From each root 1mm thick slices at coronal, middle and apical thirds were collected using hard tissue microtome under continuous water coolant. Push-out tests were done for these sections using a Universal testing machine (INSTRON 8801) at a crosshead speed of 1mm/min. One-way analysis of variance (ANOVA) was used to compare the bond strengths within groups and Tukey's multiple post hoc analysis was used for pair-wise comparison of bond strengths. Results: AH Plus exhibited higher micro-push-out bond strength than BioRootRCS though they did not differ significantly (p>0.05). Preparation of root canals with 6% taper rotary instruments showed higher bond strength than 4% though they did not differ significantly (p>0.05). Conclusion: There was no significant difference between micro-push-out bond strength values of BioRoot RCS and AH Plus. The bond strength values were high in 6% taper canals than 4% canals though the difference was not significant statistically.

Objetivo: El objetivo de este estudio fue evaluar la fuerza de unión por micro-expulsión de un sellador de conductos radiculares de base mineral, BioRoot RCS, en conductos preparados por sistemas rotativos K3XF con dos conos diferentes. Material y Métodos: En este estudio se utilizaron 80 incisivos centrales superiores libres de caries. Las muestras se distribuyeron en cuatro grupos (n = 20) de acuerdo al sellador del conducto radicular y al cono de los instrumentos rotativos. Las muestras se obturaron mediante la técnica de obturación de un solo cono. De cada raíz se recogieron rodajas de 1 mm de grosor en los tercios coronal, medio y apical utilizando un micrótomo de tejido duro con refrigeración continua por agua. Posteriormente, se realizó una prueba de expulsión para estas secciones utilizando una máquina de prueba universal (INSTRON 8801) a una velocidad del cabezal transversal de 1mm/min. Se utilizó el análisis de varianza unidireccional (ANOVA) para comparar las resistencias de la unión dentro de los grupos y el análisis post hoc multiple de Tukey se utilizó para la comparación por pares de las resistencias de la unión. Resultados: AH Plus exhibió una fuerza de unión de micro-expulsión más alta que BioRootRCS, aunque no difirieron significativamente (p>0,05). La preparación de los conductos radiculares con instrumentos rotativos ahusados al 6% mostró una fuerza de unión superior al 4%, aunque no difirieron significativamente (p>0,05). Conclusión: No hubo diferencias significativas entre los valores de fuerza de unión de micro-expulsión de BioRoot RCS y AH Plus. Los valores de la fuerza de unión fueron más altos en canales cónicos al 6% que en canales al 4%, aunque la diferencia no fue significativa estadísticamente.