Diagnóstico, planificación del tratamiento y endodoncia de un primer premolar inferior con dos canales mediante tomografía computarizada 3D: reporte de un caso

El tratamiento endodóntico debe considerar que los dientes presentan una morfología del sistema de canales radiculares con alta variabilidad y complejidad. por lo tanto, el conocimiento acabado de la anatomía radicular y la planificación del procedimiento utilizando sistemas imagenológicos previos a la realización del tratamiento endodóntico, como la tomografía computarizada 3D (CBTC), mejoran el pronóstico, aumentando las probabilidades de éxito. el objetivo de este reporte es mostrar la secuencia de una resolución clínica de un primer premolar inferior (diente 4.4) con una anatomía compleja, utilizando el CBTC tanto en el diagnóstico como en la planificación.

Do different strains of E. faecalis have the same behavior towards intracanal medications in in vitro research?

Abstract: The aim of this study was to evaluate the antimicrobial action of different endodontic pastes against Enterococcus faecalis ATCC 29212, isolated from the urinary tract, and compare the action with E. faecalis ATCC 4083, isolated from the root canal. For this purpose, dentin blocks were infected for 21 days with both bacteria at different time-intervals to ensure there would be no cross contamination. After this period, blocks were immersed in the test medications for 7 days, according to the following groups: CH/S, CH/P, CH/CMCP, CH/CHX, CH/DAP and TAP. Images of the samples were captured with a confocal microscope and the percentage of live cells was computed by means of the Bioimage program. The ATCC 29212 strain was shown to be more resistant to CH/SS, Calen, CH/DAP, and TAP than the ATCC 4083 strain. The antimicrobial action of the medications against each strain were divergent concerning the order of susceptibility. The authors concluded that the strains behaved in a different manner: in general, those extracted from the urinary tract were more resistant to the tested medications. Therefore, when E. faecalis must be used for in vitro research in endodontics, we suggest the use of ATCC 4083 strain to obtain results that are closer to the clinical reality.

Effectiveness of different final irrigation techniques and placement of endodontic sealer into dentinal tubules

Abstract: The aim of this study was to compare two irrigation techniques and four devices for endodontic sealer placement into the dentinal tubules. Ninety-nine single-rooted human teeth were instrumented and allocated to either the control (CO) (n=11) or experimental groups according to the irrigation method: syringe and NaveTip needle (NT) (n=44), and EndoActivator (EA) (n=44). These groups were subdivided according to sealer placement into K-File (KF), lentulo spiral (LS), Easy Clean (EC), and EndoActivator (EA) subgroups. Moreover, the distances of 5 mm and 2 mm from the apex were analyzed. The teeth were obturated with AH Plus and GuttaCore X3. Analyses were performed by scanning electron microscopy associated to cathodoluminescence. The percentage and maximum depth of sealer penetration were measured. Data were evaluated by three-way analysis of variance (ANOVA) and Games-Howell test (p<0.05). EA was superior to NT in percentage of sealer penetration. EC was significantly superior to EA (subgroup) for sealer penetration, and both improved the percentage of sealer penetration when compared to LS. Better sealer penetration was observed at the distance of 5 mm from the apex. Sealer penetration into the dentinal tubules was significantly improved by sonic irrigant activation.

Efficacy of an Organic Solvent and Ultrasound for Filling Material Removal

The aim of this study was to investigate whether a final rinse with Endosolv R® solvent and ultrasound resulted in cleaner root canal walls during endodontic retreatment. A total of 56 extracted premolar teeth were manually instrumented using a step-back flare technique and filled with gutta-percha and AH Plus sealer. After 9 months, the canals were retreated by removing the gutta-percha and sealer with ProTaper Universal Retreatment and rotary preparation with ProTaper Universal System up to an F5 file. As a final step, the teeth were randomly divided in 4 groups (n=14) and were subjected to passive ultrasonic irrigation (PUI) with either Endosolv R or distilled water. In the control groups, the irrigants were left undisturbed. Roots were cleaved and examined under scanning electron microscopy (SEM), and the amount of filling remnants on the canal walls was assessed by two calibrated examiners in a blinded fashion. Data were analyzed by the Kruskal-Wallis test and the Student-Newman-Keuls post hoc test (α=0.05). All groups presented filling debris in the three root canal thirds after retreatment. There were no significant differences between the groups or among the root canal thirds within each group (p>0.05). PUI with Endosolv R was not effective in the removal of filling debris from root canal walls.

O objetivo deste estudo foi investigar se a irrigação final com o solvente Endosolv R® e ultrassom promovia maior limpeza nas paredes do canal radicular durante o retratamento endodôntico. Um total de 56 dentes pré-molares extraídos foram instrumentados manualmente utilizandose a técnica escalonada e obturados com guta-percha e cimento AH Plus. Após nove meses, os canais foram retratados através da remoção da guta-percha e do cimento com Protaper Universal Retratamento e preparo rotatório com Sistema Protaper Universal até o instrumento F5. Após essa etapa, a amostra foi aleatoriamente dividida em quatro grupos (n=14) e os dentes submetidos à irrigação ultrassônica passiva (PUI) associada ao solvente Endosolv R ou à água destilada. Nos grupos controle, os irrigantes permaneceram sem agitação. Em seguida as raízes foram clivadas e examinadas sob microscopia eletrônica de varredura (MEV) para que a quantidade de material obturador remanescente nas paredes do canal fosse avaliada por dois examinadores treinados de forma cega. Os dados foram analisados através dos testes de Kruskal-Wallis e de Student-Newman-Keuls post hoc (α=0.05). Todos os grupos apresentaram resíduos de materiais obturadores nos três terços do canal radicular após o retratamento. Não houve diferenças significativas entre os grupos ou entre os terços dos canais em cada um dos grupos (p>0,05). Concluiu-se que PUI com Endosolv R não foi efetiva para a remoção de remanescentes de material obturador das paredes do canal radicular.

Influence of Endodontic Sealer Composition and Time of Fiber Post Cementation on Sealer Adhesiveness to Bovine Root Dentin

This study aimed to assess the influence of the type of endodontic sealer (salicylate resin-based sealer vs. two endodontic sealers) and the time of fiber post cementation after root filling on the post adhesion to bovine root dentin. Sixty bovine roots were assigned to six groups (n=10), considering an experimental design with two factors (factorial 3x2): endodontic sealer factor in three levels [epoxy resin-based sealer (AH Plus), eugenol-based sealer (Endofill), and salicylate resin-based sealer plus mineral trioxide aggregate - MTA (MTA Fillapex)] and time for post cementation factor in two levels (immediate post cementation or 15 days after root canal filling). After post cementation, 2-mm-thick slices were produced and submitted to push-out test. The failure modes were analyzed under a 40× stereomicroscope and scored as: adhesive at cement/dentin interface; adhesive at cement/post interface; cement cohesive; post cohesive; dentin cohesive; or mixed. Data were analyzed using two-way ANOVA and Tukey's post-hoc tests (α=0.05). When the fiber posts were cemented immediately after the root canal filling, the bond strengths were similar, independent of the endodontic sealer type. However, after 15 days, the epoxy resin-based sealer presented higher bond strength than the other sealers (p<0.05). Comparison between each sealer in different experimental times did not reveal any differences. The main failure type was adhesive at dentin/cement interface (89.4%). The time elapsed between the root canal filling and post cementation has no influence on post/root dentin adhesion. On the contrary, the type of endodontic sealer can influence the adhesion between fiber posts and root dentin.

Este estudo objetivou avaliar a influência do tipo de cimento endodôntico (um cimento à base de resina de salicilato e dois cimentos endodônticos) e do tempo decorrido entre a obturação do conduto e a cimentação do pino de fibra na adesão de pinos de fibra à dentina radicular bovina. Sessenta dentes bovinos foram divididos em seis grupos (n=10), considerando um desenho experimental de dois fatores (3x2): cimento endodôntico em três níveis [à base de resina epóxica (AH Plus), eugenol (Endofill) e resina de salicilato e MTA (MTA Fillapex)] e o tempo para cimentação em dois níveis (cimentação imediata e 15 dias pós a obturação). Após cimentação do pino de fibra, fatias com 2 mm de espessura foram obtidas e submetidas ao teste de push-out. Os padrões de falha foram analisados em estereomicroscópio (40×) e classificados em: adesiva na interface cimento/dentina, adesiva cimento/pino, coesiva do cimento, coesiva do pino, coesiva da dentina e mista. Os dados foram analisados através dos testes de ANOVA a dois fatores e post hoc de Tukey (α=0,05). Quando os pinos de fibra foram cimentados imediatamente após a obturação dos condutos, a resistência adesiva foi similar, independentemente do tipo de cimento endodôntico. Entretanto, após 15 dias, os dentes obturados com cimento resinoso à base de resina epóxica apresentaram os maiores valores de resistência adesiva (p<0,05). Os valores de resistência adesiva do mesmo cimento nos diferentes tempos experimentais não foram alterados. O principal tipo de falha foi adesiva na interface cimento/dentina (89,4%). O tempo decorrido entre a obturação dos condutos e a cimentação do pino não influenciou a adesão do pino de fibra à dentina radicular. Por outro lado, o tipo de cimento endodôntico influencia a adesão entre dentina radicular e pinos de fibra.

Carisolv as an endodontic irrigant in deciduous teeth: An SEM study.

Aim: Root canal irrigation plays an important role in the debridement and disinfection of the root canal system. "The purpose of this study was to evaluate the efficacy of Carisolv TM , 1% sodium hypochlorite (NaOCl) gel, and 1% NaOCl solution as root canal irrigants in deciduous anterior teeth." Materials and Methods: Thirty-six extracted deciduous anterior teeth were used. Root canals were flooded with NaOCl solution in Group A, NaOCl gel in Group B and Carisolv TM in Group C and incubated for 30 min. Scanning electron microscope photomicrographs of canal wall debris in the apical, middle and coronal thirds were scored. Results: The results showed that regardless of irrigation regime, canals were consistently cleaner in the coronal and middle thirds than in the apical thirds. NaOCl solution, NaOCl gel, and Carisolv TM had comparable activity at coronal third and middle third of root canals. At the apical third, NaOCl solution cleaned canals better than NaOCl gel and Carisolv TM . Carisolv TM cleaned debris better than NaOCl gel at the apical third. Conclusion: Carisolv TM can be used as an adjunct to root canal preparation.

Cleaning the apical third of curved canals after different irrigation protocols

This study evaluated the protocols of sonic and vacuum irrigation regarding the capacity of debris removal from root canal systems. Canal preparations were carried out on 30 mandibular first molars using the ProTaper Universal System. Teeth were divided into two experimental groups (n=15): Group 1: sonic irrigation and Group 2: vacuum irrigation protocol. Subsequently, the mesial roots were sectioned and observed by stereomicroscopy and scanning electron microscopy. Three independent examiners evaluated images of the apical thirds according to the following scores: 1= small presence of debris, 2= moderate presence of debris, and 3= dense presence of debris. Data were analyzed with ANOVA and Kruskal-Wallis tests (α=0.05). Comparison among the groups revealed that at the apical third, the root halves of Group 1 had significantly less surface debris (p=0.002) than those of Group 2. However, at 2 mm from the working length, Group 2's specimens showed less remaining debris in approximately 75% of the analyzed root canals. At the whole apical third, the sonic irrigation protocol removed significantly more debris than the vacuum protocol. However, in the region at 2 mm from the working length, the second irrigation method demonstrated a better performance.

Este estudo avaliou protocolos de irrigação sônica e a vácuo em relação à capacidade de remoção de debris do sistema de canais radiculares. Trinta primeiros molares mandibulares tiveram seus canais radiculares preparados pela utilização do Sistema ProTaper Universal. Os dentes foram divididos em dois grupos experimentais (n=15): Grupo 1: protocolo de irrigação sônica, e Grupo 2: protocolo de irrigação a vácuo. Posteriormente, as raízes mesiais foram seccionadas e observadas em lupa estereoscópica e microscopia eletrônica de varredura. Três examinadores independentes avaliaram as imagens do terço apical de acordo com as seguintes pontuações: 1. pequena presença de debris; 2: moderada presença de debris; e 3. densa presença de debris. Os dados foram analisados pelos testes estatísticos ANOVA e Kruskal-Wallis (α=0,05). A comparação entre os grupos revelou que, no terço apical, as hemissecções radiculares do Grupo 1 apresentaram debris remanescentes de forma significativamente menor (p=0,002) do que as do Grupo 2. No entanto, a 2 mm do comprimento de trabalho, as amostras do Grupo 2 mostraram menos debris remanescentes em aproximadamente 75% dos canais radiculares analisados. Considerando todo o terço apical, o protocolo de irrigação sônica removeu significativamente mais debris do que o protocolo de irrigação a vácuo. No entanto, na região a 2 mm do comprimento de trabalho, o segundo método de irrigação demonstrou um melhor desempenho.

Effect of light-activation with different light-curing units and time intervals on resin cement bond strength to intraradicular dentin

The aim of this study was to assess the bond strength of a resin cement to intraradicular dentin varying the light-curing unit and the moment at which the light was applied. Post spaces of endodontically treated canines were prepared. The roots were distributed into 6 groups (n=10) according to the light-curing unit and the moment of light exposure: I) Quartz tungsten halogen-600 mW/cm² (QTH) + immediate light activation (t0); II) QTH + light activation after 10 min (t10); III) Light-emitting diodes (LED)-800 mW/cm² (LED-800)+ t0; IV) LED-800 + t10; V) LED-1,500 mW/cm² (LED-1500)+ t0; VI) LED-1500 + t10. After post cementation, slices from coronal, middle and apical post/root regions were submitted to the push-out test and failure evaluation. It was verified that LED-800 (4.40 ± 3.00 MPa) and LED-1500 (4.67 ± 3.04 MPa) provided bond strength statistically superior to QTH (3.13 ± 1.76 MPa) (p<0.05), and did not differ from each other (p>0.05). There was no significant difference between t0 and t10 (p>0.05). Coronal post/root region (4.75 ± 3.10 MPa) presented significantly higher bond strength than the apical (3.32 ± 2.30 MPa) (p<0.05) and middle regions (4.14 ± 2.99 MPa) showed intermediate values. Adhesive failures were predominant when using QTH. Adhesive and mixed failures occurred more frequently in the apical region. Higher adhesion of the resin cement to intraradicular dentin was observed in the coronal region with LED light-activation, regardless of the moment of light exposure.

O objetivo deste estudo foi avaliar a resistência de união do cimento resinoso à dentina intrarradicular em função da fonte fotoativadora e do momento de aplicação da luz. Os espaços para cimentação dos pinos foram preparados em caninos tratados endodonticamente. As raízes foram distribuídas em seis grupos (n = 10) de acordo com a fonte fotoativadora e momento de exposição à luz: I) Luz halógena (LH) com densidade de potência 600 mW/cm² + fotoativação imediata (t0); II) LH + fotoativação após 10 min (t10); III) LED com densidade de potência 800 mW/cm² (LED-800)+ t0; IV) LED-800 + t10; V) LED com densidade de potência 1.500 mW/cm² (LED-1500)+ t0; VI) LED-1500 + t10. Após a cimentação dos pinos, slicesdas regiões cervical, média e apical foram submetidos ao teste de push-out e avaliação das falhas. Verificou-se que LED-800 (4,40 ± 3,00 MPa) e LED-1500 (4,67 ± 3,04 MPa) proporcionaram resistência de união estatisticamente superior à LH (3,13 ± 1,76 MPa) (p<0,05), e não diferiram entre si (p>0,05).Não houve diferença estatisticamente significante da resistência de união entre t0 e t10 (p>0,05). A região cervical (4,75 ± 3,10 MPa) apresentou maiores valores de resistência de união que a apical (3,32 ± 2,30 MPa) (p<0,05) e a região média (4,14 ± 2,60 MPa) mostrou valores intermediários. Falhas adesivas foram predominantes no grupo LH, independentemente da região pino/canal. A parte apical apresentou predomínio de falhas adesivas e mistas. Concluiu-se que a resistência de união do cimento resinoso à dentina intrarradicular foi maior no terço cervical,com fotoativação com LED, independente do momentode exposição à luz.

A SEM evaluation of dentinal adaptation of root canal obturation with GuttaFlow and conventional obturating material.

Objective: The aim of this in-vitro study was to compare dentinal adaptation of conventional obturating material and GuttaFlow in young permanent teeth of child patients. Materials and Methods: Ten young permanent anterior teeth with closed foramen were selected for the study. Root canal preparations were carried out using a step back technique. The canal was alternately irrigated with 5.25% sodium hypochlorite solution and 17% EDTA and normal saline. After root canal preparation specimens were randomly divided into two groups (n=5). GROUP "A": Obturated with zinc-oxide eugenol sealer and gutta-percha cone using cold lateral obturation technique. GROUP "B": Obturated with GuttaFlow as per the manufacturer's instruction. The teeth were split into two halves. Five randomly chosen longitudinal split teeth samples each from Group "A" and Group "B" was observed under scanning electron microscope to access the interface between obturating material and dentin at the level of 2 mm from the apex. Results: On statistical analysis the dentinal adaptation (μm) of Group A was observed with a mean of 0.52 and standard deviation 0.15, while the value of mean and standard deviation were noted 0.12 and 0.02 for Group B. The "t" value on comparison of Group A and Group B is 5.79 with "P " value of <0.001, which is highly significant. Conclusion: From result of the study it can be concluded Group B samples showed significantly superior seal when compared with Group A. Complete seal was not observed in any of Group A samples.

Root canal debris removal using different irrigating needles: An SEM study.

Aim: This study was carried out to compare the efficacy of three irrigating needle designs in removal of debris from different parts of the root canal. Materials and Methods: Thirty human maxillary canines were prepared using HERO Shaper rotary system and irrigated with 1 ml of 5.25% sodium hypochlorite (NaOCl) after each instrument change. Three 25-gauge irrigation needle designs - brush-covered Navi Tip FX (Group I), side-vented needle RC Twents (Group II) and single-beveled (Group III) irrigating needles - were tested for their efficiency in debris removal in three different parts of the root canal (n=10 canals per group). Following instrumentation, the roots were vertically sectioned and divided into coronal, middle and apical thirds for observation under scanning electron microscope (×200 magnification). Debris on the canal wall was evaluated by using a four-scale scoring system described by Paque and his co-workers. Results: The canals irrigated with brush-covered needle Navi Tip FX (Group I) showed lower average debris score, indicating greater removal of debris in coronal third as compared to middle and apical thirds, whereas the canals irrigated with side-vented needle (Group II) and single-beveled needle (Group III) exhibited lower average score in the middle third than coronal and apical thirds. All the three needle designs exhibited higher debris score in apical third of the root canal. Tukey multiple comparisons test was applied at a significance level of P>0.05. A statistically significant difference (P<0.05) was observed in the debris removal in the coronal and middle thirds of root canals irrigated with brush-covered Navi Tip FX (Group I) and side-vented (Group II) needles, respectively, when compared with other needle design groups. Conclusion: Within the limitations of this study, it can be concluded that all the needle designs tested were effective in certain regions of the root canal with apical third uncleaned. Side-vented needle by creating turbulence removed debris effectively in coronal and middle thirds.

Comparison of apical sealing and periapical extrusion of the ThermaFil obturation technique with and without MTA as an apical barrier: An in vitro study.

Aim: The aim of the study was to compare the conventional ThermaFil obturation technique and ThermaFil obturation with mineral trioxide aggregate (MTA) as an apical barrier, with regard to apical sealing and extrusion. Materials and Methods: Twenty extracted human canines were instrumented using a crown-down technique and divided into two groups. The experimental group was obturated using ThermaFil obturation with MTA as an apical barrier and the control group was obturated using the conventional ThermaFil obturation technique. AH Plus sealer was used in both the groups. Apical extrusion was recorded. Teeth of both the groups were coated with nail polish, except for the apical 3 mm. After 24 h, they were suspended in black India ink for 48 h. Canines were decalcified, rendered transparent, and linear dye penetration was measured under ×40 stereomicroscope. Results: There was a significant extrusion noticed in conventional ThermaFil obturation technique. Frequency of extrusion of sealer and/or gutta-percha was supposed to be evaluated using χ² test, but since the values of the samples of ThermaFil plus MTA group were zero, statistical analysis could not be conducted, whereas linear dye leakage was calculated with Mann-Whitney U test because the distribution was abnormal. Conclusion: Although ThermaFil plus MTA group showed microleakage, extrusion of sealer and the core material was prevented in comparison with conventional ThermaFil obturation technique. It is advantageous to use MTA as an apical plug as there is no fear of apical extrusion and the root canal system can then be packed three dimensionally against this barrier using any thermoplasticized gutta-percha obturation technique.

Comparación microscópica del barro dentinario residual en conductos radiculares, tras instrumentación rotatoria con y sin un quelante viscoso / A Microscopic Comparison of the Residual Smear Layer Remaining in Root Canals, after Rotary Instrumentation with and without a Viscous Chelator

Quelantes de consistencia viscosa son utilizados para ayudar la instrumentación en conductos muy estrechos, no obstante, podrían contribuir al acúmulo de más barro dentinario. El objetivo de este estudio fue comparar el barro dentinario residual tras instrumentar conductos radiculares, con y sin la utilización de un quelante viscoso. 39 incisivos inferiores extraídos fueron instrumentados con Protaper® y divididos en tres grupos. La irrigación de los grupos A y B fue con NaClO 5,25 por ciento entre cada lima. Al terminar la instrumentación se irrigó con EDTA 17 por ciento (1 minuto), luego con NaClO 5,25 por ciento y finalmente con suero fisiológico. Además, en el grupo A se utilizó un quelante viscoso entre cada lima. El grupo C sólo fue irrigado con suero fisiológico. Tres dientes no fueron instrumentados e irrigados (control negativo). Las raíces fueron seccionadas longitudinalmente y divididas en tercios para ser evaluadas bajo microscopía óptica. Los valores de detritus obtenidos fueron analizados con estadística no paramétrica (p<0,05). En cada tercio medio se encontraron valores muy bajos de barro dentinario, siendo iguales en todos los grupos. En cambio en el tercio apical de los grupos A y C se encontró significativamente más barro dentinario que en el grupo B. Conductos instrumentados con la ayuda de un quelante viscoso, acumularon significativamente más barro dentinario.

Viscous chelators are used to help the instrumentation of narrow root canals, however, they could contribute to greater accumulated smear layer. The aim of this study was to compare the smear layer generated following instrumentation with or without the application of a viscous chelator. 39 inferior incisors were instrumented with Protaper® and divided into three groups. Irrigation in group A and B was performed after each instrument was changed, irrigation was realized as follows: EDTA 17 percent (1 minute), then NaOCl 5.25 percent and a final rinse with physiologic saline solution. Also in group A, a viscous chelator was used between each file. Group C irrigation was performed only with physiologic saline solution. Three teeth were not instrumented and irrigated (negative control). The roots were then longitudinally grooved and sectioned by thirds for microscopic evaluation. The detritus score obtained was compared statistically using non-parametric test (p<0.05). In each third very low values of smear layer were found, and were the same in all three groups. In contrast, in the apical third of the groups A and C there was significantly more smear layer than in group B.

Effect of endodontic irrigating solutions on the microhardness and roughness of root canal dentin: An in vitro study.

Context: To evaluate the effect of widely used endodontic irrigating solutions on root dentin microhardness and surface roughness. Materials and Methods: One hundred twenty, non-carious extracted human permanent incisor teeth were selected. The crowns of the teeth were sectioned and the roots were separated longitudinally to get 240 specimens. These specimens were then divided into six groups according to the irrigating solutions used. The solutions used were 5% and 2.5% NaOCl solutions, 3% H2 O2 , 17% EDTA solution, 0.2% chlorhexidine gluconate, and distilled water. Then, the specimens were subjected to microhardness and roughness testing. The data were analyzed using ANOVA and Tukey's multiple comparison tests. Results: The results of this study indicated that all irrigation solutions, except 0.2% chlorhexidine gluconate, decreased the microhardness of root dentin, and 3% H2 O2 and 0.2% chlorhexidine gluconate had no effect on surface roughness. Conclusions: Within the limitation of this study, it is concluded that 0.2% chlorhexidine gluconate seems to be an appropriate irrigation solution, because of its harmless effect on the microhardness and surface roughness of root canal dentin.

A comparative evaluation of smear layer removal using two rotary instrument systems with ethylenediaminetetraacetic acid in different states: A SEM study.

Aim: The aim of the study was to evaluate the ability of 17% ethylenediaminetetraacetic acid (EDTA) solution and 19% EDTA gel to remove debris, and smear layer produced during root canal preparation with two NiTi files systems, Mtwo and Protaper. Materials and Methods: Twenty freshly extracted human anterior teeth with single root canal were collected. The crowns were sectioned at the cemento-enamel junction, and working length was measured. These samples were randomly divided into four groups of five samples each. In each group, 2ml of 3 % sodium hypochlorite solution was used with first instrument. The groupings were as follows. Group 1: 2 ml of 17% EDTA solution and 2 ml of 3% NaOCl were used alternatively each time a new file was employed. This group was prepared with Mtwo rotary files. Group 2: The samples in this group was prepared with Mtwo rotary files. EDTA gel (19%) was used and the samples were irrigated with 2 ml of 3% NaOCl. NaOCl and EDTA gel were used alternatively. Group 3: Five samples were prepared with Protaper file. Irrigation regime was the same as in Group 1. Group 4: Five samples were prepared with Protaper files and irrigation regime was the same as in Group 2. SEM study was done and the collected data were submitted for statistical analysis. Results: There was no statistically significant difference with the varied instruments used (Mtwo and Protaper files), and 17% EDTA solution and 19% EDTA gel. Conclusion: Both the NITI instruments produced a similar dentin surface on root canal wall when used with EDTA gel and EDTA solution.

Relationship between files that bind at the apical foramen and foramen openings in maxillary central incisors - a SEM study

Considering that instrumentation of the apical foramen has been suggested for root canal infection control, this study analyzed the relationship between the files that bind at the apical foramen and the foraminal openings in 50 maxillary central incisors. After preparation of the pulp chamber, access to the canal was obtained with #1 and 2 LA Axxess and K-files with tip cut were inserted up to the apical foramen until binding was felt. The files were fixed with methyl cyanoacrylate and the tooth-file sets were cross-sectioned 10 mm short of the apex. Scanning electron microscopic analysis was carried out and files and foraminal areas were measured using Image Tool software. Statistically significant difference (p<0.0001) was found between files and the apical foraminal areas. The mean foraminal area was 3.8 times larger than the mean file area. The results of this study suggest that it would require 4 files of greater size beyond the one that bound to the foramen in order to allow a better relationship between files and apical openings of maxillary central incisors.

Uma vez que a instrumentação do forame apical tem sido sugerida para o controle de infecção do canal radicular, este estudo analisou a relação entre as limas que se ajustam no forame apical e a abertura foraminal em cinquenta incisivos centrais superiores. Após o preparo da câmara pulpar, foi feito o acesso radicular com as brocas LA Axxess #1 e 2 e limas K com a ponta cortada foram inseridas até que oferecessem a sensação tátil de ajuste no forame apical. Foram fixadas com cianoacrilato de metila e o conjunto dente-lima foi seccionado a 10 mm aquém do ápice. Foi feita a microscopia eletrônica de varredura e as áreas das limas e dos forames foram medidas por meio do Image Tool software. A análise estatística demonstrou diferença significante entre as áreas das limas e dos forames (p<0,0001). A média da área dos forames apicais foi 3,8 vezes maior que a das limas. Os resultados deste estudo sugerem que seriam necessários 4 instrumentos de calibre maior além do que se ajustou para que haja melhor relação entre as limas e as aberturas foraminais nos incisivos centrais superiores.

Regional bond strengths to root canal dentin of fiber posts luted with three cementation systems

This study evaluated the influence of the cementation system on the regional push-out bond strength and failure pattern of fiber posts to radicular dentin. The roots of 48 extracted human incisors were prepared and divided into 3 groups (n=16), according to the cementation system: AdperScotchbond Multi-Purpose + resin cement RelyX ARC (SBMP+ARC); Adper SingleBond 2 + RelyX ARC (SB+ARC) and; RelyX U100 self-adhesive resin cement (U100). The posts were cemented as per manufacturer’s instructions for each cementation system. After 1 week, the roots were sectioned transversely into 6 discs. Two discs were obtained from the cervical, middle and apical thirds and the push-out test was carried out. The failure pattern was examined on all debonded specimens. The data were analyzed by two-way repeated measures ANOVA and Tukey’s test. When U100 was used, no statistically significant difference (p>0.05) was observed among the different root regions. Statistically higher push-out bond strength values were detected in the cervical third for SBMP+ARC and SB+ARC (p<0.05). The U100 showed significantly more mixed failures than SBMP+ARC in the apical third (p<0.05). In conclusion, the self-adhesive cement RelyX U100 was the only cement not sensitive to the root canal region.

Esse estudo avaliou a influência do sistema de cimentação na resistência de união regional e os padrões de fratura de pinos de fibra à dentina radicular. As raízes de 48 incisivos humanos extraídos foram preparadas e divididas em 3 grupos (n=16) de acordo com o sistema de cimentação: AdperScotchbond Multi-Purpose + cimento resinoso RelyX ARC (SBMP+ARC); AdperSingle Bond 2 + RelyX ARC (SB+ARC) e cimento resinoso autoadesivo RelyX U100 (U100). Os pinos foram cimentados conforme as recomendações dos fabricantes para cada sistema de cimentação. Após uma semana, as raízes foram seccionadas transversalmente em 6 discos. Dois discos foram obtidos para os terços coronário, médio e apical e o teste de push-out foi realizado. O padrão de fratura foi avaliado em todos os espécimes. Os dados obtidos foram analisados através dos testes ANOVA dois fatores e Tukey. Quando o cimento U100 foi testado, não foram observadas diferenças significativas (p>0,05) entre as diferentes regiões radiculares. Valores de resistência de união significativamente superiores foram encontrados no terço coronário para SBMP+ARC e SB+ARC (p<0,05). O U100 apresentou significativamente mais fraturas mistas que o SBMP+ARC no terço apical (p<0,05). Conclui-se que o cimento resinoso autoadesivo RelyX U100 foi o único cimento não afetado pela região do canal radicular.

Nd:YAG laser irradiation effect on apical intracanal dentin - a microleakage and SEM evaluation

The purpose of this in vitro study was to evaluate the effect of neodymium:yttrium-aluminum-garnet (Nd:YAG) laser irradiation on intracanal dentin surface by SEM analysis and its interference in the apical seal of filled canals. After endodontic treatment procedures, 34 maxillary human incisors were randomly assigned to 2 groups. In the negative control group (n=17), no additional treatment was performed and teeth were filled with vertically condensed gutta-percha; in the laser-treated group (n=17), the root canals were irradiated with Nd:YAG laser (1.5 W, 100 mJ, 15 Hz) before filling as described for the control group. Two specimens of each group were prepared for SEM analysis to evaluate the presence and extent of morphological changes and removal of debris; the other specimens were immersed in 0.5 percent methylene blue dye (pH 7.2) for 24 h for evaluation of the linear dye leakage at the apical third. SEM analysis of the laser-treated group showed dentin fusion and resolidification without smear layer or debris. The Student’s t-test showed that the laser-treated group had significantly less leakage in apical third than the control group. Within the limitations of this study, it may be concluded that the morphological changes on the apical intraradicular dentin surface caused by Nd:YAG laser resulted in less linear dye apical leakage.

Apical microleakage and SEM analysis of dentin surface after 980 nm diode laser irradiation

This study evaluated the effect of 980-nm diode laser on apical microleakage and intraradicular dentin morphology. Roots of 110 mandibular incisors were used in the study: 92 for microleakage test and 18 for scanning electron microscopy (SEM). Roots were randomly assigned to 3 groups according to the irrigating solution (water, NaOCl and NaOCl/EDTA) and were divided into 3 subgroups according to the laser irradiation protocol (without irradiation, irradiated at 1.5 W and irradiated at 3.0 W). Two specimens of each subgroup were prepared for SEM. The remaining roots were filled with AH Plus and gutta-percha. Apical leakage was assessed by ink penetration and data were analyzed statistically by ANOVA and Tukey-Krammer test (α=0.05). SEM analysis showed intensification of changes with increase of laser power as well as variations according to the irrigating solution. Modified smear layer was observed in specimens treated with water and irradiated with laser. Roots irrigated with NaOCl/EDTA had lower levels of infiltration (0.17 ± 0.18 mm) differing significantly (p<0.05) from those of roots irrigated with water (0.34 ± 0.30 mm), but similar (p>0.05) to those irrigated with NaOCl (0.28 ± 0.29 mm). Non-irradiated roots had lower levels of infiltration (0.10 ± 0.14 mm), differing (p<0.05) from those irradiated at 1.5 W (0.32 ± 0.22 mm) and 3.0 W (0.37 ± 0.32 mm). The 980 nm diode laser modified dentin morphology and increased apical microleakage.

Este estudo avaliou o efeito do laser de diodo 980 nm na microinfiltração apical e na morfologia intrarradicular da dentina. Raízes de 110 incisivos inferiores foram utilizadas no estudo: 92 para o teste de microinfiltração e 18 para microscopia eletrônica de varredura (MEV). As raízes foram divididas em 3 grupos de acordo com a solução irrigante (água, NaOCl e NaOCl/EDTA) e subdivididas em 3 de acordo com a irradiação laser (sem irradiação, irradiados com 1,5 W e irradiados com 3,0 W). Duas amostras de cada subgrupo foram preparadas para MEV. As raízes restantes foram preenchidas com AH Plus e guta percha. A infiltração apical foi avaliada nas raízes por meio da penetração do corante e os dados foram analisados por ANOVA e teste de Tukey-Krammer (α=0,05). Os resultados da MEV mostraram intensificação das mudanças quando se aumentou a potência do laser e variações de acordo com a solução irrigadora. Camada de smear modificada foi observada em espécimes tratados com água e irradiados com laser. Raízes irrigadas com NaOCl/EDTA tiveram níveis menores de infiltração (0,17 ± 0,18 mm) estatisticamente diferente (p<0,05) das raízes irrigadas com água (0,34 ± 0,30 mm), mas semelhante (p>0,05) aos irrigados com NaOCl (0,28 ± 0,29 mm). As raízes não irradiadas tiveram níveis menores de infiltração (0,10 ± 0,14 mm), diferente (p<0,05) de 1,5 W (0,32 ± 0,22 mm) e 3.0 W (0,37 ± 0,32 mm). O laser de diodo 980 nm alterou a morfologia da dentina e aumentou a infiltração marginal apical.

Effect of endodontic sealer and resin luting strategies on pull-out bond strength of glass fiber posts to dentin

The aim of this study was to evaluate the influence of eugenolcontaining endodontic sealers and luting strategy on the pull-out bond strength of glass fiber posts to dentin. Sixty-four bovine incisors were randomly assigned into two groups of 32 specimens each for obturation procedure with gutta-percha only, or with Pulp Canal Sealer EWT. Subsequently, the roots were prepared for the fiber post Reforpost and all specimens of each endodontic sealing procedure were allocated to four groups (n=8), according to the strategies for post cementation: A) Single Bond 2 and RelyX ARC; B) All Bond 2 and C&B cement; C) All Bond 2 and RelyX ARC; D) Single Bond 2 and C&B Cement. The posts were cemented immediately after the endodontic treatment. The pull-out test was performed at a cross-head speed of 0.5 mm/min in a universal testing machine (EMIC). Data (Kgf) were submitted to a two-way ANOVA and Tukey test (p ≤ 0.05). The eugenol-based sealer did not influence the pull-out bond strength of fiber posts regardless of the luting strategy. RelyX ARC showed higher bond strength than C&B Cement when used with Single Bond 2 adhesive system, when the eugenol-based sealer was present. All Bond 2, when associated to all cements studied, promoted similar bond strength, regardless of the eugenol-containing endodontic sealer. In conclusion, eugenolcontaining sealer did not influence the pull-out bond strength values of the resin luting systems for glass fiber post cementation. The bond system and resin cement association from the same manufacturer had similar bond strength values for dentin.

O objetivo desse estudo foi avaliar a influencia de cimentos endodonticos a base de eugenol e estrategia de cimentacao resinosa na resistencia a tracao de pinos de fibra de vidro a dentina. Sessenta e quatro incisivos bovinos foram aleatoriamente divididos em dois grupos com 32 especimes para cada procedimento de obturacao, com o cimento a base de eugenol Pulp Canal Sealer EWT ou somente com guta percha pela tecnica termoplastificada. Apos, realizou-se o prepare do conduto radicular para o pino de fibra Reforpost e posteriormente, as amostras de cada procedimento obturador foram separadas em quarto grupos (n=8), considerando as estrategias para cimentacao do pino: A) Adper Single Bond 2 e RelyX ARC; B) All Bond 2 e C&B cement; C) All Bond 2 e RelyX ARC; D) Adper Single Bond 2 e C&B Cement. Os pinos foram imediatamente cimentados apos o tratamento endodontico. Dessa maneira, o teste de pull-out foi realizado a uma velocidade de 0.5 mm/min em maquina de ensaio universal (EMIC DL2000). Os dados (Kgf) A analise estatistica foi realizada pelos testes ANOVA de dois fatores e teste de Tukey (p ≤ 0.05). O cimento endodontico contend eugenol nao influenciou a resistencia de uniao a tracao (pull-out) dos pinos de fibra, independente da estrategia de cimentacao. O RelyX ARC ofereceu maior resistencia de uniao do pino a dentina, comparado ao C&B Cement quanto utilizado com o Adper Single Bond 2, na presenca do cimento endodontico contendo eugenol. O All Bond 2 quando associado a todos os cimentos estudados promoveram uma resistencia de uniao semelhante, independente do conteudo de eugenol na cimentacao endodontica. Em conclusao, o cimento endodontico a base de eugenol nao influenciou na resistencia a tracao de pinos de fibra a dentina. A associacao de sistema adesivo e cimento resinoso do mesmo fabricante apresentou valores de resistencia de uniao semelhantes na cimentacao de pinos de fibra.

Effect of aquatine endodontic cleanser on smear layer removal in the root canals of ex vivo human teeth

OBJECTIVES: The purpose of this study was to measure and compare the root canal cleanliness and smear layer removal effectiveness of Aquatine Endodontic Cleanser (Aquatine EC) when used as an endodontic irrigating solution in comparison with 6 percent sodium hypochlorite (NaOCl). MATERIAL AND METHODS: Forty-five human teeth were randomly allocated to five treatment groups; the pulp chamber was accessed, cleaned, and shaped by using ProTaper and ProFile rotary instrumentation to an ISO size #40. The teeth were then processed for scanning electron microscopy, and the root canal cleanliness and removal of smear layer were examined. RESULTS: The most effective removal of smear layer occurred with Aquatine EC and NaOCl, both with a rinse of EDTA. CONCLUSIONS: Aquatine EC appears to be the first hypochlorous acid approved by the FDA to be a possible alternative to the use of NaOCl as an intracanal irrigant. Further research is needed to identify safer and more effective alternatives to the use of NaOCl irrigation in endodontics.