Cirurgia paraendodôntica com retro-obturação utilizando MTA Repair HP®: análise tomográfica longitudinal prospectiva de dois casos clínicos / Periradicular surgery with retrofilling by MTA Repair HP® having concomitant cone beam computed tomography follow-up analysis: case series repor

Objetivo: Avaliar tomograficamente, em dois casos clínicos, o efeito da nova formulação do MTA, o MTA Repair HP, na contribuição para a remissão de lesões periapicais em cirurgias paraendodônticas, bem como a sua manipulação e as suas propriedades físicas. Relatos de caso: Paciente R.C.R., 57, reportou-se à Faculdade de Odontologia da Universidade Federal de Juiz de Fora para avaliação de lesão periapical no elemento 11. Ao exame radiográfico, observou-se tratamento endodôntico e uma área radiolúcida, unilocular, circunscrita envolvendo o ápice dentário. Solicitou-se um exame de TCFC (I-Cat®, Imaging Sciences International, Hatfield, Pensilvânia, EUA), no qual foi confirmada a presença da lesão com rompimento da cortical óssea vestibular. Foram realizadas apicectomia, curetagem, retropreparo pela Técnica Clássica, e retroobturação com o novo material. Realizaram-se tomografias nos momentos pós-operatórios de três e cinco meses. Paciente R.J.G.M., 46, relatava dor, aumento de volume intraoral e drenagem de secreção purulenta na arcada superior esquerda. Aos exames clínico e radiográfico, observou-se presença de fístula e lesão refratária ao tratamento endodôntico no dente 25. Realizou-se TCFC, na qual pode-se observar a presença de uma área hipodensa circunscrita, envolvendo o ápice do 25, com rompimento da cortical óssea vestibular. Foi proposto o mesmo tratamento descrito no caso anterior. Para o acompanhamento foram realizadas novas tomografias nos mesmos tempos pós-operatórios do caso anterior. Discussão: O MTA Repair HP surgiu da necessidade de um material mais biocompatível com as estruturas dentárias no procedimento de obturação retrógrada. Este produto auxilia na regressão de lesões periapicais e na formação dos componentes do periodonto e apresenta como vantagens, o maior tempo de presa, não provocar o escurecimento coronário e maior facilidade na manipulação. Conclusão: Conclui-se que houve formação de tecido calcificado no decorrer dos tempos de três e cinco meses. Em relação à manipulação do material, não foi observada melhora pela adição de agente plastificante. Contudo, observou-se um tempo de presa menor do que o esperado, dificultando a inserção do material

Aim: To evaluate, tomographically, in two clinical cases, the effect of the new MTA formulation of the Angelus, the MTA Repair HP, in the contribution to remission of periapical lesions in paraendodontic surgery, as well its physical properties and manipulation. Case report: Patient R.C.R, 57, attended at the Faculty of Dentistry of the Federal University of Juiz de Fora for evaluation of periapical lesion in the element 11. It was observed, at the clinical and radiographic exams, endodontic treatment and a circumscribed, unilocular and radiolucid area at the apex of the tooth. It was requested a CBCT exam (I-Cat®, Imaging Sciences International, Hatfield, Pennsylvania, USA), which confirmed the presence of the lesion and rupture of the buccal cortical plate. Thus, it was performed curettage, apicectomy, retropreparation and retrofilling with the described cement. It was solicited two additional CBCT exams at the period of three and five months post-operative. Patient R.J.G.M, 46, with mean complain of pain, increased intraoral volume and purulent discharged in the upper left arch. The clinical and radiographic exams revealed fistu-la and refractory lesion, despite the endodontic treatment of the tooth 25. A CBCT exam was done and it was observed a circumscribed hypodense area, around the apex of the 25, with rupture of the buccal cortical plate. It was suggested the same surgical treatment described in the case above. It was performed two more CBCT exam, at three and five months after the procedure. Discussion: The MTA Repair HP was developed from the necessity of a more biocompatible material with the dental structures in the retrograde filling process. This product helps in the remission of periapicals lesions and in the new formation of the periodontum components; also it has the advantages of longer set-ting time, not causing the darkening of the coronary portion and easier manipulation. Conclusion:Regarding the remission of the lesions, it was noticed the generation of calcified tissue across the periods of three and five months. Regarding the manipulation and application, it was not observed any improvement related to the addition of the plasticizer. However, it was noticed a shorter setting time, making it difficult to insert the material.

Sellado apical de dos materiales de obturación retrógrada en dientes unirradiculares / Apical sealing of two root-end filling materials in unirradicular teeth

Objetivo: Comparar la capacidad de sellado de dos materiales para obturación retrógrada en dientes permanentes unirradiculares: el agregado de trióxido mineral (MTA®) y el silicato tricálcico (Biodentine®). Materiales y métodos: Se seleccionaron 38 dientes permanentes unirradiculares con cierre apical completo, los cuales fueron divididos aleatoriamente en dos grupos experimentales (n = 15): Grupo 1: MTA®, Grupo 2: Biodentine®. Además, se usaron controles positivos y negativos. El tratamiento radicular se realizó con el sistema rotatorio Mtwo y la obturación mediante el sistema termoplástico de onda continua (Beefill), y se usó como sellador el cemento tipo Grossman. Se realizó la apicectomía del extremo apical, luego la preparación de cavidades retroapicales estandarizadas y las respectivas obturaciones con MTA® y Biodentine®, según grupo. Posteriormente, los especímenes se sometieron a un proceso de filtración apical de tinta china y de transparentación, mientras que la filtración apical fue evaluada por medio de un microscopio estereoscópico. Los datos fueron analizados con la prueba U de Mann-Whitney. Resultados: El análisis inferencial mostró que Biodentine® tuvo una menor microfiltración que el MTA®, con una diferencia estadísticamente significativa al 95% (p < 0,034). Conclusión: El cemento Biodentine® mostró una mayor capacidad de sellado a nivel apical que el cemento MTA® en obturaciones retrógradas de dientes unirradiculares ex vivo. (AU)

Aim: To compare the sealing capacity of mineral trioxide (MTA®) and tricalcium silicate (Biodentine®) for retrograde filling in single-root permanent teeth. Materials and methods: Thirty-eight permanent single-root teeth with complete apical closure were selected and randomly divided into two experimental groups (n = 15): Group 1: MTA®, and Group 2: Biodentine®, in addition to positive and negative controls. Root treatment was performed with the MTWO rotary system, and obturation was carried out by means of the continuous wave thermoplastic system (Beefill) using Grossman-type cement as a sealant. Apical end apicoectomy was performed followed by the preparation of standardized retro-apical cavities and the respective fillings with MTA ® and Biodentine® according to the study group. Subsequently, the specimens were subjected to an apical filtration process of Chinese ink and transparency, while the apical filtration was evaluated with a stereoscopic microscope. The data were analyzed with the Mann-Whitney U test. Results: Inferential analysis showed that Biodentine® had less microleakage than MTA® with a statistically significant difference of 95% (p <0.034). Conclusion: Biodentine® cement showed greater apical sealing capacity than MTA® cement in retrograde fillings of single-root teeth ex vivo. (AU)

Evaluación de la citotoxicidad de Biodentine, IRM y MTA en cultivos de fibroblastos del ligamento periodontal humano / An evaluation of the cytotoxicity of Biodentine, IRM and MTA in cultures of human periodontal ligament fibroblasts

Introducción: Los materiales para la obturación retrógrada son diversos. Actualmente, IRM y MTA son las alternativas clínicas más utilizadas, no obstante, es relativamente reciente la introducción de materiales a base de silicatos tricálcicos tal como Biodentine. Objetivo: Determinar la citotoxicidad de fibroblastos del ligamento periodontal humano expuestos a medios de cultivo condicionados con Biodentine, IRM y MTA. Material y métodos: 1 × 103 fibroblastos del ligamento periodontal humano fueron expuestos a medios DMEM/F12 condicionados con MTA, IRM y Biodentine en tres protocolos diferentes. Se realizó un ensayo de MTT para determinar la viabilidad celular a las cero, 24, 48, 72 horas, siete y 14 días. Se realizó una prueba ANOVA (p < 0.05). Resultados: En los tres protocolos con los diferentes medios de cultivo condicionados, la viabilidad de las células fue predominantemente proliferativa; sin embargo, las células expuestas a Biodentine mostraron una tendencia mayor que la MTA o la IRM. Conclusión: Las células expuestas a la Biodentine mostraron un comportamiento proliferativo a los 14 días de análisis. Se debe realizar más investigación a nivel in vivo y clínico para obtener más información sobre la conducta de estos materiales empleados para la obturación retrógrada (AU)

Introduction: The materials for retrograde filling are diverse. Currently, IRM and MTA are the most commonly used clinical alternatives, however, the introduction of materials based on tricalcium silicates such as Biodentine is relatively recent. Objective: To determine the cytotoxicity of human periodontal ligament fibroblasts exposed to culture media conditioned with Biodentine, IRM and MTA. Material and methods: 1 × 103 fibroblasts of the human periodontal ligament were exposed to DMEM/F12 media conditioned with MTA, IRM and Biodentine in 3 different protocols. An MTT assay was performed to determine cell viability at 0, 24, 48, 72 hours, seven and 14 days. An ANOVA test was performed (p < 0.05). Results: In the three protocols with the different conditioned culture media, the viability of the cells was predominantly proliferative, however, the cells exposed to Biodentine showed a higher tendency than the MTA or the IRM. Conclusion: The cells exposed to the Biodentine showed a proliferative behavior at 14 days of analysis. More research should be done at in vivo and clinical level to obtain more information about the behavior of these materials used for retrograde filling (AU)

Evaluation of the dislodgement resistance of bioceramic reparative cements placed in a retrograde cavity using a different technique

Aim: Calcium silicate-based fillings have been widely used in surgical endodontic treatment because of hard-tissue conductive and inductive properties. The aim of present study is to investigate the bond strength of different calcium silicate-based fillings in retrograde cavities. Methods: Forty-four maxillary single rooted teeth were endodontically treated. The apical portions of the teeth were removed and root-end cavities were prepared using an ultrasonic tip. The roots were randomly divided into four experimental groups (n = 11) according to the material used; (1) MTA-FILLAPEX, (2) MTA Repair HP, (3) MTA-FILLAPEX+ MTA Repair HP, and (4) MTA Plus. Two horizontal cross sections (1±0.1 mm thick) from each specimen were resected from the apices. These sections were placed in a universal testing machine to evaluate the push-out bond strength force required for dislodgement of the root end filling was recorded. The failure type was also evaluated by using a stereomicroscope. The differences in bond strength were analyzed using the two-way analysis of variance (ANOVA). Results: MTA-FILLAPEX and MTA Plus displayed the lowest and highest dislocation resistance, respectively (P < 0.05). In the apical level, bond strength was significantly higher than the coronal level in all groups except for MTA-FILLAPEX. Mixed failure was prevalent in all groups, except for MTA-FILLAPEX, which showed purely cohesive failures. Conclusions: Investigated calcium silicate-based filling materials showed different bond strength to the root-end cavity. The bond strength was significantly decreased when the prior application of MTA-FILLAPEX before delivery of MTA Repair HP

Effect of ultrasonic agitation on push-out bond strength and adaptation of root-end filling materials

OBJECTIVES: This study evaluated the effect of ultrasonic agitation of mineral trioxide aggregate (MTA), calcium silicate-based cement (CSC), and Sealer 26 (S26) on adaptation at the cement/dentin interface and push-out bond strength. MATERIALS AND METHODS: Sixty maxillary canines were divided into 6 groups (n = 10): MTA, S26, and CSC, with or without ultrasonic activation (US). After obturation, the apical portions of the teeth were sectioned, and retrograde cavities were prepared and filled with cement by hand condensation. In the US groups, the cement was activated for 60 seconds: 30 seconds in the mesio-distal direction and 30 seconds in the buccal-lingual direction, using a mini Irrisonic insert coupled with the ultrasound transducer. After the materials set, 1.5-mm thick sections were obtained from the apexes. The presence of gaps and the bond between cement and dentin were analyzed using low-vacuum scanning electron microscopy. Push-out bond strength was measured using a universal testing machine. RESULTS: Ultrasonic agitation increased the interfacial adaptation of the cements. The S26 US group showed a higher adaptation value than MTA (p < 0.05). US improved the push-out bond strength for all the cements (p < 0.05). CONCLUSIONS: The US of retrograde filling cements enhanced the bond to the dentin wall of the root-end filling materials tested.

Análise comparativa da adaptação marginal, infiltração microbiana e da citotoxicidade em ápices retrobturados com os cimentos Palacos-R e MTA / Comparative analysis of marginal adaptation, microbial leakage and cytotoxicity in apices in retrofills with cements Palacos-R and MTA

O sucesso do tratamento endodôntico está relacionado com uma adequada limpeza, modelagem e um bom selamento do sistema de canais radiculares. A cirurgia parendodôntica é um procedimento que tem como finalidade resolver problemas que não puderam ser solucionados pelo tratamento endodôntico convencional nem pelo retratamento. Essas cirurgias são realizadas através da exposição e remoção dos ápices radiculares, confecção de retrocavitações no longo eixo dos canais radiculares e retrobturações com materiais seladores específicos. Sendo assim, o presente trabalho teve o objetivo de realizar um estudo comparativo dos cimentos MTA (Agregado Trióxido Mineral) e Palacos-R (cimento ósseo) nas retrobturações endodônticas através da avaliação da adaptação marginal, da infiltração microbiana e da citotoxicidade. Para avaliação da adaptação marginal e da capacidade seladora pelo método da infiltração microbiana, foram selecionados 48 caninos superiores permanentes humanos extraídos, instrumentados e obturados. As apicetomias para a remoção dos 3mm apicais das raízes foram realizadas com a utilização da ponta ultrassônica diamantada CVD DENTUS 8.1117. Os retropreparos foram confeccionados com pontas ultrassônicas diamantadas CVD DENTUS 6.1107-E, com 4mm de profundidade. As 28 amostras foram retrobturadas com o cimento ósseo Palacos-R (HERAEUS KULZER) e o cimento MTA cinza (ANGELUS), num total de 14 espécimes para cada cimento testado. A avaliação da adaptação marginal foi realizada pela microscopia eletrônica de varredura (MEV) com 8 dentes (4 para cada cimento retrobturador). A capacidade seladora foi analisada através de ensaios de infiltração bacteriana com Enterococcus faecalis (ATCC 29212), com 10 dentes para o grupo do Palacos-R, 10 dentes para o grupo do MTA cinza, 10 dentes para o grupo controle positivo e 10 dentes para o grupo controle negativo. A avaliação da citotoxicidade foi feita com os eluatos dos cimentos pelo teste MTT, com fibroblastos gengivais de camundongos (células L929). A análise ao MEV mostrou uma melhor adaptação do Palacos-R aos retropreparos do que o MTA cinza. Apesar do Palacos-R ter obtido os menores índices numéricos de infiltração bacteriana, não houve diferença estatisticamente significativa entre ambos. Os dois cimentos não demonstraram atividade citotóxica sobre células L929, contudo nos extratos duplamente concentrados o cimento Palacos-R foi menos citotóxico do que o MTA cinza (P< 0.0001). Pôde-se concluir que o Palacos-R apresentou uma melhor adaptação marginal do que o MTA cinza ao MEV, que não houve diferença entre o Palacos-R e o MTA quanto à infiltracao microbiana e a citotoxicidade tornando-o um material retrobturador promissor a ser utilizado em Endodontia

The success of endodontic treatment is related to a proper cleaning, and a good seal of root canal system. Paraendodôntic surgery is a procedure that aims to solve problems that couldn't be solved by conventional endodontic treatment. These surgeries are performed by exposing and removing the root tips, making retrocavitations on the long axis of the root canals, and retrofilling with specific sealant materials Thus, the present work had the objective of performing a comparative study of MTA (Mineral Trioxide Aggregate) and Palacos-R (bone cement) cements in endodontic retrofillings through the evaluation of marginal adaptation, microbial infiltration and cytotoxicity. To evaluate the marginal adaptation and the sealing ability by the microbial infiltration method, 48 human permanent upper canines were selected, instrumented and obturated. The apicetomies for removal of the apical 3mm from the roots were performed using the diamond ultrasound tip CVD DENTUS 8.1117. The retroprepares were made with ultrasonic CVD DENTUS 6.1107-E diamond tips, 4mm deep. The 28 samples were retrobured with the Palacos-R (HERAEUS KULZER) cement and the gray MTA cement (ANGELUS), in a total of 14 specimens for each cement tested. The evaluation of the marginal adaptation was performed by scanning electron microscopy (SEM) with 8 teeth (4 for each retroburst cement). Sealing capacity was analyzed through bacterial infiltration assays with Enterococcus faecalis (ATCC 29212), with 10 teeth for the Palacos-R group, 10 teeth for the gray MTA group, 10 teeth for the positive control group and 10 teeth for the the negative control group. Cytotoxicity evaluation was performed with the eluates of the cements by the MTT test, with mouse gingival fibroblasts (L929 cells). The SEM analysis showed a better adaptation of the Palacos-R to the retroprepares than the gray MTA. Although Palacos-R had the lowest numerical rates of bacterial infiltration, there was no statistically significant difference between the two. The two cements did not demonstrate cytotoxic activity on L929 cells, however in the doubly concentrated extracts the Palacos-R cement was less cytotoxic than the gray MTA (P <0.0001). It was concluded that the Palacos-R presented a better marginal adaptation than the gray MTA to the SEM, that there was no difference between the Palacos-R and the MTA in terms of microbial infiltration and cytotoxicity, making it a promising retrofilling material to be used in Endodontics

Tratamiento de las várices gástricas con cianoacrilato, experiencia institucional / Institutional Experience with Cyanoacrylate Treatment of Gastric Varices

La principal causa de hemorragia de vías digestivas altas es la enfermedad ulcerosa del estómago y/o duodeno (Enfermedad ulceropéptica). Cada vez y con mayor frecuencia se presentan pacientes con sangrado originado en várices gástricas, quizás debido al número creciente de pacientes que las presentan como una secuela de la hipertensión portal causada a su vez por problemas hepáticos, especialmente por la cirrosis. Las opciones actuales de tratamiento de las várices gástricas incluyen desde métodos preventivos o profilácticos, hasta los propiamente terapéuticos mediante el uso de medicamentos (vasopresina, somatostatina y sus análogos), las derivaciones portosistémicas transyugulares (TIPS, por sus siglas en inglés) los métodos endoscópicos y la cirugía. Los métodos endoscópicos incluyen el uso de bandas y de inyección de sustancias esclerosantes, o de sustancias obturativas como el N-Butyl-2-cianoacrilato (Histoacryl®). Desde hace poco tiempo, y basados en la literatura cada vez con mejores niveles de evidencia y grados de recomendación, hemos empezado a usar el cianoacrilato en la Clínica Universitaria Colombia. Presentamos nuestra casuística y realizamos una revisión del tema

The main causes of upper digestive tract bleeding are ulcers in the stomach and/or duodenum (peptic ulcer disease). With increasing frequency, patients are being seen who have bleeding gastric varices. This may be due to the increasing number of patients who have portal hypertension caused in turn by liver problems, especially cirrhosis. Current options for treatment of gastric varices range include preventive and prophylactic methods. These include therapy using drugs including vasopressin, somatostatin and their analogs, transjugular intrahepatic portosystemic shunts (TIPS) endoscopic methods and surgery. Endoscopic methods include the use of bands and injection sclerotherapy and sealants such as N-Butyl-2-cyanoacrylate (Histoacryl ®). Recently, on the basis of literature with increasingly higher levels of evidence and recommendations, we have started using cyanoacrylate at the Clínica Universitaria Colombia. We present our cases and we review the issue.

Materiais usados em retro-obturações: comparação entre cimento de ionômero de vidro fotopolimerizável e cimento de portland / Materials used in retrograde obturations: comparison between light-cured glass ionomer and Portland cement

O objetivo deste estudo foi comparar, por meio de um teste in vitro, se ocorre infiltração ou não pelo corante azul de metileno a 0,2% em retro-obturações seladas com cimento ionômero de vidro fotopolimerizável e cimento Portland. Quarenta dentes unirradiculares receberam tratamento endodôntico convencional. As coroas foram removidas com um corte na junção cemento-esmalte, perpendicular ao longo eixo do dente e um corte horizontal de 2 a 3 mm do ápice. As raízes foram revestidas externamente, com duas camadas de esmalte de unha. Foi realizada uma cavidade apical para retro-obturação dos condutos. A amostra foi dividida em 2 grupos: Grupo 1 - isolamento apical com cimento de ionômero de vidro fotopolimerizável e Grupo 2 - isolamento com cimento Portland. Logo após a realização da obturação retrógrada, as amostras foram submetidas à imersão parcial em corante azul de metileno a 0,2% de pH neutro, durante 24 horas. As amostras foram lavadas em água corrente por 12 horas e 10 dias de secagem. Depois, as raízes foram seccionadas longitudinalmente no sentido mésio-distal e observadas por 2 examinadores independentes, com o auxílio de uma lupa com aumento de duas vezes. Foi utilizado o teste estatístico qui-quadrado para verificar as hipóteses. No total de 20 dentes retro-obturados com ionômero, apenas 1 deles foi infiltrado. Entretanto, com relação ao cimento Portland, em 18 dentes, houve infiltração com azul de metileno 0,2%. Nesse teste in vitro, os resultados apontam que o selamento apical com ionômero de vidro é superior ao selamento com cimento Portland.

The objective of this study was to compare through an in vitro test, if infiltration occurs or not by 0.2% methylene blue dye in retrograde obturations sealed with glass ionomer light-curing cement and Portland cement. Forty single-rooted teeth recieved conventional endodontic treatment. The crowns were removed with a cut at the cementoenamel junction perpendicular to the long axis of the tooth and a horizontal cut 2 to 3 mm from the apex. The roots were externally coated with two layers of nail polish. An apical cavity was performed for retrofilling of the conduits. The sample was divided into 2 groups: Group 1 with apical insulated glass ionomer light-curing cement and Group 2 with insulation with Portland cement. After the completion of the retrograde filling, the samples were subjected to partial immersion of 0.2% methylene blue dye in neutral pH for 24 hours. The samples were washed in running water for 12 hours and then 10 days of drying. After the roots were split lengthwise mesiodistally and observed by two independent examiners with the aid of a magnifying glass with an increase of twice. The chi-square statistical test was used to verify the hypotheses. Of the total of 20 teeth with retrograde obturations using ionomer, only one tooth was infiltrated, since with respect to Portland cement in 18 teeth there was infiltration with 0.2% methylene blue. In this in vitro test, the results suggest that the apical seal with glass ionomer is better than the sealing with Portland cement.

Sealing ability of MTA, CPM, and MBPc as root-end filling materials: a bacterial leakage study

ABSTRACT Objectives To evaluate the sealing ability of three root-end filling materials (white MTA, CPM, and MBPc) using an Enterococcus faecalis leakage model. Material and Methods Seventy single-root extracted human teeth were instrumented and root-ends were resected to prepare 3 mm depth cavities. Root-end preparations were filled with white MTA, CPM, and MBPc cements. Enterococcus faecalis was coronally introduced and the apical portion was immersed in BHI culture medium with phenol red indicator. The bacterial leakage was monitored every 24 h for 4 weeks. The statistical analysis was performed using the Wilcoxon-Gehan test (p<0.05). Results All cements showed bacterial leakage after 24 hours, except for the negative control group. The MBPc showed significantly less bacterial leakage compared with the MTA group (p<0.05). No significant differences were found between the CPM and the other groups. Conclusions The epoxy resin-based cement MBPc had lower bacterial leakage compared with the calcium silicate-based cements MTA and CPM.

Solubility and bacterial sealing ability of MTA and root-end filling materials

ABSTRACT Objective To evaluate solubility and sealing ability of Mineral Trioxide Aggregate (MTA) and root-end filling materials. Material and Methods The materials evaluated were: MTA, Calcium Silicate Cement with zirconium oxide (CSC/ZrO2), and zinc oxide/eugenol (ZOE). Solubility test was performed according to ANSI/ADA. The difference between initial and final mass of the materials was analyzed after immersion in distilled water for 7 and 30 days. Retrograde cavities in human teeth with single straight root canal were performed by using ultrasonic tip CVD 9.5107-8. The cavities were filled with the evaluated materials to evaluate sealing ability using the bacterial leakage test with Enterococcus faecalis. Bacterial leakage was evaluated every 24 hours for six weeks observing the turbidity of Brain Heart infusion (BHI) medium in contact with root apex. Data were submitted to ANOVA followed by Tukey tests (solubility), and Kruskal-Wallis and Dunn tests (sealing ability) at a 5% significance level. Results For the 7-day period, ZOE presented highest solubility when compared with the other groups (p<0.05). For the 30-day period, no difference was observed among the materials. Lower bacterial leakage was observed for MTA and CSC/ZrO2, and both presented better results than ZOE (p<0.05). Conclusion MTA and CSC/ZrO2 presented better bacterial sealing capacity, which may be related to lower initial solubility observed for these materials in relation to ZOE.

Evaluación de la microfiltración apical de BiodentineTM como material de obturación apical mediante el transporte de fluidos computarizado / Evaluation of the apical microleakage of BiodentineTM when used as an apical sealing material, using computerized fluid dynamics

Objetivo: evaluar la capacidad de BiodentineTM para resistir la microfiltración cuando es usado como material de retroobturación medianteun sistema de transporte de fluidos computarizado. Metodología: En este estudio se utilizaron 60 raíces de dientes unirradiculares, se instrumentaron y obturaron con el sistema de cono único estandarizadodel sistema ProTaper (Dentsply, Maillefer, Suiza) con ultrasonido,utilizando el sellador de conductos radiculares Silco (Silva-Collyan SLP,México). Se hizo la preparación de la cavidad retrógrada con ultrasonidoutilizando la punta E31D del sistema Retro Kit (NSK Company, Japón),con un diámetro de 2 mm. Se llevó a cabo la retroobturación con cada uno de los cementos a evaluar; grupo 1: bturados con Biodentine™ (Septodont, Francia), grupo 2: obturados con MTA Gris (Angelus™, Londrina PR, Brasil), grupo 3: control. Se utilizó un software creado específi camente para evaluar microfi ltración; éste, por medio de sensores infrarrojos, detecta la variación de voltaje de una burbuja de aire dentro de un capilar. El programa expresa el tiempo que tarda la burbuja en pasar por el segundo sensor (mm/min), los cuales se convierten a μL/min, para después expresarlos en unidades de fi ltración, realizándosemediciones en un solo lapso. Resultados: La evaluación en este estudio de la microfi ltración apical de Biodentine™ y MTA Gris Angelus™, arrojó resultados favorables para ambos; se comprobó que no existe diferencia signifi cativa en cuanto a la microfiltración entre ellos; sin embargo, ambos materiales mostraron diferentes características en cuanto a su manipulación, tiempo de fraguado y porosidad. No se presentódiferencia estadísticamente significativa entre los grupos (p = 0.256) U Mann-Whitney y Kruskal Wallis. Conclusión: El Biodentine™ y TA Gris AngelusTM presentan un comportamiento óptimo para la obturación retrógrada. Se requiere realizar otros estudios en cuanto a la interfase con la estructura dentinaria.

Objective: To evaluate, using computational fl uid dynamics, the ability of BiodentineTM to resist microleakage when used as a retro-sealing material. Methodology: In this study, 60 single-rooted teeth were used, which were biomechanically prepared and fi lled using the standardized ProTaper single-cone technique (Dentsply, Maillefer, Switzerland) and ultrasound, using Silco root-canal sealer (Silva-Collyan, SLP, Mexico). The retrograde cavity was prepared using ultrasound and a Retro Kit (NSK Company, Japan) E31D 2 mm-diameter tip. Retrograde fi lling was performed using each of the sealers to be evaluated, as follows: group 1: sealed with BiodentineTM (Septodont, France); group 2: sealed with Grey MTA (AngelusTM, Londrina PR, Brazil); group 3: control. A specially designed software was used, which measures microleakage by using infrared sensors to detect changes in voltage in an air bubble within a capillary tube. The software expresses the time it takes (mm/min) for the bubble to pass through the second sensor, then converts these measurements into μL/min to express the rate of leakage. All of the measurements are taken considering a single interval. Results: The results of the evaluation of the apical microleakage of BiodentineTM and MTA Grey AngelusTM obtained in this study were, in both cases, favorable, proving that there is no signifi cant difference between the two in this respect. However, the characteristics of each in terms of their handling, setting time, and porosity differed. No statistically signifi cant difference between the Mann-Whitney U group and the Kruskal-Wallis group was found (p = 0.256). Conclusion: The performance of Bio-dentineTM and Gray MTA AngelusTM is ideal for retrograde fi lling pur-poses. Further studies are needed, including SEM analysis, in order to determine the quality of the seal, with respect to the interface formed with the dentin structure.

Endodontic retreatment: Analysis of three specialists' retreatment rates / Retratamento endodôntico: avaliação dos índices de três especialistas

Endodontic retreatment is a clinical intervention intended to correct errors that have occurred in a treatment performed previously. There are several causes of failures. The anatomical variations between root canals and the diffi culties of achieving microbial disinfection are reported as two of the main causes. However, in the dental offi ces of both general practitioners and specialists, it is very common that the causes of indications for endodontic retreatment are technical failures due to poorly executed treatment. In view of this, the objective of this study is to analyze the records of three specialists in Endodontics and analyze the causes for referral of their endodontic retreatment patients. Examination of 24,553 treatments conducted over varying periods revealed that cases of retreatment accounted for a considerable proportion of the routine work performed by these specialists, at an average of 23% of cases. The majority of retreatment indications were due to technical failure of the initial treatment, in combination with microbial factors caused by contamination of coronal restorations and poorly executed endodontic preparation and fi lling.

O retratamento endodôntico é uma intervenção clínica destinada para a correção de falhas ocorridas num tratamento anteriormente realizado. Vários são os motivos desencadeadores de insucessos. A variedade anatômica dos canais radiculares e a difi culdade de proporcionar a desinfecção microbiana são referenciadas como duas das causas principais. Entretanto, nos consultórios dentários de clínicos gerais e especialistas, é muito comum a indicação para oretratamento endodôntico por razões técnicas devido a sua mal execução. Estabelecida esta problemática, o objetivo deste estudo consiste em avaliar os prontuários de três especialistas em endodontia e verifi car quais são os motivos de encaminhamentos de seus pacientes para o retratamento endodôntico. Após o exame de 24.553 tratamentos em períodos distintos, verifi couse que os casos de retratamentos chegam a uma média relevante de 23% na rotina destes especialistas e que a maioria das indicações se deram por inabilidade no primeiro tratamento, aliadas ao fator microbiano causado por contaminações de restaurações coronárias, preparos e obturações endodônticas mal executadas.

El retratamiento ortógrado y quirúrgico: dos alternativas endodónticas para evitar la extracción dental: serie de casos / Orthograde retreatment and surgical retreatment: two endodontic alternatives to avoid dental extraction. Case reports

destacar la importancia del retratamiento y de la cirugía perirradicular en el campo endodóntico, a fin de mantener la estética y la función del órgano dental. Casos clínicos: se presentan 6 casos: 3 de retratamientos realizados por la vía coronaria convencional y 3 de tratamientos en los que se empleó la cirugía perirradicular. En todos los casos, se obtuvo la curación del área perirradicular afectada, por medio de diferentes procedimientos. Conclusión: el retratamiento endodóntico y la cirugía perirradicular, dentro de la diversidad de procedimientos, son terapéuticas que colaboran con el mantenimiento de la integridad de la arcada dentaria...

Agregado de trióxido mineral e uso como material retro-obturador em cirurgia paraendodôntica / Mineral trioxide aggregate and the use as a material for retrofilling endodontic surgery

O Agregado de Trióxido Mineral (MTA) foi desenvolvido com a finalidade de selar perfurações dentárias que ocorrem acidentalmente. A obturação retrógrada consiste no tratamento de lesões perirradiculares que visa solucionar complicações decorrentes do tratamento endodôntico mal sucedido. Materiais como o MTA têm sido propostos com o objetivo de promover o selamento do canal radicular por via retrógrada. O objetivo deste trabalho foi realizar uma revisão de literatura sobre o uso de MTA na Endodontia, abordando aspectos de sua apresentação, composição, propriedades físicas, químicas e biológicas, aplicações clínicas, enfatizando sua utilização na prática cirúrgica-periapical. Concluiu-se que o MTA pode ser empregado no retratamento endodôntico cirúrgico, apresentando-se como material promissor.

The Mineral Trioxide Aggregate (MTA) was initially developed in order to seal dental fractures that may occur accidentally. The retrograde obturation to solve complications by unsuccessful endodontic treatment. Various materials have been proposed, aiming to promote the sealing of the root canal by retrograde via. The objective of this study was to review the literature on the mineral trioxide aggregate in Endodontics, regarding to the presentation, composition, physical, chemical and biological properties, clinical applications It has concluded that MTA can be used on surgical endodontic retreatment.

Enucleação de cisto radicular maxilar associado à apicectomia: relato de caso / Enucleation root of jaw cyst associated apicectomy: Report of case

Os cistos radiculares são as lesões císticas mais comuns dos maxilares, e apresentam como local de predileção a região anterior da maxila. Seu tratamento pode ser realizado cirurgicamente associado ao tratamento endodôntico da unidade envolvida. O objetivo do presente artigo é relatar um caso clínico de um cisto radicular maxilar, através de associação do tratamento endodôntico e cirúrgico, utilizando o agregado trióxido mineral (MTA) na obturação retrógrada das unidades envolvidas... (AU)

Radicular cysts are the most common cystic lesions of the jaws, and present as a place of predilection to previous region of the maxilla. Your treatment may be accomplished surgically associated the endodontic treatment of the unit involved. The goal of this article is to report a case of a radicular cyst jaw, through association of surgical and endodontic treatment, using mineral trioxide aggregate (MTA) in retrograde obturation of the units involved... (AU)

Análise físico-química do MTA e do cimento Portland associado a quatro diferentes radiopacificadores / Physicochemical analysis of MTA and Portland cement associated with four different radiopacifiers

Introdução: O Mineral Trióxido Agregado (MTA) é composto por cimento Portland (CP) e um radiopacificador (óxido de bismuto). Objetivo: Avaliar tempo de presa, solubilidade, pH, liberação de íons Cálcio e radiopacidade do cimento Portland puro ou associado a quatro radiopacificadores (sulfato de bário, carbonato de bismuto, óxido de bismuto e iodofórmio), comparados ao MTA branco (Angelus, Londrina, Brasil). Material e Método: A proporção empregada CP/radiopacificador foi de 4:1 em peso, (80% de cimento Portland e 20% de radiopacificador). A especificação 57 da ADA foi usada para avaliação do tempo de presa. A solubilidade foi analisada segundo a especificação ISO 6876/2001. A avaliação do pH foi realizada com peagâmetro digital e a liberação de íons Ca++foi verificada por meio de espectrofotômetro de absorção atômica. A radiopacidade foi determinada em milímetros de alumínio (mm/Al). Os resultados foram submetidos aos testes de Análise de Variância e Tukey, nível de significância 5%. Resultado: O sulfato de bário não alterou o tempo de presa final do CP. Radiopacidade inferior ao mínimo recomendado pelas normas da ADA nº 57 e ISO 6876/2001 foi observada para CP e CP associado com sulfato de bário. O CP associado ao iodofórmio apresentou solubilidade acima dos 3% recomendados pela ISO 6876/2001. Todos os materiais proporcionaram alcalinização do meio e promoveram liberação de íons cálcio. Conclusão: Carbonato de bismuto ou óxido de bismuto proporcionaram tempo de presa inicial, solubilidade, pH, liberação de íons Cálcio e radiopacidade adequados quando associados ao CP. .

Introduction: Mineral Trioxide Aggregate (MTA) is composed of Portland cement (PC), and a radiopacifier (bismuth oxide). Objective: To evaluate the setting time, solubility, pH, calcium ion release and radiopacity of pure Portland cement and its association to four radiopacifiers, (Barium sulfate, bismuth carbonate, bismuth oxide and iodoform), and White MTA (Angelus, Londrina, Brazil). Material and Method: The ratio CP/radiopacifier used was 4:1 by weight (80% Portland cement and 20% radiopacifier). The setting time was evaluated according the specification ADA 57. The solubility was analyzed according to ISO 6876/2001 specification. The pH was evaluated using a digital pHmeter and the release of Ca++ ions by atomic absorption spectrophotometer. The radiopacity was measured in millimeters of aluminum (mm/Al). The results were submitted to ANOVA and Tukey tests using 5% of significance level. Result: Barium sulfate did not alter the final setting time of the PC. Observed radiopacity was less than the minimum recommended by ADA 57 and ISO 6876/2001 for CP and CP associated with barium sulfate. The PC associated with iodoform showed solubility above the 3% recommended by ISO 6876/2001. All materials provided alkalinization and promoted calcium ion release. Conclusion: Bismuth carbonate and bismuth oxide provided proper initial setting time, solubility, pH, calcium ion release and radiopacity when combined with CP. .

Use of a new retrograde filling material (Biodentine) for endodontic surgery: two case reports / 国际口腔科学杂志·英文版

Mineral trioxide aggregate (MTA) is considered at the present time as the gold standard for root-end filling in endodontic surgery. However, this biocompatible material presents several drawbacks such as a long setting time and handling difficulties. The aim of this article is to present a new commercialized calcium silicate-based material named Biodentine with physical improved properties compared to MTA in a clinical application. Two endodontic microsurgeries were performed by using specific armamentarium (microsurgical instrumentation, ultrasonic tips) under high-power magnification with an operatory microscope. Biodentine was used as a root-end filling in order to seal the root canal system. The two cases were considered completely healed at 1 year and were followed for one more year. The 2-year follow-up consolidated the previous observation with absence of clinical symptoms and radiographic evidence of regeneration of the periapical tissues.

Resolução cirúrgica de periodontite apical crônica: relato de caso / Surgical resolution of chronic apical periodontitis: case report

A cirurgia paraendodôntica é um conjunto de procedimentos com o objetivo básico de tratar lesões perirradiculares decorrentes de complicações do tratamento endodôntico ou seu insucesso. O objetivo deste trabalho é apresentar um caso clínico de cirurgia paraendodôntica em um incisivo lateral superior. O tratamento da lesão perirradicular foi realizado através da curetagem, apicectomia, retropreparo com inserto de ultrassom e retro-obturação com MTA. O exame histopatológico confirmou o diagnóstico de granuloma periapical. O controle de um ano demonstrou a neoformação óssea e ausência de sintomatologia

Apical surgery is a set of procedures with the basic aim of treating complications arising from lesions of endodontic treatment or its failure. The objective of this study is to present a clinical case of apical surgery in a maxillary lateral incisor. The treatment of lesion was performed by curettage, apicectomy, root-end preparation with ultrasonic unit and root-end filling with MTA. The biopsy confirmed the diagnosis of apical granuloma. The control for a year showed new bone formation and absence of symptoms

Sealing Ability of MTA Used as a Root End Filling Material: Effect of the Sonic and Ultrasonic Condensation

Despite the excellent properties of mineral trioxide aggregate (MTA), the condensation technique may have some influence in its sealing ability. The purpose of this study was to compare the sealing ability of sonic and ultrasonic setting of MTA. Thirty-four extracted human teeth had their canals prepared and filled with Sealapex sealer and gutta-percha using the active lateral condensation technique. The teeth were rendered waterproof and apicoectomy performed at 3 mm from the apex. Root-end cavities (3.0 mm deep and 1.4 mm diameter) were prepared with diamond ultrasonic tips. The root-end cavities were filled with Pro-Root MTA® with ultrasonic vibration, sonic vibration or no vibration. The positive control group did not receive any material while the negative control group was totally rendered waterproof. After material set, the specimens were immersed in Rodhamine B for 24 h, under vacuum in the first 15 min, then washed, dried and split longitudinally for evaluating the infiltration at the dentin/material interface. Data were analyzed using ANOVA and Tukey's tests at 5% significance level. Sonic vibration promoted the lowest infiltration values (p<0.05). It was concluded that sonic vibration could be considered an efficient aid to improve the sealing ability of MTA when used as root-end filling material.

Resumo O objetivo deste estudo foi avaliar in vitro, a influência da vibração sônica e ultrassônica no selamento marginal proporcionado pelo MTA. Trinta e quatro dentes humanos tiveram seus canais radiculares instrumentados e obturados com cimento Sealapex® pela técnica da condensação lateral ativa. Os dentes foram impermeabilizados e seccionados os 3 mm apicais. Retrocavidades (3 mm de profundidade e 1,4 mm de diâmetro) foram preparadas com pontas ultrassônicas diamantadas. As retrocavidades foram preenchidas com Pro-Root MTA® com auxílio da vibração ultrassônica, com auxílio da vibração sônica e sem vibração alguma. O grupo controle positivo não recebeu material retrobturador, enquanto que o negativo foi totalmente impermeabilizado. Após a presa do material, os espécimes foram mergulhados em Rodamina B por 15 min em vácuo, permanecendo nesta solução por mais 24 h. Em seguida, foram lavados, secados e clivados longitudinalmente para avaliação da infiltração do corante na interface dentina/material retrobturador. Os dados foram analisados utilizando a análise de variância e o teste de Tukey (p<0,05). Observou-se que apenas a vibração sônica foi diferente apresentando os menores índices de infiltração. Pode-se concluir que vibração sônica contribui com a melhora da capacidade de selamento marginal proporcionado pelo MTA quando empregado como material retrobturador. .

Maxillary first molar with an O-shaped root morphology: report of a case / 国际口腔科学杂志·英文版

This case report is to present a maxillary first molar with one O-shaped root, which is an extended C-shaped canal system. Patient with chronic apical periodontitis in maxillary left first molar underwent replantation because of difficulty in negotiating all canals. Periapical radiographs and cone-beam computed tomography (CBCT) were taken. All roots were connected and fused to one root, and all canals seemed to be connected to form an O-shape. The apical 3 mm of the root were resected and retrograde filled with resin-modified glass ionomer. Intentional replantation as an alternative treatment could be considered in a maxillary first molar having an unusual O-shaped root.