Physicochemical properties, cytocompatibility and antibiofilm activity of a new calcium silicate sealer

Abstract The aim of this study was to evaluate the physicochemical properties, cytocompatibility and antibiofilm activity of a new calcium silicate-based endodontic sealer, Sealer Plus BC (MK Life, Brazil), in comparison with TotalFill BC Sealer (FKG Dentaire SA, Switzerland) and AH Plus (Dentsply, Germany). Setting time and flow were evaluated based on ISO 6876 standard. The pH was evaluated after different periods, and radiopacity by radiographic analysis (mmAl). Solubility (% mass loss) and volumetric change (by micro-CT) were assessed after 30 days of immersion in distilled water. Cytocompatibility was assessed by methyltetrazolium (MTT) and neutral red (NR) assays, after exposure of Saos-2 cells to the sealer extract for 24 h. An additional analysis was performed by using MTT assay after 1, 3 and 7 days of exposure of Saos-2 to the sealers 1:8 dilution extracts. Antibiofilm activity against Enterococcus faecalis and/or Candida albicans was evaluated by crystal violet assay and modified direct contact test. The physicochemical properties were analyzed using ANOVA/Tukey tests; MTT and NR data were analyzed by ANOVA and Bonferroni tests; the antimicrobial tests were analyzed by Kruskal-Wallis and Dunn tests (α=0.05). Sealer Plus BC had proper setting time, radiopacity, flow and alkalization capacity. Sealer Plus BC was significantly more soluble than AH Plus (p<0.05) and presented volumetric change similar to AH Plus and TotalFill BC (p>0.05). Sealer Plus BC presented antibiofilm activity and no cytotoxic effect. In conclusion, although Sealer Plus BC had higher solubility, this sealer showed proper physicochemical properties, cytocompatibility, and antibiofilm activity.

Resumo O objetivo deste estudo foi avaliar as propriedades físico-químicas, a citocompatibilidade e a atividade antibiofilme de um novo cimento endodôntico à base de silicato de cálcio, Sealer Plus BC (MK Life, Brasil), em comparação com TotalFill BC Sealer (FKG Dentaire SA, Suíça) e AH Plus (Dentsply, Alemanha). O tempo de presa e o escoamento foram avaliados com base nas normas ISO 6876. O pH foi avaliado após diferentes períodos, e a radiopacidade por análise radiográfica (mmAl). A solubilidade (% de perda de massa) e alteração volumétrica (por micro-CT) foram avaliadas após 30 dias de imersão em água destilada. Citocompatibilidade foi avaliada pelos ensaios metiltetrazólio (MTT) e vermelho neutro (NR), após exposição das células Saos-2 ao extrato de cimento por 24 horas. Análise adicional foi realizada através do ensaio MTT após 1, 3 e 7 dias de exposição das células Saos-2 aos extratos dos cimentos na diluição de 1:8. Atividade antibiofilme contra Enterococcus faecalis e/ou Candida albicans foi avaliada pelos ensaios cristal violeta e contato direto modificado. As propriedades físico-químicas foram analisadas utilizando os testes ANOVA e Tukey; MTT e NR foram analisados pelos testes ANOVA e Bonferroni; os ensaios antimicrobianos foram analisados pelos testes Kruskal-Wallis e Dunn (α=0.05). Sealer Plus BC apresentou tempo de presa, radiopacidade e escoamento adequados, além de capacidade de alcalinização. Sealer Plus BC foi significantemente mais solúvel que AH Plus (p<0.05) e apresentou alteração volumétrica similar à de AH Plus e TotalFill BC (p>0.05). Sealer Plus BC apresentou atividade antibiofilme, sem efeito citotóxico. Como conclusão, embora Sealer Plus BC apresente maior solubilidade, este cimento apresentou propriedades físico-químicas adequadas, citocompatibilidade e atividade antibiofilme.

Antibacterial Activity of a New Ready-To-Use Calcium Silicate-Based Sealer

Abstract The aim of this study was to evaluate the antibacterial potential of a calcium silicate-based sealer (Bio-C Sealer, Angelus) against common bacteria in primary and secondary endodontic infections. Enterococcus faecalis, Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus and Streptococcus mutans were exposed to fresh Bio-C Sealer for 24 h by the agar diffusion method (n=5). Additionally, the antibacterial activity was investigated against E. faecalis and S. mutans biofilms (48 h old) grown in discs with 4 mm in diameter and 2 mm in height. (n=3) of set discs of Bio-C Sealer (Angelus), EndoFill (Dentsply-Mallefer), Sealer 26 (Dentsply), AH Plus (Dentsply), Sealapex (Sybron-Endo) and EndoSequence BC Sealer (Brasseler). The antibacterial activity was evaluated by colony forming unity (CFU) counting using ImageJ software. Data were compared by one-way ANOVA followed by Holm-Sidak test (a=5%). Fresh Bio-C Sealer exhibited antimicrobial activity against all bacteria evaluated by agar diffusion method, except for S. mutans. Set discs of all endodontic sealers tested showed similar CFU values for E. faecalis (p>0.05). S. mutans in biofilms showed higher susceptibility to EndoFill compared with the other sealers (p<0.05). In conclusion, the results indicate that fresh Bio-C Sealer does not inhibit S. mutans growth, but exhibits antibacterial activity against E. faecalis, S. aureus, P. aeruginosa and E. coli. After setting, the Bio-C Sealer exhibits an antimicrobial potential comparable to that of the other sealers evaluated in E. faecalis biofilm, but lower than that of EndoFill for S. mutans biofilm.

Resumo O objetivo deste estudo foi avaliar o potencial antibacteriano do novo cimento biocerâmico (Bio-C Sealer, Angelus) contra bactérias comuns em infecções endodônticas primárias e secundárias. Culturas de Enterococcus faecalis, Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus e Streptococcus mutans foram expostos a amostras frescas do Bio-C sealer durante 24 h pelo método de difusão em agar (n=5). A atividade antibacteriana de amostras dos cimentos Bio-C Sealer (Angelus), EndoFill (Dentsply-Mallefer), Sealer 26 (Dentsply), AH Plus (Dentsply), Sealapex (Sybron-Endo) e EndoSequence BC Sealer (Brasseler) após a presa também foi investigada em biofilmes de 48 h das bactérias E. faecalis e S. mutans, crescidos em discos com 4 mm de diâmetro e 2 mm de altura. A atividade antibacteriana foi avaliada por contagem das unidades formadoras de colônias (UFC) utilizando o software ImageJ. Os dados foram comparados por ANOVA a um critério seguido pelo pós-teste Holm-Sidak (a=5%). Amostras frescas do Bio-C Sealer exibiram atividade antimicrobiana contra todas as bactérias avaliadas pelo método de difusão em ágar, exceto para S. mutans. A análise da formação de biofilme mostrou que todos os cimentos endodônticos testados apresentaram valores similares de UFC para E. faecalis (p> 0,05), enquanto biofilmes de S. mutans foram mais suscetíveis ao EndoFill em comparação com os demais cimentos (p<0,05). Conclui-se que o cimento Bio-C Sealer fresco exibe atividade antibacteriana para E. faecalis, S. aureus, P. aeruginosa e E. coli, mas não inibe o crescimento de S. mutans. Após a presa, o cimento Bio-C Sealer exibe potencial antimicrobiano similar ao dos demais cimentos avaliados em biofilme de E. faecalis, mas inferior ao do EndoFill para S. mutans.

Avaliação da citotoxicidade in vitro de diferentes pastas endodônticas utilizadas em odontopediatria / In vitro cytotoxic effects of different endodontic pastes used in pediatric dentistry

Objetivo: O presente estudo teve como objetivo avaliar o potencial citotóxico de três diferentes pastas endodônticas em cultura celular de osteoblastos humanos. Material e Métodos: As pastas endodônticas Calen PMCC (SSWhite Artigos Dentários LTDA, Rio de Janeiro, Brasil), Feapex (Fórmula e Ação, São Paulo, Brasil) e CTZ (Lenzafarm, Belo Horizonte, Brasil) foram preparadas e eluídas em meio de cultura celular durante 24 horas em estufa a 37°C e 5% de CO2. Foram realizadas quatro diluições distintas desses meios nas concentrações 1: 1, 1: 2, 1: 4 e 1: 8. Culturas de células de Osteoblastos Humanos da linhagem Saos-2 foram expostas a estas diluições durante 24 horas. O controle negativo foi realizado expondo as células ao meio de cultura sem contato com nenhuma pasta endodôntica. A citotoxicidade desses meios foi avaliada utilizando o ensaio MTT e os resultados foram transformados em porcentagens de células viáveis em relação ao grupo controle negativo. A análise estatística foi realizada com nível de significância de 5%, utilizando ANOVA seguido do teste de Tukey. Resultados: A viabilidade celular foi significativamente alterada de acordo com o material testado (p <0,05) e sua concentração (p <0,05). Em todas as concentrações testadas, a pasta Feapex apresentou maior viabilidade celular comparada aos demais materiais (p <0,05). Embora não tenha sido observada diferença estatisticamente significante entre a pasta Calen PMCC e a pasta CTZ nas concentrações de 1: 1 e 1: 2 (p> 0,05), a pasta CTZ apresentou maior citotoxicidade nas concentrações de 1: 4 e 1: 8 (p <0,05 ). De forma geral, a citotoxicidade diminuiu com o aumento da diluição do material. Conclusão: De acordo com os resultados do presente estudo, a pasta endodôntica Feapex parece ser a melhor opção para utilização entre as pastas analisadas, pois apresentou menor citotoxicidade que as pastas Calen PMCC e CTZ

Objective: The aim of the present study was to evaluate the cytotoxic potential of three different endodontic filling materials on human osteoblast cell cultures. Material and Methods: The endodontic pastes Calen PMCC (SSWhite Dental Articles LTDA, Rio de Janeiro, Brazil), Feapex (Formula and Action, São Paulo, Brazil) and CTZ (Lenzafarm, Belo Horizonte, Brazil) were eluted in cell culture medium during 24 hours in an oven at 37°C and 5% CO2. Four distinct dilutions of these media were performed at the concentrations 1:1, 1:2, 1:4 and 1:8. Cell cultures of Saos-2 Human Osteoblast-like were exposed to these dilutions for 24 hours. The negative control group was performed by exposing the cells to culture medium without contact with any endodontic paste. The cytotoxic potential of these media was evaluated using the MTT assay and the results were transformed into viable cell percentages in relation to the negative control group. Statistical analysis was submitted with a significance level of 5%, using univariate Analysis of Variance (ANOVA) followed by Tukey's test. Results: Cell viability was significantly altered according to the material tested (p<0.05) and its concentration (p<0.05). Feapex samples presented higher cell viability than the other materials in all concentrations tested (p<0.05). Although no statistically significant difference was observed between Calen PMCC paste and CTZ paste at concentrations of 1: 1 and 1: 2 (p>0.05), CTZ paste showed a higher cytotoxicity at concentrations of 1: 4 and 1: 8 (p<0.05). In general, cytotoxicity decreases with increasing material dilution. Conclusion: According to the results of the present study, Feapex endodontic paste seems to be the better option for use among the analyzed pastes, since it presented lower cytotoxicity than Calen PMCC and CTZ pastes

Effect of a novel bioceramic root canal sealer on the angiogenesis-enhancing potential of assorted human odontogenic stem cells compared with principal tricalcium silicate-based cements

Abstract Objective: This study evaluated the angiogenesis-enhancing potential of a tricalcium silicate-based mineral trioxide aggregate (ProRoot MTA), Biodentine, and a novel bioceramic root canal sealer (Well-Root ST) in human dental pulp stem cells (hDPSCs), human periodontal ligament stem cells (hPLSCs), and human tooth germ stem cells (hTGSCs). Methodology: Dulbecco's modified Eagle's medium was conditioned for 24 h by exposure to ProRoot MTA, Biodentine, or Well-Root ST specimens (prepared according to the manufacturers' instructions). The cells were cultured in these conditioned media and their viability was assessed with 3-(4,5-dimethyl-thiazol-2-yl)-5-(3-carboxy-methoxy-phenyl)-2-(4-sulfo-phenyl)-2H tetrazolium (MTS) on days 1, 3, 7, 10, and 14. Angiogenic growth factors [platelet-derived growth factor (PDGF), basic fibroblast growth factor (FGF-2), and vascular endothelial growth factor (VEGF)] were assayed by sandwich enzyme-linked immunosorbent assay (ELISA) on days 1, 7, and 14. Human umbilical vein endothelial cell (HUVEC) migration assays were used to evaluate the vascular effects of the tested materials at 6-8 h. Statistical analyses included Kruskal-Wallis, Mann-Whitney U, and Friedman and Wilcoxon signed rank tests. Results: None of tricalcium silicate-based materials were cytotoxic and all induced a similar release of angiogenic growth factors (PDGF, FGF-2, and VEGF) (p>0.05). The best cell viability was observed for hDPSCs (p<0.05) with all tricalcium silicate-based materials at day 14. Tube formation by HUVECs showed a significant increase with all tested materials (p<0.05). Conclusion: The tricalcium silicate-based materials showed potential for angiogenic stimulation of all stem cell types and significantly enhanced tube formation by HUVECs.

A comparative study of the biocompatibility of two root-end filling materials in rat connective tissue / Estudio comparativo de la biocompatibilidad de dos materiales de retro-obturación en tejido conectivo de rata

The aim of the present study was to examine the short-term biocompatibility of Endosequence Root Repair Material (ERRM) paste and white Mineral Trioxide Aggregate MTA by implanting them into polyethylene tubes in the subcutaneous connective tissue of rats. twenty five male Wistar rats, 3-4 months old, weighing 300-350 g, were used. The tubes were implanted dorsally into the subcutaneous connective tissues of the rats. Five animals were sacrificed at five examination time points: 1, 3, 5, 7 and 15 days. The connective tissues containing the implants were excised. These sections were studied qualitatively and quantitatively using a light microscope. An average value for each group was obtained by averaging the sum of all inflammatory cells counted in 10 randomly selected, separate areas. For the ERRM group: There was a significant increase in the number of inflammatory cells on days 1-3 and on days 5-7 (P ≤ 0.003 and P ≤ 0.024). In the WHITE MTA group, the mean values of the sum of the inflammatory cells during the periods 1-3 days and 5-7 days were statistically significant (P ≤ 0.001 and P ≤ 0.044, respectively) and the XILOPERCHA group: Difference was observed significant in the value of the sum of inflammatory cells during the period of 3-5 days (P ≤ 0.05). According to the results it can be concluded that both, ERRM as MTA, caused an inflammatory reaction, which decreased over time; suggesting that both materials are biocompatible; showing however the presence of a higher organization of collagen fibers around the implants of ERRM.

El objetivo del presente estudio fue evaluar la biocompatibilidad a corto plazo de Material de Reparación de la Raíz Endodóntica (MRRE) y el agregado de trióxido mineral (AgTM), implantándolos dentro de tubos de polietileno en el tejido conectivo subcutáneo de ratas. Se usaron 25 ratas Wistar macho, de 3-4 meses de edad, con peso de 300 a 350 g. Los tubos fueron implantados en el tejido conectivo subcutáneo del dorso de las ratas. Cinco animales fueron sacrificados en cada uno de los siguientes períodos de tiempo: 1, 3, 5, 7, y 15 días. El tejido conectivo con los implantes fue escindido y seccionado. Los cortes se evaluaron cualitativa y cuantitativamente mediante microscopio óptico. Se obtuvo un valor para cada grupo resultado al promediar la suma de las células inflamatorias contadas en 10 áreas separadas seleccionadas aleatoriamente. Para el grupo de MRRE; hubo un incremento significativo en la cantidad de células inflamatorias entre los días 1-3 y 5-7 (p ≤ 0,003 y p ≤ 0,024). En el grupo de AgTM blanco, los valores promedio de la suma de células inflamatorias entre los períodos 1-3 días, y 5-7 días mostraron ser estadísticamente significativos (p≤ 0,001 y p ≤ 0,044 respectivamente) y en el grupo control de Xilopercha se observó diferencia significativa entre los valores de la suma de células inflamatorias entre los períodos de 3-5 días (P ≤ 0,05). De acuerdo a los resultados, puede concluirse que ambos materiales, AgTM y MRRE causaron una reacción inflamatoria que disminuyó a través del tiempo, sugiriendo que ambos materiales son biocompatibles; mostrando sin embargo una mayor organización de fibras colágenas alrededor de los implantes de MRRE.

Penetration degree of sealer in artificial lateral canal after passive ultrasonic irrigation with EDTA for different times / Grau de penetração do cimento obturador em canais laterais simulados após ativação ultrassonica passiva do EDTA em diferentes tempos

The aim of this study was to evaluate the degree of penetration of obturation cement in artificial lateral canals after Passive Ultrasonic Irrigation (PUI) with ethylenediaminetetraacetic acid (EDTA) for different times. Fifty upper molar palatine roots were used, in which two artificial lateral canals were made at distances of 7 and 3 millimeters from the root apex. After instrumentation and drying the canal, the final toilet stage was performed on five groups (n = 10), as follows: G1 - EDTA 17% + PUI for 10 seconds; G2 - EDTA 17% + PUI for 20 seconds; G3 - EDTA 17% + PUI for 30 seconds; G4 - EDTA 17% + PUI for 60 seconds; G5 - EDTA 17% + activation by instrument R50 for 5 minutes (Control). The canals were sealed by the single cone technique, and after 72 hours, sectioned in two planes transverse to the artificial canal, to see the degree of penetration of the sealing cement. In the radiographic analysis, there was no statistical difference (p> 0.05) between groups in the two artificial lateral canals. However, PUI of EDTA for 60 seconds produced a significant difference in the degree of penetration of the sealing cement (p <0.05) at 7 mm from the apex. Therefore, PUI with EDTA for 60 seconds promoted a higher degree of penetration of the obturator cement in the artificial lateral canal.

O objetivo deste trabalho foi avaliar o grau de penetração do cimento obturador em canais laterais artficiais, após Irrigação Ultrassonica Passiva (IUP) do ácido etilenodiaminotetracético (EDTA), em diferentes tempos. Foram utilizadas 50 raízes palatinas de molares superiores, e em seguida confeccionados dois canais laterais artificiais a 7 e 3 milímetros do ápice radicular. Após a instrumentação e secagem dos canais, foi iniciada a etapa de toillet final, de acordo com os seguintes grupos (n=10): G1- EDTA 17%+IUP durante 10 segundos; G2 - EDTA 17%+IUP durante 20 segundos; G3 - EDTA 17%+IUP durante 30 segundos; G4- EDTA 17%+IUP durante 60 segundos; G5- EDTA 17%+ativação pelo instrumento R50 durante 5 minutos (Controle). Os canais foram obturados pela técnica do cone único, e após 72 horas, seccionados em dois planos transversais dos canais artificiais, para se visualizar o grau de penetração do cimento obturador. Na análise radiográfica, não houve diferença estatística (p>0,05) entre os grupos, nos dois canais laterais artificiais. Entretanto, a IUP do EDTA por 60 segundos conseguiu um obter resultado significativo, sobre o grau de penetração do cimento obturador (p<0,05) a 7 milímetros do ápice. Portanto, a IUP do EDTA no tempo de 60 segundos promoveu maior grau de penetração do cimento obturador nos canais laterais artifciais.

A comparison of the sealing abilities between Biodentine and MTA as root-end filling materials and their effects on bone healing in dogs after periradicular surgery

ABSTRACT Objectives: To compare the sealing ability and biocompatibility of Biodentine with mineral trioxide aggregate (MTA) when used as root-end filling materials. Methodology: The Cell Counting Kit-8 (CCK-8) assay was used to compare the cytotoxicity of MTA and Biodentine. Twenty-one extracted teeth with a single canal were immersed in an acidic silver nitrate solution after root-end filling. Then, the volume and depth of silver nitrate that infiltrated the apical portion of the teeth were analyzed using micro-computed tomography (micro-CT). Seventy-two roots from 3 female beagle dogs were randomly distributed into 3 groups and apical surgery was performed. After six months, the volume of the bone defect surrounding these roots was analyzed using micro-CT. Results: Based on the results of the CCK-8 assay, MTA and Biodentine did not show statistically significant differences in cytotoxicity (P>0.05). The volume and the depth of the infiltrated nitrate solution were greater in the MTA group than in the Biodentine group (P<0.05). The volume of the bone defect was larger in the MTA group than in the Biodentine group. However, the difference was not significant (P>0.05). The volumes of the bone defects in the MTA and Biodentine groups were smaller than the group without any filling materials (P<0.05). Conclusions: MTA and Biodentine exhibited comparable cellular biocompatibility. Biodentine showed a superior sealing ability to MTA in root-end filling. Both Biodentine and MTA promoted periradicular bone healing in beagle dog periradicular surgery models.

Effect of ProRoot MTA® and Biodentine® on osteoclastic differentiation and activity of mouse bone marrow macrophages

Abstract Objectives This investigation aimed to assess the differentiation inhibitory effects of ProRoot MTA® (PMTA) and Biodentine® (BIOD) on osteoclasts originated from murine bone marrow macrophages (BMMs) and compare these effects with those of alendronate (ALD). Materials and Methods Mouse BMMs were cultured to differentiate into osteoclasts with macrophage colony-stimulating factor and receptor activator of NF-κB (RANKL), treated with lipopolysaccharide. After application with PMTA, BIOD, or ALD, cell toxicities were examined using WST-1 assay kit, and RANKL-induced osteoclast differentiation and activities were determined by resorption pit formation assay and tartrate-resistant acid phosphate (TRAP) staining. The mRNA levels of osteoclast activity-related genes were detected with quantitative real time polymerase chain reaction. Expressions of molecular signaling pathways were assessed by western blot. All data were statistically analyzed with one-way ANOVA and Tukey's post-hoc test (p<0.05). Results Mouse BMMs applied with PMTA, BIOD, or ALD showed highly reduced levels of TRAP-positive osteoclasts. The BIOD treated specimens suppressed mRNA expressions of cathepsin K, TRAP, and c-Fos. Nonetheless, it showed a lower effect than PMTA or ALD applications. Compared with ALD, PMTA and BIOD decreased RANKL-mediated phosphorylation of ERK1/2 and IκBα. Conclusions PMTA and BIOD showed the inhibitory effect on osteoclast differentiation and activities similar to that of ALD through IκB phosphorylation and suppression of ERK signaling pathways.

Experimental furcal perforation treated with mineral trioxide aggregate plus selenium: immune response

Abstract The aim of this study is to evaluate the expression of cytokines in response to mineral trioxide aggregate (MTA) plus selenium in germ-free mice with experimental furcal perforation. The first left maxillary molar was opened, and the furcal area was perforated and treated with post-MTA-Se (experimental group). The same surgical intervention was performed for the maxillary right first molar, which was treated with MTA (control group). Fifteen mice were sacrificed 7, 14, and 21 days after furcal perforation, and periapical tissue samples were collected. The mRNA expression levels of the cytokines TGF-β, TNF-α, IFN-γ, HPRT, IL-10, IL-4, RANK, RANKL, IL-1, and IL-17 were assessed by using real-time polymerase chain reaction. In the experimental group, at 21-days post-MTA-Se sealing, the mRNA levels of TNF-α and IL-10 were upregulated compared with those in the control group (p < 0.05). Futher assessment revealed basal mRNA expression levels of IL-1α, IFN-γ, RANK, RANKL, IL-17A, IL-4, and TGF-β, over long experimental times, in both the experimental and control groups (p > 0.05). In conclusion, MTA+Se sealing favoured increased expression of IL-10 and TNF-α at later time points (day 21).

Immediate tooth replantation: root canal filling for delayed initiation of endodontic treatment

Abstract The aim of this study is to evaluate the action of paramonochlorophenol associated with Furacin followed by calcium hydroxide (CH) dressing in the control of inflammatory root resorption in cases of immediate tooth replantation with delayed endodontic treatment. A total of 28 incisors of 3 male dogs were extracted and replanted after 15 minutes, and randomly divided into 3 groups: Group I (n = 8) - endodontic treatment was performed before the extraction and replantation; Group II (n = 10) - endodontic treatment was performed 30 days after replantation and the root canal was filled with CH dressing; Group III (n = 10) - endodontic treatment was performed 30 days after replantation and root canals received temporary medication of paramonochlorophenol-Furacin followed by CH dressing. The animals were euthanized 90 days after replantation. The histomorphological events analyzed at the epithelial reattachment site were the intensity and extent of acute and chronic inflammatory processes, periodontal ligament (PDL) organization, the intensity and extent of acute and chronic inflammatory processes in the PDL space, root resorption, bone tissue, and ankylosis. Data were submitted to the Wilcoxon Signed Ranks Test for group comparison (α = 5%). In Groups I, II and III the periodontal ligament was regenerated and most of the resorption areas were repaired by newly formed cementum. The depth and extent of root resorption were significantly higher in Group II than in Group III. The use of paramonochlorophenol-furacin followed by CH dressing was more effective in controlling inflammatory root resorption after immediate tooth replantation.

Endodontic medicine: interrelationships among apical periodontitis, systemic disorders, and tissue responses of dental materials

Abstract: Endodontic medicine, which addresses the bidirectional relationship between endodontic infections and systemic diseases, has gained prominence in the field of endodontics. There is much evidence showing that while systemic disease may influence the pathogenesis of endodontic infection, endodontic infection can also cause systemic alterations. These alterations include more severe bone resorption and inflammation in the periapical area as well as enhanced systemic disease symptoms. Similarly, many reports have described the impact of systemic diseases on the tissue responses to dental materials. Conversely, the local use of dental materials may show systemic effects in the form of altered production of biomarkers. Thus, studies to better understand the mechanisms related to those connections are extremely important. In this context, the objective of this review was to analyze and discuss the current literature regarding the connections among these three factors—systemic diseases, endodontic infection, and endodontic dental materials—and determine how these connections may interfere in the systemic health status and the endodontic treatment outcomes, which are represented by periapical wound healing.

Evaluation of physical-mechanical properties, antibacterial effect, and cytotoxicity of temporary restorative materials

Abstract The objective of this study was to compare selective physical-mechanical properties, antibacterial effects and cytotoxicity of seven temporary restorative materials (TRM): five resin-based materials [Bioplic (B), Fill Magic Tempo (FM), Fermit inlay (F), Luxatemp LC (L) and Revotek LC (R)], and zinc oxide-eugenol cement (IRM) and glass ionomer cement (GIC) as the controls. Material and methods The physical-mechanical properties were evaluated by determining microleakage (ML), ultimate tensile strength (UTS) and Shore D hardness (SDH). In addition, the polymerization rate (Pr-1), depth of cure (DC), water sorption and solubility (WS/SL) were evaluated. The antimicrobial effects of the materials were assessed by biofilm accumulation of Streptococcus mutans (BT) and the direct contact test (DCT) by exposure to Enterococcus faecalis for 1 and 24 h, and cytotoxicity by MTT assay. The data were analyzed by ANOVA or Kruskall-Wallis tests, and a complementary post-hoc method (p<0.05). Results Group B, followed by FM and GIC had significantly lower percentages of microleakage in comparison with the other groups; Groups FM and L showed the highest WS, while Groups R and FM showed the significantly lowest SL values (p<0.05). Group R showed the statistically highest UTS mean and the lowest DC mean among all groups. Group F showed the lowest S. mutans biofilm accumulation (p=0.023). Only the Group L showed continued effect against E. faecalis after 1 h and 24 h in DCT. The L showed statistically lower viability cell when compared to the other groups. Conclusions These findings suggest the antibacterial effect of the temporary materials Fill Magic and Bioplic against S. mutans, while Luxatemp showed in vitro inhibition of S. mutans biofilm accumulation and E. faecalis growth. Regarding the cell viability test, Luxatemp was the most cytotoxic and Fill Magic was shown to be the least cytotoxic.

Intradentinal antimicrobial action and filling quality promoted by ultrasonic agitation of epoxy resin-based sealer in endodontic obturation

Abstract The aim of this study was evaluate the influence of ultrasonic activation (UA) of AH Plus to improve canal and isthmus filing, and analyse the antimicrobial effect against Enterococcus faecalis within dentinal tubules. Material and Methods: Thirty mesial roots of mandibular first molars were selected and divided into 2 groups (n = 15): with and without UA of the sealer. Then the root canals were filled by using the single cone technique, and the specimens were sectioned at 2, 4 and 6 mm from the apex for stereomicroscope and confocal laser scanner microscopy (CLSM) analysis. In addition, 30 bovine incisors were contaminated with Enterococcus faecalis and divided into 3 groups (n = 10). The specimens were obturated by using the single cone technique with (G1) and without (G2) UA of the sealer and G3 as the control group. All were sectioned into 6 mm-long cylinders and stained with LIVE/DEAD to assess bacterial viability by CLSM. Results: The UA of the sealer significantly reduced the presence of unfilled areas in the canal and isthmus area in all sections (p<0.05), and there was a significant increase in sealer penetration in both canals and isthmuses (p<0.05). As regards gaps, a significant reduction was found at 2 and 6 mm in the isthmus area of the UA group (p<0.05). Moreover, UA of the sealer significantly reduced bacterial viability in the superficial dentine when compared with the other groups (p<0.05). Conclusion: Ultrasonic activation of the AH Plus sealer promoted a better quality of root canal filling and increased the intratubular penetration of sealer, especially in the isthmus area. Additionally, ultrasonic activation of the sealer increased the intradentinal antimicrobial action against Enterococcus faecalis, mainly in the superficial dentine of the root canal.

Systemic effect of mineral aggregate-based cements: histopathological analysis in rats

Abstract Objective: Several studies reported the local tissue reaction caused by mineral aggregate-based cements. However, few studies have investigated the systemic effects promoted by these cements on liver and kidney when directly applied to connective tissue. The purpose of this in vivo study was to investigate the systemic effect of mineral aggregate-based cements on the livers and kidneys of rats. Material and Methods: Samples of Mineral Trioxide Aggregate (MTA) and a calcium aluminate-based cement (EndoBinder) containing different radiopacifiers were implanted into the dorsum of 40 rats. After 7 and 30 d, samples of subcutaneous, liver and kidney tissues were submitted to histopathological analysis. A score (0-3) was used to grade the inflammatory reaction. Blood samples were collected to evaluate changes in hepatic and renal functions of animals. Results: The moderate inflammatory reaction (2) observed for 7 d in the subcutaneous tissue decreased with time for all cements. The thickness of inflammatory capsules also presented a significant decrease with time (P<.05). Systemically, all cements caused adverse inflammatory reactions in the liver and kidney, being more evident for MTA, persisting until the end of the analysis. Liver functions increased significantly for MTA during 30 d (P<.05). Conclusion: The different cements induced to a locally limited inflammatory reaction. However, from the systemic point of view, the cements promoted significant inflammatory reactions in the liver and kidney. For MTA, the reactions were more accentuated.

Antibacterial effect of four endodontic cements against enterococcus faecalis ATCC 29212: an in vitro study

Objective: to compare the in vitro antibacterial effect of the root canal cements Endobalsam, Top Seal, Apexit and Endofill against enterococcus faecalis ATCC 29212. Materials and method: Eighty-five applications of cements on enterococcus faecalis, cultured in vitro on solid media in Petri dishes, were analyzed. five groups were evaluated: four for each cement, and the fifth for the positive control (amoxicillin). the antibacterial effect was measured by the diameters of the bacterial inhibition halos at 24 hours, 48 hours, and seven days. student´s t-test, ANOVA and the Tukey test were used for the statistical analysis. results: no statistically significant differences were found at 24 hours (p>0.05); at 48 hours and seven days, Endofill and Apexit had the greatest effect (p<0.05); finally, on day 7 only Endofill showed an effect similar to the positive control (p>0.05). conclusion: enterococcus faecalis ATCC 29212 was susceptible to all cements. Endofill had greater in vitro antibacterial effect than Apexit, Top Seal and Endobalsam.

El rol de la pasta triple antibiótica en endodoncia regenerativa: una revisión bibliográfica / The role of the triple antibiotic paste in regenerative endodontics: a review of the literature

El tratamiento endodóntico convencional en casos de dientes con desarrollo radicular incompleto y periodontitis apical incluye opciones como la cirugía endodóntica o laapexificación mediante el uso de hidróxido de calcio o del compuesto de minerales trióxido. Sin embargo, numerosos ensayos ex vivo e in vivo en modelos animales, así como estudios clínicos en humanos, han demostrado que, luego de una adecuada desinfección y la formación de un coágulo sanguíneo, la posibilidad de obtener la regeneración de los tejidos infectados dentro del espacio del sistema de conductos radiculares –permitiendo a su vez la continuación del desarrollo de la raíz en DDRI con periodontitis apical– es actualmente una realidad con evidencia científicacomprobada. En ese sentido, la combinación de tres antibióticos talescomo metronidazol, ciprofloxacina y minociclina –conocida como pasta triple antibiótica– ha demostrado ser muy efectiva para obtener el nivel de desinfección necesaria. El propósito del presente estudio fue analizar la bibliografía referida al rol de la pasta triple antibiótica en endodoncia regenerativa para el tratamiento de dientes con desarrollo radicular incompleto con periodontitis apical.

In vitro antibacterial activity of a silicone-based endodontic sealer and two conventional sealers

Abstract The aim of this study was to evaluate whether the modification in the silver component is capable of providing GuttaFlow 2 with antibacterial activity against Enterococcus faecalis compared with epoxy resin-based (AH Plus) and zinc oxide and eugenol-based (Endofill) sealers. The antibacterial activity was evaluated using a reference strain of E. faecalis (ATCC 29212). Freshly mixed sealers were subjected to the agar diffusion test (ADT), while the direct contact test (DCT) was performed after materials setting. ADT results were obtained through measurements, in millimeters, of the inhibition zones promoted by the materials, using a digital caliper. In DCT, values of CFU/mL promoted by the three sealers were compared in three experimental periods (1 min, 1 h, and 24 h). The data were analyzed using Kruskal-Wallis and Dunn post-hoc tests (p < 0.05). In both ADT and DCT, GuttaFlow 2 presented no effect against E. faecalis, while Endofill and AH Plus showed similar inhibition zones. Endofill was the only material capable of reducing bacterial growth in DCT. In conclusion, modifications in the silver particle of GuttaFlow 2 did not result in a sealer with antibacterial effect against E. faecalis.

Biocompatibility and biomineralization assessment of bioceramic-, epoxy-, and calcium hydroxide-based sealers

Abstract Obturation of the root canal system aims to fill empty spaces, promoting hermetic sealing and preventing bacterial activity in periapical tissues. This should provide optimal conditions for repair, stimulating the process of biomineralization. An endodontic sealer should be biocompatible once it is in direct contact with periapical tissues. The aim of this study was to evaluate the rat subcutaneous tissue response to implanted polyethylene tubes filled with Smartpaste Bio, Acroseal, and Sealapex and investigate mineralization ability of these endodontic sealers. Forty Wistar rats were assigned to the three sealers groups and control group, (n = 10 animals/group) and received subcutaneous implants containing the test sealers, and the control group were implanted with empty tubes. After days 7, 15, 30, and 60, animals were euthanized and polyethylene tubes were removed with the surrounding tissues. Inflammatory infiltrate and thickness of the fibrous capsule were histologically evaluated. Mineralization was analyzed by Von Kossa staining and polarized light. Data were tabulated and analyzed via Kruskal-Wallis and Dunn's test. All tested materials induced a moderate inflammatory reaction in the initial periods. Smartpaste Bio induced the mildest inflammatory reactions after day 15. No difference was observed among groups after days 30 or 60. Von Kossa-positive staining and birefringent structures observed under polarized light revealed a larger mineralization area in Sealapex-treated animals followed by Smartpaste Bio-treated animals. At the end of the experiment, all tested sealers were found to be biocompatible. All sealers induced biomineralization, except Acroseal, which induced a mild tissue reaction.

Antimicrobial action of calcium hydroxide-based endodontic sealers after setting, against E. faecalis biofilm

Abstract Enterococcus faecalis are gram positive bacteria that can mostly resist endodontic therapy, inducing persistent infection in the root canal system. Endodontic sealers with antimicrobial activity may help eliminate residual microorganisms that survive endodontic treatment. The present study aimed at comparing the antimicrobial activity of Acroseal, Sealapex and AH Plus endodontic sealers in an in vitro biofilm model. Bovine dentin specimens (144) were prepared, and twelve blocks for each sealer and each experimental time point (2, 7 and 14 days) were placed and left in contact with plates containing inoculum of E. faecalis (ATCC 51299), to induce biofilm formation. After 14 days, the samples were transferred to another plate with test sealers and kept at 37°C and 5% CO2 for 2, 7 and 14 days. The specimens without sealers were used as a control for each period. The samples were agitated in a sonicator after each experiment. The suspensions were agitated in a vortex mixer, serially diluted in saline, and triple plated onto m-Enterococcus agar. Colonyforming units were counted, and the data were statistically analyzed using ANOVA, Shapiro-Wilk and Kruskal-Wallis one-way tests (p < 0.05) to determine antimicrobial potential. Sealapex showed significant differences at all the experimental time points, in comparison with all the other groups. AH Plus and Acroseal showed antimicrobial activity only on the 14th experimental day. Neither of the sealers tested were able to completely eliminate the biofilm. Sealapex showed the highest antimicrobial activity in all the experimental periods. The antimicrobial activity of all the sealers analyzed increased over time.

Antimicrobial activity of different filling pastes for deciduous tooth treatment

Guedes-Pinto paste is the filling material most employed in Brazil for endodontic treatment of deciduous teeth; however, the Rifocort® ointment has been removed. Thus, the aim of this study was to investigate the antimicrobial potential of filling pastes, by proposing three new pharmacological associations to replace Rifocort® ointment with drugs of already established antimicrobial power: Nebacetin® ointment, 2% Chlorhexidine Gluconate gel, and Maxitrol® ointment. A paste composed of Iodoform, Rifocort® ointment and Camphorated Paramonochlorophenol (CPC) was employed as the gold standard (G1). The other associations were: Iodoform, Nebacetin® ointment and CPC (G2); Iodoform, 2% Chlorhexidine Digluconate gel and CPC (G3); Iodoform, Maxitrol® ointment and CPC (G4). The associations were tested for Staphylococcus aureus (S. aureus), Streptococcus mutans (S. mutans), Streptococcus oralis (S. oralis), Enterococcus faecalis (E. faecalis), Escherichia coli (E. coli), and Bacillus subtilis (B. subtilis), using the methods of dilution on solid medium – orifice agar – and broth dilution. The results were tested using statistical analysis ANOVA and Kruskal-Wallis. They showed that all the pastes had a bacteriostatic effect on all the microorganisms, without any statistically significant difference, compared with G1. S. aureus was statistically significant (multiple comparison test of Tukey), insofar as G2 and G3 presented the worst and the best performance, respectively. All associations were bactericidal for E. coli, S. aureus, S. mutans and S. oralis. Only G3 and G4 were bactericidal for E. faecalis, whereas no product was bactericidal for B. subtilis. Thus, the tested pastes have antimicrobial potential and have proved acceptable for endodontic treatment of primary teeth.