Remoción de hidróxido de calcio del canal radicular con irrigación manual, sónica y ultrasónica / Calcium hydroxide removal from the root canal by manual, sonic and ultrasonic irrigation

Introducción: Resulta fundamental la remoción por completo del hidróxido de calcio previo a la obturación del canal radicular que podría impedir la penetración de los selladores en los túbulos dentinarios. Objetivo: Determinar la efectividad de la eliminación de la medicación con hidróxido de calcio del canal radicular de dientes utilizando diferentes sistemas de irrigación. Métodos: Se irrigaron con hipoclorito de sodio 148 conductos radiculares rectos de dientes humanos. Se utilizó Ca(OH)2 mezclado con tinta negra para rellenar los canales radiculares y facilitar la visualización. Los dientes se dividieron en 5 grupos de acuerdo al protocolo de eliminación. En cada uno de los grupos, la extrusión apical se midió durante la etapa de irrigación por el método Huang X, después de la eliminación del Ca(OH)2, se seccionaron longitudinalmente y luego, en un portaobjetos, se observaron las muestras bajo un microscopio óptico. Finalmente, se analizó el contenido para cuantificar el grado de extrusión causado durante el procedimiento clínico. Se utilizó el test de ANOVA para el análisis estadístico Resultados: Se encontró diferencias significativas entre los grupos 1-2, 1-3, 1-4 y 1-5. El promedio de remanecía fue superior (66,4 por ciento). Los grupos 2 (41,6 por ciento) y 5 (34,8 por ciento) obtuvieron mayor eficacia en la remoción. ANOVA (α = 0,05) determina que no existieron diferencias significativas entre los 5 grupos. Conclusiones: Los dispositivos de activación ultrasónica mostraron una mayor eliminación de la medicación con hidróxido de calcio desde las paredes dentinarias a las técnicas manuales, sin embargo, demostró ser una terapia más invasiva debido a una mayor extrusión de detritus(AU)

Introduction: Root canal sealing should indispensably be preceded by complete calcium hydroxide removal, otherwise the latter might prevent the penetration of the sealers into the dentinal tubules. Objective: Determine the effectiveness of eliminating calcium hydroxide medication from the root canal of teeth using various irrigation systems. Methods: Preparation was conducted of 148 straight root canals of human teeth irrigating with sodium hypochlorite. The root canals were filled with Ca(OH)2 mixed with black ink to facilitate visualization. The teeth were divided into 5 groups in compliance with the removal protocol. Apical extrusion was measured in each group during the irrigation stage using the Huang X method. After Ca(OH)2 removal they were sectioned longitudinally and placed on a slide for observation of the samples under an optical microscope. Finally the content was analyzed to quantify the degree of extrusion obtained during the clinical procedure. The ANOVA test was used for statistical analysis. Results: Significant differences were found between the groups 1-2, 1-3, 1-4 and 1-5. Average remanence was above 66.4 percent. Groups 2 (41.6 percent) and 5 (34.8 percent) displayed higher removal efficacy. ANOVA (α = 0.05) did not determine any significant differences between the 5 groups. Conclusions: Ultrasonic activation obtained greater calcium hydroxide removal from the dentinal walls than manual techniques. However, it proved to be a more invasive therapy due to the greater detritus extrusion(AU)

Effect of passive ultrasonic activation on microorganisms in primary root canal infection: a randomized clinical trial

Abstract Objective: This clinical study sought to evaluate the effectiveness of passive ultrasonic activation (PUA) in eliminating microorganisms in primary endodontic infection (PEI) after instrumentation of root canals using microbiological culture and checkerboard DNA-DNA hybridization. Methodology: Twenty root canals with PEI and apical periodontitis were selected. The root canals were instrumented and then randomly divided into 2 groups, according to the irrigation method: PUA and conventional needle irrigation (CNI). Microbiological samples were collected before instrumentation (S1), after instrumentation (S2) and after irrigation with 17% EDTA (S3). The samples were subjected to anaerobic culture technique and checkerboard DNA-DNA hybridization analysis. Results: A statistically significant difference was found between CNI (23.56%) and PUA (98.37%) regarding the median percentage values for culturable bacteria reduction (p<0.05). In the initial samples, the most frequently detected species was S. constellatus (50%), and after root canal treatment was E. faecalis (50%). Conclusion: Both treatments significantly decreased the number of bacterial species compared with the initial sample. However, no statistical difference in the total microbial load between PUA and CNI groups was detected. The number of cultivable anaerobic bacteria reduced significantly using PUA, and the bacterial composition and number of bacterial species after using either CNI or PUA was similar.

Systematic review of the literature on surgical treatment of chronic rhinosinusitis in children: what is the best approach? / Revisão sistemática da literatura no tratamento cirúrgico da rinossinusite crônica na infância: qual a melhor abordagem?

ABSTRACT Objective: To carry out a systematic literature review on the surgical treatment of chronic rhinosinusitis in the pediatric population. Data sources: A bibliographic review methodology was used, based on data from National Library of Medicine (Medline), PubMed, Latin American and Caribbean Health Sciences Literature (LILACS) and Scientific Electronic Library Online (SciELO), of the indexed works from 2006 to 2016, including the pediatric population from zero to 13 years of age. The search keywords according to Medical Subject Heading (MESH) and Health Sciences Descriptors (DeCS) were: child, surgery, sinusitis and chronic disease. A total of 318 articles were collected, five of which met the inclusion criteria and were used as a basis for this review. All articles were prospective cohort studies, level of evidence 2B, according to the criterion used by evidence-based medicine. Data synthesis: The literature agreed that the next step for the cases refractory to drug treatment in chronic rhinosinusitis in childhood would be surgery. Adenoidectomy would be the initial method, for the safety of the procedure and improvement in about 50% of the cases, although more significant results were found in patients who associated this procedure with facial sinus surgery. Conclusions: Surgical treatment should be indicated for chronic rhinosinusitis in childhood after treatment failure. The results pointed out that adenoidectomy, when associated with some type of approach to the facial sinus, present better results.

RESUMO Objetivo: Realizar uma revisão sistemática da literatura sobre o tratamento cirúrgico da rinossinusite crônica na população pediátrica. Fonte de dados: Utilizou-se metodologia de revisão bibliográfica, por meio de levantamentos nas bases de dados científicas National Library of Medicine (Medline), PubMed, Literatura Latino-americana e do Caribe em Ciências da Saúde (LILACS) e Scientific Electronic Library Online (SciELO), dos trabalhos indexados no período entre 2006 e 2016, incluindo a população pediátrica de zero a 13 anos. Os descritores de busca, segundo o Medical Subject Heading (MESH) e os Descritores em Ciências da Saúde (DeCS), foram: Child, Surgery, Sinusitis e Chronic Disease. Foram levantados 318 artigos, dos quais cinco preencheram os critérios de inclusão e foram usados como base para esta revisão. Todos os artigos foram estudos de coorte prospectivos, nível de evidência 2B, segundo critério usado pela medicina baseada em evidências. Síntese dos dados: Foi consenso na literatura que, para os casos refratários ao tratamento medicamentoso na rinossinusite crônica na infância, o próximo passo seria a cirurgia. A adenoidectomia seria o método inicial, pela segurança do procedimento e pela melhora em cerca de 50% dos casos, embora resultados mais significativos terem sido encontrados em pacientes que associaram esse procedimento à cirurgia dos seios da face. Conclusões: O tratamento cirúrgico pode ser indicado na rinossinusite crônica na infância após falha terapêutica. Os resultados apontaram que a adenoidectomia, quando associada a algum tipo de abordagem aos seios, apresenta melhores resultados.

Uso de la Fibrina Rica en Plaquetas Inyectable (i-PRF) en Defectos Infra Óseos en Terapia Periodontal no Quirúrgica. Reporte de Dos Casos / Use of Injectable Platelet-Rich Fibrin (i-PRF) in Infra Osseous Defects in Non-Surgical Periodontal Therapy. Report of Two Cases

RESUMEN: Entre los concentrados plaquetarios de segunda generación, ha suscitado creciente interés, el uso de fibrina rica en plaquetas y leucocitos inyectable (i-PRF); que se obtiene a partir de la centrifugación inmediata de sangre venosa del propio individuo, y que aporta concentraciones elevadas de factor de crecimiento vascular endotelial, factor de crecimiento transformante beta, y factor de crecimiento derivado de plaquetas, entre otras proteínas que inician y coordinan el proceso reparativo. Su nula citotoxicidad y consistencia líquida abren un nuevo campo de estudio y experimentación en el ámbito de la Cirugía Oral y de la Periodoncia, como sustancia para irrigar. El objetivo de este manuscrito fue reportar el uso del i-PRF como irrigador subgingival en el tratamiento periodontal convencional de defectos infra óseos con 6 meses de seguimiento. En ambos casos, se verificó un efecto positivo de irrigación, lo que abre el debate al uso de productos farmacéuticos tradicionales como la clorhexidina versus preparados autólogos sin efectos adversos reportados a la fecha.

ABSTRACT: Second generation platelet concentrates include the use of injectable platelet-rich fibrin (i-PRF), which has generated increasing interest because it is derived from immediate centrifugation of venous blood from the patients themselves. It provides high concentrations of vascular endothelial growth factor, transforming growth factor beta, and platelet-derived growth factor, among other proteins that initiate and coordinate the healing process. Its null cytotoxicity and liquid consistency has opened new research lines in the field of oral surgery and periodontics, as an irrigation substance. The aim of this manuscript was to report the use of i-PRF, as a subgingival irrigator in conventional periodontal treatment of infra osseous defects, with six months follow-up. In both cases, a positive effect of irrigation was confirmed. These findings, open the debate as regards the use of traditional pharmaceutical products (such as chlorhexidine), versus autonomous preparations without adverse effects reported to date.

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.

Anterograde irrigation - assisted ureteroscopic lithotripsy in patients with percutaneous nephrostomy

ABSTRACT In complicated urinary tract infection with ureteral calculi, urinary diversion is inevitable. So, stenting or percutaneous drainage can be an option. In hemodynamically unstable patients, percutaneous drainage is superior to ureteral stenting (1). Once acute infection is controlled, definite treatment of the stone is necessary. According to a guideline, semirigid ureteroscopy is recommended for lower and mid - ureter stone and flexible ureteroscopy for upper ureter stone (2). Semi - rigid ureteroscopy can migrate stone to kidney, especially in upper ureter stone, lowering stone free rate (3). Not only flexible ureteroscopy creates additional costs but also is barely available in developing countries (4, 5). So, the authors would like to introduce anterograde irrigation - assisted ureteroscopic lithotripsy in patients with percutaneous nephrostomy. Retrograde irrigation was connected and flowed minimally enough to secure visual field. Once stone is noted, another saline irrigation, which is placed above 40 cm over the patient is connected to nephrostomy. Retrograde irrigation is disconnected from ureteroscope and the previous connected channel on ureteroscope is opened. Actual pressure detected by barometer from the opened channel of ureteroscope is usually about 30 cmH2 O while anterograde irrigation is administered in maximal flow, which means fully opened anterograde irrigation is not hazardous to kidney. There was no complication in 17 patients submitted to this method. Video shows advantages of our practice: clear visual field; reduced risk of stone migration into kidney; induced spontaneous passage of fragments without using instrumentation; and decreased operation time. In short, most of surgeons, even unexperienced, can perform an excellent procedure with less time consuming using our method.

Volume and/or time of naocl influences the fracture strength of endodontically treated bovine teeth

Abstract The aim of this study was to evaluate whether amplifying the volume and/or time of contact of NaOCl affects the fracture strength of endodontically treated bovine teeth. Four bovine incisors from 10 animals were allocated into 4 groups using a split-mouth design. Root canals were instrumented using a sequence of 4 manual stainless steel files and irrigated with a 5.25% alkalized NaOCl solution. The total volume and time of irrigation, per sample, varied among the groups as following: standard volume and time of contact - 15 mL/11.5 min; volume raise - 30 mL/11.5 min; time of contact raise - 15 mL/19 min; and volume and time of contact raise - 30 mL/19 min. Samples were subjected to a fracture resistance assay. At p=0.05, two-way ANOVA statistically scrutinized the results. Effect size of NaOCl time of contact and volume were also calculated (η2). The variation in time (p=0.000), volume of irrigation (p=0.000) and the combination of both (p=0.038) negatively influenced the fracture resistance. Standard volume and time of irrigation showed the highest fracture strength while isolated increase in volume or time reduced in 25% and 37%, respectively, the fracture resistance; the simultaneous increase in volume and time of irrigation promoted a reduction of 47%. Effect size of NaOCl time of contact was superior (0.746) than the volume (0.564). Raising the volume and/or time of a 5.25% alkalized NaOCl solution reduces the fracture resistance of endodontically treated bovine teeth.

Resumo O objetivo desse estudo foi o de avaliar se o aumento de volume e/ou tempo de contato do NaOCl afeta a resistência à fratura de dentes bovinos tratados endodonticamente. Quatro incisivos bovinos de 10 animais foram alocados em 4 grupos usando um desenho experimental de boca dividida. Os canais radiculares foram instrumentados usando uma sequência de 4 limas manuais de aço inoxidável e irrigados com uma solução de NaOCl alcalinizada a 5,25%. O volume total e o tempo de irrigação, por amostra, variaram entre os grupos da seguinte forma: volume e tempo de contato padrão (grupo controle) - 15 mL/11,5 min; aumento de volume - 30 mL/11,5 min; aumento no tempo de contato - 15 mL/19 min; e aumento no volume e no tempo de contato - 30 mL/19 min. As amostras foram submetidas a um ensaio de resistência à fratura. Com p=0.05, o teste two-way ANOVA analisou estatisticamente os resultados. O tamanho do efeito do tempo de contato e volume de NaOCl também foi calculado (h2). A variação no tempo (p=0,000), no volume de irrigação (p=0,000) e a interação entre ambos (p=0.038) influenciaram negativamente a resistência à fratura. O volume e o tempo padrão de irrigação apresentaram a maior resistência à fratura, enquanto o aumento isolado no volume ou no tempo de contato reduziram 25% e 37%, respectivamente, a resistência à fratura; o aumento simultâneo do volume e tempo de irrigação promoveu uma redução de 47%. O tamanho do efeito do tempo de contato com o NaOCl foi superior (0,746) ao volume (0,564). Aumentando o volume e/ou o tempo de uma solução de NaOCl alcalinizada a 5,25% reduz a resistência à fratura de dentes bovinos tratados endodonticamente.

Cleaning effectiveness of a nickel-titanium ultrasonic tip in ultrasonically activated irrigation: a SEM study

Abstract In endodontic treatment, regardless of the instrumentation technique, the presence of a smear layer covering contaminated dentin walls is always a concern. Thus, irrigation plays an essential role in reducing bacterial load. To enhance irrigation effectiveness, different ultrasonic activation methods and the use of different tips have been studied. This study assessed the cleaning capacity of the novel NiTi ultrasonic tip for smear layer removal using ultrasonically activated irrigation (UAI) with passive or continuous ultrasonic irrigation (PUI or CUI, respectively), compared with conventional irrigation. Forty-five single-rooted human mandibular premolars were decoronated to a standardized length of 16 mm. Instrumentation was performed using the Genius system up to size 50.04 and irrigated with 3% NaOCl. The specimens were divided into three groups (n = 15) according to the final irrigation activation technique: conventional irrigation (CI), as control group; PUI; and CUI, following the manufacturer's protocol. The samples were longitudinally cleaved and analyzed under a scanning electron microscope for smear layer removal according to a cleanliness score for the cervical, middle, and apical thirds. Data were evaluated by means of the Kruskal-Wallis and Tukey's tests, with a 5% level of significance. UAI enhanced cleaning compared to conventional irrigation, mainly at the apical third. CUI showed the best results, with statistically significant lower scores than PUI and CI (p < 0.05). Final irrigant activation with the NiTi tip showed better cleaning capacity than conventional irrigation. In addition, CUI resulted in better smear layer removal than PUI.

Efeito da irrigação ultrassônica e da medicação intracanal com hidróxido de cálcio na quantidade e no metabolismo de bactérias que persistiram após o preparo dos canais radiculares de dentes com periodontite apical / Effect of ultrasonic irrigation and calcium hydroxide intracanal medication on the levels and metabolism of bacteria that persisted after root canal preparation of teeth with apical periodontitis

Estudos moleculares ressaltam as limitações do protocolo endodôntico tradicional em eliminar bactérias dos canais radiculares. Apesar do preparo químico-cirúrgico (PQC) promover uma drástica redução bacteriana, muitos canais continuam infectados após essa etapa do tratamento. Dessa forma, estudos apontam para a necessidade de complementação técnica para potencializar a desinfecção dos canais radiculares após o PQC. Assim, o objetivo deste estudo clínico foi avaliar, por métodos moleculares baseados em DNA e RNA, o efeito dos métodos complementares ao preparo na desinfecção dos canais radiculares. Coletas microbiológicas dos canais de 20 dentes unirradiculares com periodontite apical foram feitas em diferentes etapas do tratamento endodôntico: previamente ao preparo (S1); após o PQC realizado com sistema Reciproc associado à irrigação com NaOCl 2,5% (S2); após a irrigação ultrassônica passiva, denominada PUI (S3); e após a medicação intracanal à base de hidróxido de cálcio (S4). As amostras foram submetidas à extração de DNA e RNA. O RNA foi submetido à reação de transcrição reversa (RT-PCR) para confecção da fita dupla de DNA complementar (cDNA). DNA e cDNA foram submetidos a reações de qPCR, com iniciadores universais para a região 16S rRNA do domínio Bacteria. A atividade metabólica das bactérias foi verificada através da relação entre os níveis de rRNA e rDNA determinados pelos ensaios de qPCR. Os dados foram analisados pelo teste de Wilcoxon para amostras pareadas (p < 0,05). As amostras S1 dos 20 casos apresentaram altos níveis de rDNA (mediana: 1,25 x 105, intervalo 1,83 x 104 - 9,2 x 106) e rRNA bacteriano (mediana: 5,47 x 105, intervalo 7,8 x 104 - 5,95 x 107). Dezessete canais (85%) apresentaram reações qPCR positivas para rDNA nas amostras pós-preparo (S2). A redução de rDNA após o preparo foi estatisticamente significativa (p = 0,0003), com mediana de 2,5 x 104 (intervalo 2,26 x 103 - 9,52 x 104) cópias de rDNA em S2. Por sua vez, os níveis de rRNA (mediana: 7,84 x 104, intervalo 2,91 x 103 - 1,09 x 106) foram maiores que os níveis de rDNA (p = 0,01), sugerindo que essas bactérias estavam metabolicamente ativas em S2. Após a PUI, o número de amostras S3 com resultados positivos para rDNA caiu para 12, representando uma redução significativa em relação às amostras S2 (p = 0,008). Além disso, a PUI promoveu uma redução significativa dos níveis de rDNA (mediana 2,94 x 103, intervalo 2,70 x 103 - 1,09 x 105) em relação à amostras S2 (p = 0,01). Na análise baseada em rRNA, os níveis em S3 (mediana: 03 x 104, intervalo 1,82 x 103 - 1,39 x 105) não apresentaram diferença significativa em comparação aos níveis de rDNA (p = 0,07), sugerindo que houve uma redução do metabolismo bacteriano após a PUI. Em S4, o número de casos positivos para rDNA bacteriano (n = 13) e os níveis de rDNA (mediana: 3,73 x 104, intervalo 1,98 x 103 - 3,21 x 105) foram ligeiramente maiores quando comparados aos valores das amostras S3, porém sem diferenças significativas. Entretanto, os níveis de rRNA (mediana: 1,08 x 105, intervalo 3,41 x 103 - 1,60 x 106) foram maiores que os de rDNA (p = 0,02) nas amostras S4, sugerindo que as bactérias retomaram sua atividade metabólica apesar do uso da medicação intracanal. Portanto, foi possível concluir que a irrigação ultrassônica passiva contribuiu para a desinfecção dos canais radiculares, promovendo uma redução do número e do metabolismo de bactérias. Por outro lado, as bactérias persistiram ativas nos canais radiculares após o uso do hidróxido de cálcio como medicação intracanal em dentes com periodontite apical.

Efficacy of sonic and ultrasonic irrigation devices in the removal of debris from canal irregularities in artificial root canals

Abstract Objective To evaluate the efficacy of different sonic and ultrasonic devices in the elimination of debris from canal irregularities in artificial root canals. Materials and Methods A resin model of a transparent radicular canal filled with dentin debris was used. Five groups were tested, namely: Group 1 - ultrasonic insert 15.02; Group 2 - ultrasonic insert 25/25 IRRI K; Group 3 - ultrasonic insert 25/25 IRRI S; Group 4 - sonic insert 20/28 Eddy on a vibrating sonic air-scaler handpiece; Group 5 - 20.02 K-file inserted on a Safety M4 handpiece. Two different irrigants (5% sodium hypochlorite and 17% EDTA) and 3 different times of activation (20, 40, and 60 seconds) were tested. Means and standard deviations were calculated and statistically analyzed with the Kruskal-Wallis and Wilcoxon tests (p<0.05). Results No statistically significant differences were found between the two irrigants used. Group 4 removed more debris than the other groups (p<0.05). Groups 1, 2, and 3 removed more debris than group 5 (p<0.05). A statistically significant difference (p<0.05) was found for the time of activation in all groups and at all canal levels, except between 40 and 60 seconds in group 4 at coronal and middle third level (p>0.05). Conclusions No significant differences were found between 5% sodium hypochlorite and 17% EDTA. When the time of activation rises, the dentin debris removal increases in all groups. Both sonic and ultrasonic activation demonstrate high capacity for dentin debris removal.

Irrigation trends among members of the Chilean Endodontic Society

Introduction: the aim of this study is to determine the current trends of irrigation during root canal therapy by specialists who are members of the Chilean Endodontic Society. materials and method: a survey (survey monkey -SurveyMonkey.com) was e-mailed to the 485 members of the Chilean Endodontic Society. the instrument was translated and adapted from the survey "irrigation trends among American Association of Endodontists members: a web-based survey" applied in the USA in 2012. participants answered a set of 16 questions that included irrigant selection, irrigant concentration, the adopted protocol, techniques or devices for irrigant activation. results: 99 percent of respondents use sodium hypochlorite as the main irrigant. data indicate that 74 percent of respondents use hypochlorite at a concentration of 5 percent. most respondents (94 percent) also include EDTA in their usual practice. In addition, 90 percent of respondents reported that they activate the irrigating agent, and 94 percent confirmed that they perform a final irrigation protocol. conclusion: the majority of respondents use sodium hypochlorite as the main irrigant at a concentration of 5 percent, use ethylenediaminetetraacetic acid (EDTA) as a smear removal agent, activate the irrigant, and perform a final irrigation protocol.

Effect of post-space irrigation with naocl and caocl at different concentrations on the bond strength of posts cemented with a self-adhesive resin cement

Abstract The aim of this study was to evaluate the effect of post-space irrigation with NaOCl and CaOCl at different concentrations on the bond strength of posts cemented with a self-adhesive resin cement. Eighty premolars were sectioned 14 mm from the apex, and endodontically treated. The root canal filling was partially removed. Specimens were randomly assigned into 8 groups (n=10), according to the irrigant for post-space irrigation: SS - 0.9% saline solution (control group); CHX - 2% chlorhexidine; 1% NaOCl - 1% sodium hypochlorite; 2.5% NaOCl - 2.5% sodium hypochlorite; 5% NaOCl - 5% sodium hypochlorite; 1% CaOCl - 1% calcium hypochlorite; 2.5% CaOCl - 2.5% calcium hypochlorite; and 5% CaOCl - 5% calcium hypochlorite. For each group, irrigation was performed continuously with 2 ml of solution. The post-spaces were dried with paper points (#80), and glass fiber posts were cemented using a self-adhesive resin cement. The specimens were sectioned perpendicularly and the push-out test was performed. Optical microscopy was used to analyze the failure mode. ANOVA and Bonferroni tests analyzed the bond strength data. NaOCl and CaOCl presented similar bond strength regardless the concentration used to irrigate the post-space (p>0.05). SS showed the highest bond strength (11.47 MPa) (p<0.05). Adhesive failures at the cement/dentin interface were predominant (58.33%). Saline solution should be irrigant of choice to irrigate the post-space before fiber post cementation with self-adhesive resin cement. NaOCl and CaOCl negatively affect the bond strength values.

Resumo O objetivo deste estudo foi avaliar o efeito da irrigação do espaço preparado para o pino com NaOCl e CaOCl em diferentes concentrações na resistência adesiva de pinos cimentados com um cimento resinoso autoadesivo. Oitenta pré-molares foram seccionados 14 mm do ápice e endodonticamente tratado. As obturações foram parcialmente removidas. Os espécimes divididos randomicamente em 8 grupos (n=10) de acordo com o irrigante usado para irrigação do espaço preparado para pino: SF - soro fisiológico 0,9% (grupo controle); CHX - clorexidina 2%; NaOCl 1% - hipoclorito de sódio 1%; NaOCl 2,5% - hipoclorito de sódio 2,5%; NaOCl 5% - hipoclorito de sódio 5%; CaOCl 1% - hipoclorito de cálcio 1%; CaOCl 2,5% - hipoclorito de cálcio 2,5%; CaOCl 5% - hipoclorito de cálcio 5%. Para cada grupo, irrigação foi realizada com 2 mL de solução. O espaço preparado para pino foi seco com cone de papel absorvente (#80) e os pinos de fibra foram cimentados com cimento resinoso autoadesivo. Os espécimes foram seccionados perpendicularmente e o teste de push-out foi realizado. Microscopia óptica foi usada para analisar o padrão de falha. Os testes de ANOVA e Bonferroni analisaram os dados de resistência adesiva. NaOCl e CaOCl apresentaram similar resistência adesiva, independentemente da concentração usada para irrigar o espaço preparado para pino (p>0,05). SF apresentou os maiores valores de resistência adesiva (11,47 MPa) (p<0,05). Falhas adesivas na interface cimento/dentina foram predominantes (58,33%). Soro fisiológico deve ser o irrigante de escolha para irrigar o espaço preparado para pino antes da cimentação de pinos de fibra com cimentos resinosos autoadesivos. NaOCl e CaOCl afetam negativamente os valores de resistência adesiva.

Percutaneous endoscopic debridement and irrigation for thoracic infections

SUMMARY OBJECTIVE: To investigate the safety and efficacy of percutaneous endoscopic debridement and irrigation for thoracic infections and to make an appropriate choice according to the patient's condition. METHODS. Thirty patients with thoracic infections who received surgical treatment from August 2014 to December2016 were retrospectively analyzed. There were 16 males and 14 females, aged from 41 to 90 years, with an average of 64.4 years. A total of 9 cases were treated with percutaneous endoscopic debridement and irrigation (minimal group), and 21 cases were treated with open debridement in combination with pedicle screw fixation (conventional group). Patients underwent follow-up for 1 month. General condition, operative index, laboratory results, and imaging features were recorded. RESULTS. Compared with the conventional group, there were more comorbidities in patients in the minimal group (8 cases in the minimal group, 10 cases in the conventional group, P=0.049), shorter hospital stay (10.1 + 2.26 days in the minimal group, 16.1 + 6.81 days in the conventional group, P=0.016), less bleeding volume (383.3 + 229.86ml in the minimal group, 90 + 11.18ml in the conventional group, P=0.000), lower VAS score at discharge (2.9 + 0.93 in the minimal group, 3.9 + 0.91 in the conventional group, P=0.013). There was no spinal instability case in the minimal group, 10 cases in the conventional group, P=0.013. There were significant differences. The C reaction protein prior to operation in the minimal group was 28.4±7.50mg/L. Compared with 45.1 + 15.78mg/L in the conventional group, P=0.005, it was lower. CONCLUSIONS. Percutaneous endoscopic debridement and irrigation are an effective surgery for treatment of thoracic infections, especially suitable for patients with comorbidities and poor general condition. However, for severe infection and spinal instability, we tend to choose open surgery in combination with fixation.

RESUMO OBJETIVOS: Investigar a eficácia e segurança de desbridamento endoscópico percutâneo e irrigação torácica para infecções e fazer uma escolha adequada de acordo com a condição do paciente. MÉTODOS: Trinta pacientes com infecção torácica que receberam tratamento cirúrgico de agosto de 2014 a dezembro de 2016 foram analisadosretrospectivamente. Havia 16 homens e 14 mulheres, de 41 a 90 anos, com uma média de 64,4 anos. Nove casos foram tratados com desbridamento endoscópico percutâneo e irrigação (grupo mínimo) e 21 casos foram tratados com desbridamento aberto em combinação com fixação do parafuso pedicular(grupo convencional). Os pacientes foram submetidos a acompanhamento durante um mês. Estado geral, índice operacional, resultados de laboratório e imagem e funcionalidades foram gravados. RESULTADOS: Em comparação com o grupo convencional, há mais comorbidades em pacientes do grupo mínimo (8 casos no grupo mínimo, 10 casos no grupo convencional, P = 0,049), menos tempo no hospital (10,1 + 2,26 dias no grupo mínimo, 16,1 + 6,81 dias no grupo convencional, P = 0,016), menos volume de sangramento (383,3 + 229,86 ml no grupo mínimo, 90 + 11,18 ml no grupo convencional, P = 0,000), menor pontuação no VAS a quitação (2,9 + 0,93 no grupo mínimo, 3,9 + 0,91 no grupo convencional, P = 0,013). Não houve nenhum caso de instabilidade espinhal no grupo mínimo, e 10 casos no grupo convencional, P = 0,013. Houve diferenças significativas. O nível de proteína C-reativa antes da operação no grupo mínimo era de 28,4±7,50mg/L. Em comparação com 45,1 + 15,78 mg/L no grupo convencional, P = 0,005, era mais baixa. CONCLUSÃO: O método de desbridamento endoscópico percutâneo e irrigação é eficaz para o tratamento de infecções em cirurgia torácica, especialmente adequado para pacientes com comorbidades e mau estado geral. Mas, para a infecção grave e instabilidade vertebral, tendemos a escolher a cirurgia aberta em combinação com a fixação.

Evaluation of apically extruded debris using positive and negative pressure irrigation systems in association with different irrigants

Abstract This study evaluated the amount of apically extruded debris after chemo-mechanical preparation (CMP) using positive and negative pressure irrigation systems [Conventional irrigation (CI) and EndoVac (EV)] in association with different irrigants [6% Sodium Hypochlorite (NaOCl), 2% Chlorhexidine gel + saline solution (CHXg + SS), 2% Chlorhexidine solution (CHXs) or Saline solution (SS)]. Eighty mandibular premolars with single root canals were selected and randomly assigned into 8 groups (n = 10) according to the irrigation system and the irrigant used during CMP: G1 (EV + NaOCl), G2 (EV + CHXg + SS), G3 (EV + CHXs), G4 (EV + SS), G5 (CI + NaOCl), G6 (CI + CHXg + SS), G7 (CI + CHXs) and G8 (CI + SS). Reciproc® R25 files (25/.08) were used during the CMP and the extruded debris from each tooth was collected in pre-weighted Eppendorf tubes and dried. The average weight of debris was assessed using a microbalance, and the data were statistically analyzed using ANOVA and the post hoc Tukey's test (a = 0.05). All groups were associated with debris extrusion. EV was the irrigation system with less extruded debris (p < 0.05). No differences were observed regarding the irrigant when EV was used. When CI was used, CHXg + SS were associated with lower debris extrusion (p < 0.05). It was concluded that no irrigation protocol succeeded in preventing debris extrusion. EV resulted in lower levels of debris extrusion than CI. The use of CHXg + SS resulted in lower debris extrusion.

Resumo Este estudo avaliou a quantidade de debris extruídos apicalmente após o preparo químico-mecânico (PQM) utilizando sistemas de irrigação com pressão positiva e negativa [irrigação convencional (IC) e EndoVac (EV)] em associação com diferentes irrigantes [hipoclorito de sódio 6% (NaOCl), clorexidina gel + solução salina (CLXg + SS), solução de clorexidina 2% (CLXs) ou solução salina (SS)]. Oitenta pré-molares inferiores com único canal radicular foram selecionados e aleatoriamente alocados em 8 grupos (n=10) de acordo com o sistema de irrigação e irrigante utilizado durante o PQM: G1 (EV + NaOCl), G2 (EV + CLXg + SS), G3 (EV + CLXs), G4 (EV + SS), G5 (IC + NaOCl), G6 (IC + CLXg + SS), G7 (IC + CLXs) e G8 (IC + SS). Limas Reciproc® R25 foram utilizadas durante o PQM e os debris extruídos de cada dente foi coletado em tubos pré-pesados e secos. O peso médio de debris foi avaliado por meio de microbalança, e os dados foram analisados estatisticamente utilizando ANOVA e teste de Tukey (a = 0.05). Todos os grupos foram associados com extrusão de debris. EV foi o sistema de irrigação com menos debris extruídos (p<0.05). Não foram observadas diferenças entre os irrigantes quando o EV foi utilizado. Quando foi utilizada IC, CLXg + SS foram associados a menor extrusão de debris (p<0.05). Concluiu-se que nenhum protocolo de irrigação conseguiu prevenir extrusão de debris. EV resultou em menores níveis de extrusão de debris que a IC. A utilização da CLXg + SS resultou em menor extrusão de debris.

Effect of sonic versus ultrasonic activation on aqueous solution penetration in root canal dentin

The aim of this study was to observe the penetration of an aqueous solution into the root canal dentin under sonic activation and ultrasonic activation. Materials and Method: this study consisted of experimental in vitro research. In order to achieve a closed system, the apex of 45 single-rooted teeth was sealed with wax. The step-back technique was manually performed using a K50 apical master file and 3 groups were organized according to the protocol of the final irrigant activation: group I: non-activated chinese ink for 30 seconds, group II: chinese ink sonically activated with EndoActivator for 30 seconds, and group III: chinese ink ultrasonically activated with Varios 350 equipment for 30 seconds. Teeth were sectioned longitudinally, and the samples obtained were observed under a stereomicroscope at 1X magnification in order to be photographed and scanned to calculate the penetration area using the Image J software. The tinted radicular area was evaluated in relation to the total area of the root dentin. The tukey's post-hoc test and ANOVA were used for the statistical analysis (p<0.05). Results: group I and II obtained 9.13 percent and 9.42 percent penetration respectively, while in group III the highest degree of dye infiltration was achieved (13.9 percent), being statistically significant (p<0.001). Conclusions: ultrasonic activation produced a significantly higher penetration of the dye when compared to conventional activation and sonic activation.

Effect of ductus deferens lavage on the time to achieve azoospermia in patients undergoing vasectomy

OBJECTIVE: To evaluate the effect of normal saline lavage of the distal vas deferens ampulla in patients undergoing vasectomy on the time to achieve azoospermia. METHODS: A prospective randomized study of 60 men divided into two groups, group lavage (GL, n=30) in which distal vas deferens ampulla lavage was performed with 10 ml of normal saline during the vasectomy, and group without lavage (GWL, n=30) in which control patients received only a vasectomy. The patients provided sperm for semen analysis at the 5th, 10th, 15th, 20th and 25th ejaculations. RESULTS: Fifteen participants in GL and 16 in GWL, for a total of 31 patients, were excluded due to not completing the control spermiogram. The tests carried out at the five ejaculations showed immobile spermatozoa in 40 and 85.71%, 66.67 and 78.57%, 93.33 and 85.71%, 86.67 and 71.43%, and 93.33 and 85.71% of participants in GL and GWL, respectively. CONCLUSION: Vas deferens duct lavage with 10 ml of normal saline during vasectomy did not decrease the time required to achieve postoperative azoospermia.

Apical Negative Pressure irrigation presents tissue compatibility in immature teeth

Abstract Aim: To compare the apical negative pressure irrigation (ANP) with conventional irrigation in the teeth of immature dogs with apical periodontitis. Methods: Fifty-two immature pre-molar root canals were randomly assigned into 4 groups: ANP (n=15); conventional irrigation (n=17); healthy teeth (control) (n = 10); and teeth with untreated apical periodontitis (control) (n=10). After induction of apical periodontitis, teeth were instrumented using EndoVac® (apical negative pressure irrigation) or conventional irrigation. The animals were euthanized after 90 days. The sections were stained by HE and analyzed under conventional and fluorescence microscopy. TRAP histoenzymology was also performed. Statistical analyses were performed with the significance level set at 5%. Results: There was difference in the histopathological parameters between ANP and conventional groups (p<0.05). The ANP group showed a predominance of low magnitude inflammatory infiltrate, a smaller periodontal ligament, and lower mineralized tissue resorption. There were no differences in the periapical lesion extensions between the ANP and conventional groups (p>0.05). However, a lower number of osteoclasts was observed in the ANP group (p<0.05). Conclusion: The EndoVac® irrigation system presented better biological results and more advanced repair process in immature teeth with apical periodontitis than the conventional irrigation system, confirming the hypothesis.

Effect of ultrasound streaming on the disinfection of flattened root canals prepared by rotary and reciprocating systems

Abstract New technical and scientific developments have been advocated to promote the success of the endodontic treatment. In addition to rotary and reciprocating systems, irrigating solution agitation has been suggested and passive ultrasonic irrigation (PUI) is the most used. Objective: To evaluate, in vitro, the effect of ultrasound streaming (US) in the disinfection of flattened root canal systems prepared by the ProTaper, BioRaCe and Reciproc systems, utilizing the microbiological culture. Methodology: Extracted human mandibular incisors (n=84) were used. Suspensions of Enterococcus faecalis (ATCC 29212) were standardized and inserted along with the teeth immersed in brain-heart infusion (BHI) broth. The contamination was made following a protocol during 5 days. The teeth were randomly divided into six groups: G1, ProTaper Universal; G2, ProTaper Universal with US; G3, BioRaCe; G4, BioRaCe with US; G5, Reciproc; and G6, Reciproc with US. Irrigation was performed with saline solution. After biomechanical preparation, microbiological samples were performed with sterilized paper points, which were diluted and spread on BHI agar; after 48 h, the colony forming units (CFU/mL) were counted for each sample. Results: Groups using ultrasonic agitation presented a greater antibacterial effect than the other ones, even using saline solution as irrigant. The ProTaper Universal system showed the best antibacterial activity of the tested systems (median of 0 CFU/mL with and without surfactant or ultrasonic activation [PUI]). Even with PUI, Reciproc (median of 2.5 CFU/mL with PUI and 5 without it) could not reduce as many colonies as ProTaper Universal without US. The BioRaCe system had greater bacterial reduction when using US (median of 0 CFU/mL with PUI and 30 without it). Conclusions: US promoted greater reduction in the number of bacteria in the flattened root canals prepared with nickel-titanium mechanized systems. Regarding the instruments used, the ProTaper Universal system was the most effective in reducing the bacterial number.

Acetylcholine chloride 1% usage for intraoperative cataract surgery miosis / Cloridrato de Acetilcolina 1% na obtenção da miose intraoperatória na cirurgia de catarata

Abstract Objective: To test the efficacy of Acetylcholine chloride use in obtaining intraoperative miosis on phacoemulsification cataract surgery. Methods: Patients with cataract diagnosis and elected for surgical phacoemulsification procedure were selected. All patients underwent conventional phacoemulsification procedure performed by a single surgeon and all patients had 0.2 ml of Acetylcholine chloride 1% irrigated in the anterior chamber at the end of the surgery. The pupillary diameter was measured immediately before the beginning of surgery, immediately before and two minutes after the use of acetylcholine chloride 1%. Results: A total of 30 eyes from 30 patients were included in the study. 18 were female, and mean age was of 69.5 years with a 7.2y standard deviation on the population study. The mean pupillary diameter immediately before the beginning of surgery was 7.5 mm with a standard deviation of 0.56 mm; the mean pupillary diameter immediately before the acetylcholine chloride 1% use (after the intraocular lens im-plantation) was 7.1 mm with a standard deviation of 0.57 mm. The mean pupillary diameter two minutes after the use of acetylcholine chloride 1% in the anterior chamber was 3.4 mm with standard deviation of 0.66 mm. The mean maximum action time of ACH chloride 1% was 64 seconds, with a standard deviation of 8 seconds. The mean intraocular pressure on the first postoperative day was 19.1 mmHg with a standard deviation of 2.45 mmHg. Conclusion: We conclude that acetylcholine chloride 1% is an important drug to obtaining intraoperative miosis in cataract surgery.

Resumo Objetivo: Demonstrar a eficácia do cloridrato de acetilcolina 1% na obtenção da miose intraoperatória na cirurgia de catarata pela técnica de facoemulsificação. Métodos: Pacientes com diagnóstico de catarata e indicação de cirurgia foram selecionados para participar do presente estudo. Todos os pacientes foram operados pela técnica de facoemulsificação convencional pelo mesmo cirurgião, todos foram submetidos à aplicação de 0,2 ml do cloridrato de acetilcolina 1% na câmara anterior ao final do procedimento cirúrgico. A medida do diâmetro pupilar foi realizada imediatamente antes do início da cirurgia, imediatamente antes do uso do cloridrato de acetilcolina 1% e após 2 minutos. Resultados: Foram estudados 30 olhos de 30 pacientes, destes, 18 eram do sexo feminino, a média de idade do estudo foi de 69,5 anos com desvio padrão de 7,2 anos. A média do diâmetro pupilar imediatamente antes do início da cirurgia foi 7,55 mm com desvio padrão de 0,56mm, a média do diâmetro pupilar imediatamente antes do uso do cloridrato de acetilcolina 1% (após implante da lente intraocular no saco capsular) foi 7,1mm com desvio padrão de 0,57mm. A média do diâmetro pupilar após 2 minutos da aplicação da acetilcolina na câmara anterior foi de 3,4 mm com desvio padrão de 0,66mm. O tempo médio de ação máxima do medicamento foi de 64 segundos, com desvio padrão de 8 segundos. A média da pressão intraocular no primeiro dia do pós-operatório foi de 19,1 mmHg com desvio padrão de 2,45mmHg. Conclusão: O estudo acima mostrou que a acetilcolina apresenta boa eficácia na obtenção de miose intraoperatória na cirurgia de facoemulsificação, permitindo uma maior facilidade na confecções das suturas corneanas ou corneo-escleral, reduzindo a incidência de sinéquias anteriores periféricas. Concluimos que o cloridrato de acetilcolina 1% é um importante medicamento na obtenção da miose intraoperatória na cirurgia de catarata.

Penetración Dentinaria in vitro del Hipoclorito de Sodio a Diferentes Concentraciones con las Técnicas de Irrigación Convencional y Ultrasónica Pasiva / In vitro Dentinary Penetration of Sodium Hypochlorite at Different Concentrations with the Conventional and Ultrasonic Passive Irrigation Techniques

RESUMEN: El objetivo del presente trabajo fue comparar la penetración dentinaria in vitro entre las concentraciones de hipoclorito de sodio (NaClO) al 5 % y al 2,5 % con técnicas de irrigación convencional e irrigación ultrasónica pasiva. Este fue un estudio transversal, prospectivo y experimental. Se trabajó con 40 segmentos radiculares (especímenes) de 5 mm de longitud, divididos en 4 grupos. Todos los especímenes se sumergieron en violeta cristal durante 24 horas. Se realizó la preparación biomecánica con sistema rotatorio Pro Taper. Al primer grupo se irrigó con NaClO al 2,5 % con irrigación convencional, al segundo grupo con NaClO al 2,5 % con irrigación convencional más irrigación ultrasónica pasiva por 30 segundos, al tercer grupo con NaClO al 5 % con irrigación convencional y al cuarto grupo con NaClO al 5 % con irrigación convencional más irrigación ultrasónica pasiva por 30 segundos. Al final de la preparación a todos los especímenes se les realizó un corte mesio distal. La profundidad de la penetración del NaClO fue deterrminado por el blanqueamiento de la mancha y medido con un microscopio de luz con una magnificación de 40 X. La prueba estadística usada fue ANOVA con un nivel de significancia de 5 %. El NaClO al 5 % con técnica de irrigación ultrasónica pasiva presentó la mayor penetración dentinaria in vitro.

ABSTRACT: The objective of the present study was to compare in vitro dentin penetration between 5 % and 2.5 % sodium hypochlorite (NaClO) concentrations using conventional irrigation and passive ultrasonic irrigation techniques. This was a cross-sectional, prospective and experimental study. It was worked with 40 root segments (specimen) of 5 mm length, divided into 4 groups. All specimens were immersed in crystal violet for 24 hours. The biomechanical preparation was performed with Pro Taper rotary system. The first group was irrigated with 2.5 % NaClO with conventional irrigation, the second group with 2.5 % NaClO with conventional irrigation plus ulrasonic passive irrigation for 30 seconds, the third group with 5 % NaClO with conventional irrigation and the fourth with 5 % NaClO with conventional irrigation plus ultrasonic passive irrigation for 30 seconds. At the end of the preparation, all specimens had a distal mesio cut. The depth of NaClO penetration was determined by bleaching of the stain and measured with a light microscope at a magnification of 40 X. The statistical test used was ANOVA with a significance level of 5 %. The 5 % NaClO with passive ultrasonic irrigation showed the highest dentin penetration in vitro.