Probióticos em endodontia: uma revisão de literatura / Probiotics in endodontics: a literature review

Introdução: Os probióticos são micro-organismos vivos que geram benefícios à saúde do hospedeiro. Seus mecanismos de ação consistem, principalmente, em efeitos anti-inflamatórios e antimicrobianos que os tornam importantes no processo de saúde-doença. Na endodontia, a permanência de infecção no interior do sistema de canais radiculares é a principal causa do insucesso do tratamento endodôntico. A partir do sucesso obtido por outras especialidades odontológicas, a utilização de probióticos como nova abordagem no tratamento endodôntico vem sendo alvo de pesquisas com a expectativa de ajudar a combater as infecções endodônticas e manter o equilíbrio da microbiota oral. Objetivo: O objetivo desta revisão de literatura foi apresentar os principais resultados disponíveis até o presente momento na literatura científica acerca do uso dos probióticos na endodontia. Fonte dos dados: As bases de dados utilizadas foram Pubmed, Web of Science e Embase e a pesquisa foi realizada até junho de 2021. Síntese dos dados: Foi encontrado um total de oito artigos sobre o tema, avaliando diversos aspectos relacionados ao tratamento endodôntico, como o uso de probióticos contra patógenos endodônticos, como irrigantes, como medicação intracanal e no tratamento da periodontite apical. Conclusão: Embora grande parte dos artigos tenham apresentado resultados positivos acerca do uso dos probióticos, os mesmos apresentam baixo nível de evidência, isso porque foram utilizados modelos in vitro e em animais. Portanto, para embasar a introdução dos probióticos em Endodontia, existe a necessidade da realização de pesquisas clínicas.

Introduction: Probiotics are live microorganisms that produce health benefits for the host. Their mechanisms of action consist mainly of antimicrobial effects and make them important in the health-disease process. In endodontics, the permanence of infection within the root canal system is the main cause of endodontic treatment failure. Based on the success obtained by other dental specialties, the use of probiotics as a new approach in endodontic treatment has been the subject of research with the prevention of oral microbiota. Purpose: The purpose of this review of literature was to present the main results available so far in the scientific literature on the use of probiotics in endodontics. Data source: The databases used were Pubmed, Web of Science and Embase and the search was carried out until June 2021. Data synthesis: A A total of eight articles on the subject, evaluating various aspects of endodontic treatment, such as the use of probiotics against endodontic pathogens, as irrigants, as intracanal treatment and in the treatment of apical periodontitis. Conclusion: Although many of the foods presented positive results close to the same use presented in the low level of articles, this is because animal models were used. Therefore, to support the introduction of probiotics in Endodontics, there is a need for clinical research.

Effect of passive ultrasonic irrigation on hard tissue debris removal: a systematic review and meta-analysis

Abstract: Accumulated hard tissue debris (AHTD) in root canal irregularities may negatively impact adequate root canal disinfection. In light of this, the efficacy of passive ultrasonic irrigation (PUI) to reduce AHTD has been largely studied in in vitro studies, which have adopted different analytic methods of varying accuracy to determine the extent of AHTD more correctly. Therefore, the aim of this study was to compare how well PUI and non-activated irrigation (NAI) systems perform in reducing AHTD during final irrigation protocols, based exclusively on studies whose analyses used microCT scanning. A systematic search of the studies published up to April 2020 was performed using MeSH terms and free terms, in the following databases: PubMed, Scopus, Web of Science, BVS (Lilacs and BBO) and Embase. The inclusion criteria consisted of laboratory studies that evaluated the amount of AHTD, and compared PUI with NAI protocols using microCT analysis. The risk of bias in the selected studies was assessed critically by two reviewers. A meta-analysis was performed using the RevMan software program (P<0.05), and included studies providing the standardized mean difference (SMD), using a fixed effect model, and adopting a confidence interval of 95%. In all, 3495 studies were identified, three of which met the inclusion criteria. All three were considered as having a low risk of bias. The meta-analysis comparing the ability of PUI and NAI protocols to remove hard tissue debris showed a higher percentage of AHTD reduction (P<0.01) for PUI, with a confidence interval of 1.41 [0.79, 2.02]. The heterogeneity among the studies was 82% (I2). Considering the limitations of the present study, this systematic review and meta-analysis showed that PUI was more effective than NAI in removing hard tissue debris, based exclusively on studies that used microCT scanning to provide a more precise analysis of the two techniques used. The findings presented in the present study reinforce the concept that PUI can increase residue removal and improve the cleanliness of the root canal in endodontic treatments.

Efeito do consumo de álcool no desenvolvimento de lesão periapical induzida em ratos: uma análise microtomográfica / The Effect of Alcohol Consumption on the Development of Periapical Lesion Induced in Rats: a Micro-CT Analysis

Objetivo: O objetivo deste estudo foi avaliar a influência do consumo crônico de álcool no aumento da destruição óssea periapical em ratos. Material e métodos: Foram selecionados 12 ratos machos da linhagem Wistar, aleatoriamente divididos nos grupos controle e álcool (n=6). Os ratos do grupo álcool foram submetidos à auto-administração de solução alcoólica contendo 25% de álcool puro. O grupo controle recebeu apenas água filtrada durante o estudo. Após as 5 semanas de adaptação do grupo álcool, todos os ratos foram anestesiados e a polpa dos seus primeiros molares inferiores esquerdos foi exposta à cavidade oral para indução da lesão periapical. Após 28 dias de exposição pulpar, os ratos foram sacrificados por sobredose de anestesia, e suas mandíbulas foram removidas e seccionadas para avaliação microtomográfica. As hemimandíbulas esquerdas foram fixadas e escaneadas no microtomógrafo SkyScan 1173 (Bruker, Kontich, Belgium). O tamanho da lesão periradicular foi medido a partir das imagens de microtomografia computadorizada (micro-CT), onde foram calculados a área de superfície e o volume da lesão. Também foram avaliadas a taxa percentual de ganho de peso e a ingestão de sólidos/líquidos dos grupos. Os dados foram estatisticamente analisados utilizando o teste t de Student (p<0,05). Resultados: Os animais do grupo controle tiveram uma maior taxa percentual de ganho de peso corporal e de ingestão tanto de sólidos como de líquidos (p<0,05). As lesões periapicais apresentaram maior volume e maior área nos animais do grupo álcool, em comparação ao grupo controle (p<0,05). Conclusão: O consumo crônico de álcool contribuiu para o aumento da destruição óssea periapical em casos de periodontite apical.

Objective: the aim of this study was to evaluate the influence of alcohol consumption on the increase of periapical bone destruction in rats. Material and Methods: the sample included 12 Wistar male rats, randomly assigned into a control group and an alcohol group (n=6). Rats in the alcohol group were submitted to self-administration of a 25% pure alcoholic solution. The control group received only filtered water throughout the study. After 5 weeks of adaptation to the alcohol dose, all animals were anesthetized and the pulps of their mandibular left first molar were exposed to the oral cavity to induce periapical lesion. Twenty-eight days after the pulp exposure, those rats were euthanized due to overdose of anesthesia and their mandibles were removed and sectioned to obtain a micro-computed tomographic (micro-CT) scan. The rats' left hemimandibles were fixed and scanned on the SkyScan 1173 (Bruker, Konitch, Belgium) microtomograph. The size of the periradicular lesions was measured from the images obtained on the micro-CT and the surface area and volume were calculated. It was also evaluated the weight gain rate and the ingestion of solid/liquid of both groups. Data were analyzed by the Student's t-test (p<0.05). Results: the control group showed higher rates of weight gain and ingested more solid and liquid than the alcohol group (p<0.05). Periapical lesions found in the alcohol group had higher volume and surface area than the ones of the control group (p<0.05). Conclusion: the chronic consumption of alcohol contributed to the increase of periapical bone destruction in cases of apical periodontitis

Bond strength of experimental root canal sealers based on mta and butyl ethylene glycol disalicylate

Abstract This study investigated the bond strength of two experimental root canal sealers based on MTA and butyl ethylene glycol disalicylate: MTAe and MTAe-HA. The reference materials used for comparison were AH Plus and MTA Fillapex. Twenty human upper incisors were selected and one 1 mm slice was obtained from the cervical third of each root. On the coronal surface of each slice, four 0.9 mm wide holes were drilled through the dentine. Standardized irrigation was performed and holes were filled with one of the four tested sealers: AH Plus, MTA Fillapex, MTAe, and MTAe-HA. The filled slices were stored in a PBS solution (pH 7.2) for 7 days at 37 °C. A push-out assessment was performed with a 0.7 mm plunger tip. Load was applied at a crosshead speed of 0.5 mm/min until sealer displacement. The results were expressed in MPa. The Kruskal-Wallis test was applied to assess the effect of each sealer on the push-out bond strength. Mann-Whitney with Bonferroni correction was used to isolate the differences. The alpha-type error was set at 0.05. Significant differences among medians values obtained by materials were observed (p<0.001). AH Plus displayed the highest value of bond strength (p<0.001). In contrast, MTA Fillapex presented the lowest bond strength among all tested sealers (p<0.001). Experimental sealers showed intermediary bond strength values, with no statistical differences between them (p>0.05). In conclusion, experimental root canal sealers presented suitable bond strength outcomes when compared to MTA Fillapex.

Resumo Esse estudo investigou a resistência de união de dois cimentos endodônticos experimentais à base de MTA e butiletilenoglicol dissalicilato: MTAe e MTAe. Os materiais de referência utilizados para comparação foram os cimentos endodônticos MTA Fillapex e AH Plus. Vinte incisivos superiores humanos foram selecionados e um slice dentinário de 1 mm de espessura foi obtido do terço cervical de cada raiz. Na superfície coronária de cada slice, quatro orifícios com 0,9 mm de diâmetro foram confeccionados através da dentina. Uma irrigação padronizada foi realizada e os orifícios foram preenchidos com um dos quatro cimentos endodônticos avaliados: AH Plus, MTA Fillapex, MTAe, e MTAe-HA. Os slices preenchidos foram armazenados em solução PBS (pH 7,2) durante 7 dias a 37°C. O ensaio de push-out foi realizado por meio de um dispositivo com 0,7 mm de diâmetro. A carga foi aplicada com a velocidade de 0,5 mm/min até a obtenção de deslocamento do material obturador. Os resultados foram expressos em MPa. O teste de Kruskal-Wallis foi aplicado para avaliar o efeito da resistência de união de cada cimento endodôntico. O teste de Mann-Whitney com correção de Bonferroni foi utilizado para isolamento das diferenças. O erro do tipo-alfa foi fixado em 0,05. Diferenças significantes entre os valores de medianas obtidos pelos materiais foram observados (p<0,001). O AH Plus demonstrou os maiores valores de resistência de união (p<0,001). Em contraste, o MTA Fillapex apresentou a menor resistência de união entre todos os cimentos testados (p<0,001). Os cimentos experimentais demonstraram valores intermediários, com ausência de diferenças estatísticas entre si (p>0,05). Em conclusão, os cimentos endodônticos experimentais à base de MTA e butiletilenoglicol dissalicilato apresentaram resultados adequados de resistência de união quando comparados ao MTA Fillapex.

Improved sealing ability promoted by calcium silicate-based root canal sealers

Aim: This study investigated the sealing ability produced by AH Plus (Dentsply DeTrey, Konstaz, Germany), EndoSequence BC sealer (Brasseler USA, Savannah, GA, USA), GuttaFlow (Coltène/Whaledent, Altstätten, France) and MTA Fillapex (Angelus, Londrina, Brazil). Methdos: A total of forty-six single-root human canines were prepared and randomly divided into four experimental groups (n=10): MTA Fillapex, EndoSequence BC Sealer, AH Plus or GuttaFlow. Teeth with intact crowns served as negative controls (n=3) and teeth filled with only gutta-percha served as positive controls (n=3). Teeth were mounted in a two-chamber apparatus and exposed to Enterococcus faecalis. The number of days over a 60-days period was recorded for the appearance of turbidity in the lower chamber. Kaplan-Meier method was used to estimate the survival curves. The nonparametric log-rank test was used to compare the survival curves using a significance level of 0.05. Results: The results at the end of the observation time were further analyzed by chi-square testing. All positive controls leaked within 24 h, whereas none of the negative controls leaked after 60 days. EndoSequence BC Sealer and MTA Fillapex had significant less bacterial leakage (P<0.05) than the other tested sealers. No significant difference between AH Plus and GuttaFlow was observed (P>0.05). Conclusion: In conclusion, calcium-silicate based root canal sealers promoted improved sealing ability when compared to other endodontic sealers

Epidemiological evaluation of apical periodontitis prevalence in an urban Brazilian population

The present study aimed to assess the prevalence of apical periodontitis (AP) in an urban Brazilian population according to gender, age group and tooth type. Data were collected from clinical files containing the medical and dental histories and periapical radiographs of 1,126 patients treated at the School of Dentistry at Universidade do Estado do Rio de Janeiro between March 2000 and December 2010. A total of 15,724 periapical radiographs were evaluated. All the radiographs were evaluated by two independent, previously calibrated endodontists (kappa = 0.88). Periapical areas on the radiographs were classified as N (normal) or AR (apical radiolucency). The frequency of AP and the 95% Confidence Interval (95%CI) were calculated according to gender, age group and tooth type. Differences between groups were calculated using the Z-test at a significance level of 5% (p < 0.05). AP was present in 7.87% of the samples, with 16.70% occurring on previously endodontically treated teeth and 44.65% occurring on teeth referred for endodontic treatment (TR-RCT). The frequency of AP was higher among females (64%) than among males (35%). The central and lateral maxillary incisors were the most frequently affected teeth. The frequency of AP was higher among individuals between 30 and 49 years of age. In this population, AP was more prevalent among females and among individuals between 30 and 49 years of age, and the central and lateral maxillary incisors were the most frequently affected teeth.

In vitro analysis of microbial contamination of paper points

Introduction: During endodontic treatment, the maintennance of the aseptic chain is mandatory. Therefore, all substances, instruments, and medications inserted into root canals must be free of microorganisms. Objective: To evaluate in vitro and microbiologically the contamination of absorbent paper points. Material and methods: Absorbent paper points of different brands and under different conditions were evaluated and subdivided into the following groups: esterilized by the manufacturer (G1 to G5), not esterilized by the manufacturer (G6), esterilized in autoclave by the operator (G7), and intentionally contaminated (G8). The two last groups were the positive and negative controls, respectively. All paper points were unpacked and immersed into tubes with culture medium for 48 hours and then analyzed according to culture broth turbidity. Results: Only the samples esterilized by the manufacturers Dentsply® (G1), Endopoints® (G2), and Meta® (G3), and the samples esterilized in autoclave by the operator (G7) did not evidence microbial growth after 48 hours. Although sterilized by the manufacturer, both the brands Tanari® (G4) and Roeko® (G5) showed bacterial contamination; Dentsply® (G6) non-sterile paper points also showed bacterial contamination. Conclusion: Paper point esterilization before clinical use should be recommended regardless of the commercial brand.

Refinement influence in the cleaning efficacy of rotary nickel-titanium Mtwo ® instruments in oval-shaped canals by means of optical microscopy.

Objective: This study evaluated the cleaning efficacy of the rotary nickel–titanium Mtwo® by means of optical microscopy in oval‑shaped root canals and compared refinement influence using ultrasonic files or Hedströem files. Materials and Methods: Twenty mandibular incisors were accessed, included in epoxy resin blocks, and cut transversely at 3, 6, and 9 mm from the apex. Teeth were instrumented using rotary nickel–titanium Mtwo. Digital images of the root cross sections were obtained before and after instrumentation with a digital camera attached to an optical microscope. Subsequently, samples were randomly divided into two groups for refinement. Group I was refined using ultrasonic files #30 and group II with Hedströem files #30. Final digital images of cross sections after refinement were captured and analyzed. The boundaries for the uninstrumented perimeter were measured by the software ImageTool 3.0. The data obtained were statistically analyzed by analysis of variance (ANOVA) and t‑test. Results: Mtwo instrumentation produced 41.48% of the uninstrumented perimeter. The final refinement using Hedströem and ultrasonic files decreased the uninstrumented perimeter. Significant differences (t‑test, P = 0.00) were found at the three thirds after the final refinement, except for the apical third that was enhanced by Hedströem file. However, there was no statistical difference between the two refinement techniques used (P > 0.05). Mtwo instrumentation was not capable of cleaning and shaping the entire perimeter of the root canals walls. Conclusions: The final refinement, either with ultrasonic files or with Hedströem files, resulted in significantly less uninstrumented perimeter.

Histological evaluation of refinement influence in the cleaning efficacy of rotary nickel-titanium ProTaper® instruments in oval-shaped root canals

Introduction and objective: The aim of this in vitro study was to evaluate the cleaning and shaping efficacy of rotary nickel-titanium ProTaper® instrumentation in oval canals and the influence of ultrasonic irrigation on the final refinement. Material and methods: Twenty mandibular molars were accessed and divided in two groups. Only distal roots with oval canals were used. Group I was instrumented using only rotary nickel-titanium ProTaper® instruments. Group II received the same preparation followed by refinement with 3 minutes of ultrasonic passive irrigation. After preparation, the distal roots were sectioned for histological processing. Coronal, middle and apical thirds were analyzed. Uninstrumented perimeter in each third was measured by the software Image tool 3.0. Results: The percentage of uninstrumented perimeter was calculated for each third of each root and average percentage was calculated for each third in both groups. Statistical analysis was performed with t-test through the software SPSS 11.0.1 for Windows. The level of significance was set at 1%. Group I showed higher percentage of uninstrumented perimeter in all thirds. Group II, which received ultrasonic irrigation showed better results in all thirds (p < 0.01). Comparing the three thirds in the same group, no statistically significant differences were found (p > 0.05). Conclusion: Under the conditions of this ex vivo study, the three minutes use of ultrasonic irrigation after rotary instrumentation resulted in significantly more instrumented walls in the distal roots of mandibular molars.

Avaliação ex vivo da precisão de um localizador apical antes e após o pré-alargamento das paredes dos canais sob a influência de diferentes substâncias irrigadoras / Evaluation ex vivo precision of an apex locator before and after pre-flaring of the root canals under the influence of different irrigants

O objetivo desse trabalho foi avaliar, ex vivo, a influência do peróxido de hidrogênio (H 2 O 2 ) a 3,0% e do hipoclorito de sódio (NaOCl) a 2,5% e 5,25% na precisão das medidas obtidas por um localizador apical eletrônico antes e após o pré-alargamento. Foram utilizadas 25 raízes mesiais de primeiros molares inferiores, totalizando 50 canais radiculares, que tiveram as coroas cortadas na junção amelocementária. A medida real de cada canal foi realizada e, em seguida, as amostras foram incluídas em uma mistura de alginato, usada como meio condutor, onde foram realizadas as medições eletrônicas com o localizador apical auxiliadas com o uso das três soluções irrigadoras antes e após o desgaste do terço médio e cervical dos canais com brocas Gates-Glidden. As medidas obtidas pelo método eletrônico foram então comparadas com a medida real dos canais. Os resultados obtidos foram tabulados e submetidos ao teste estatístico t de Student. Os resultados revelaram que não houve significância estatística (p>0,05) entre as leituras obtidas antes e após o desgaste dos terços cervical e médio dos canais com uso de NaOCl 2,5 e 5,25%, com resultados demonstrando, em média, leituras mais próximas do comprimento real do canal no grupo sem pré-alargamento. Porém, observamos diferença estatística com uso de H 2 O 2 (p<0,05) entre as leituras obtidas tanto antes quanto após o desgaste dos dois terços iniciais do canal. Desta forma, conclui-se que o preparo médio-cervical com brocas Gates Glidden não foi capaz de interferir significativamente na precisão do localizador apical testado

The aim of this paper was to evaluate the influence of 3% hydrogen peroxide (H 2 O 2 ) and 2.5% and 5.25% sodium hypochlorite (NaOCl) measured by a root apex locator before and after the pre-flaring of the root canal. The mesial root of twenty five mandibular first molars, total of 50 root canals, was tested with the crown cut off from the enamel-cementum junction. The real measure of each root was defined and after that the samples were stored in a mix of alginate, used as a conductor. The measures were done with a root apex locator using three different irrigation solutions before and after the instrumentation of the medium and cervical parts of the roots by means of Gates-Glidden drills. The measures obtained by the electronic method were compared to the real length of each root canal. These data were evaluated by means of the student t test for statistical analysis that demonstrate no statistical differences between the measures before and after the pre-flaring using 2.5% or 5.25% sodium hypochlorite (p>0.05). The results showed measures closer to the actual root canal length in the group without the pre-flaring, however statistical significance was observed with 3% hydrogen peroxide between the measures done before and after the root canal pre-flaring (p<0.05). Thus, we concluded that the medium and cervical preparation with Gates-Glidden drills was not able to interfere in the root apex locator precision

In vitro genotoxicity and cytotoxicity in murine fibroblasts exposed to EDTA, NaOCl, MTAD and citric acid

The aim of the present study was to evaluate the capacity of some root canal irrigants to induce genetic damage and/or cellular death in vitro. Murine fibroblast cells were exposed to ethylenediaminetetraacetic acid (EDTA), sodium hypochlorite (NaOCl), MTAD™ and citric acid in increasing concentrations for 3 h at 37ºC. The negative control group was treated with vehicle control (phosphate buffer solution - PBS) for 3 h at 37°C, and the positive control group was treated with methylmetanesulfonate, 1 μM. for 3 h at 37°C. Cytotoxicity was assessed by the trypan blue test and genotoxicity was evaluated by the single cell gel (comet) assay. The results showed that exposure to 2.5% and 5% NaOCl and 8.5% citric acid resulted in a significant cytotoxic effect. NaOCl, EDTA and citric acid did not produce genotoxic effects with respect to the comet assay data for all evaluated concentrations. Although MTAD was not a cytotoxic agent, it showed significant genotoxic effects at all tested concentrations (ANOVA and Tukey's test; p<0.05). NaOCl, EDTA and citric acid were found to be cytotoxic in a dose-dependent manner, but they were not genotoxic. MTAD did not cause cell death, but presented genotoxic effects.

O objetivo do presente estudo foi avaliar a capacidade de alguns irrigantes endodônticos em induzir danos genéticos e/ou morte celular in vitro. Células de fibroblastos murinos foram expostas ao ácido etilenodiaminotetracético (EDTA), hipoclorito de sódio (NaOCl), MTAD™ e ácido cítrico em concentrações crescentes durante 3 h a 37°C. O grupo controle negativo foi tratado com solução tampão fosfato - PBS por 3 h a 37° C e o grupo controle positivo foi tratado com metilmetanesulfonato a 1 μM por 3 h a 37° C. A citotoxicidade foi testada pelo azul de tripan e a genotoxicidade foi avaliada pelo teste do cometa. Os resultados apontaram que a exposição ao NaOCl a 2,5% e 5%, e ácido cítrico a 21% resultou em efeitos citotóxicos significativos. O NaOCl, EDTA e o ácido cítrico não produziram efeitos genotóxicos no que diz respeito aos dados obtidos pelo ensaio do Cometa em todas as concentrações testadas. Embora o MTAD não tenha sido um agente citotóxico, mostrou efeitos genotóxicos significativos em todas as concentrações testadas (ANOVA e teste de Tuckey; p<0,05). O NaOCl, o EDTA e o ácido cítrico mostraram-se citotóxicos de maneira dose-dependente, mas não genotóxicos. Por outro lado, apesar do MTAD não ter causado a morte celular, foi genotóxico em todas as concentrações testadas.

Antimicrobial activity of sodium hypochlorite, chlorhexidine and MTAD® against Enterococcus faecalis biofilm on human dentin matrix in vitro

Objective: This study evaluated the antimicrobial efficacy of 2.5% and 5.25% NaOCl, 2% gel and liquid CHX and MTAD® against Enterococcus faecalis biofilms on human dentin. Material and methods: E. faecalis biofilms grown on dentin matrix of 216 root sections were submerged in test irrigants for 1, 5, 15 and 30 minutes. The antimicrobial activity of the test irrigants were assessed through CFU counts. Biofilm formation over the dentin surface was ensured by SEM analysis.Results: Results showed no statistic difference among CHX gel, 2.5% and 5.25% NaOCl. However, the CHX liquid and MTAD were less effective than 2.5% and 5.25% NaOCl. Only CHX liquid and MTAD had differences in its efficacy depending on the time.Conclusion: The most effective irrigants in eliminating E. faecalis biofilms were 2.5% and 5.25% NaOCl and 2% CHX gel, at all the tested time intervals, in comparison to CHX liquid and MTAD.

Atividade antimicrobiana de materiais reparadores de uso endodôntico pelos testes de difusão em ágar e por contato direto / Antimicrobial activity of repair materials of endodontic use by the agar diffusion test and the direct contact

O presente trabalho teve como objetivo avaliar a atividade antimicrobiana dos materiais reparadores de uso endodôntico: MTA/Bio Angelus®, cimento Portland branco, MTA Angelus® branco e MTA ProRoot® branco sobre os micro-organismos Enterococcus faecalis, Escherichia coli e Staphylococcus aureus, pelos os testes de difusão em ágar e por contato direto. Os dados experimentais foram obtidos através da mensuração do halo de inibição formado e pela contagem de unidades formadoras de colônia, respectivamente. De posse dos resultados, foi possível verificar que o MTA/Bio Angelus® apresentou atividade antimicrobiana superior para todas as espécies bacterianas testadas tanto no teste de difusão em ágar quanto no teste por contato direto e que este último teste demonstrou ser uma metodologia segura, reproduzível e confiável.

The aim of this study was to evaluate the antimicrobial activity of repair materials of endodontic use MTA/Bio Angelus®, white Portland cement, white MTA Angelus® and white MTA ProRoot® on Enterococcus faecalis, Escherichia coli and Staphylococcus aureus by the agar diffusion test and the direct contact test. Data was retrieved by measuring the zones of inhibition and by counting colony-forming units, respectively. The results showed that MTA/Bio Angelus® presented superior antimicrobial activity against all bacteria in the agar diffusion test and in the direct contact test. In addition, our results suggest that the use of the direct contact test is a safe, reproducible and trustable method.

Clinical management of a complicated crown-root fracture: a case report

This report describes the clinical procedures involved in the treatment of a complicated crown-root fracture in the maxillary left central incisor with a wide open apex of a 10-year-old male patient, due to fall from his own height. Post-trauma treatment comprised cervical pulpotomy and adhesive tooth fragment reattachment. After 1 year, clinical and radiograph examinations showed pulp necrosis and an associated periapical lesion. Endodontic therapy with calcium hydroxide-base intracanal dressing, root canal filling and orthodontic extrusion were performed. Extrusion was completed within approximately 16 weeks and the tooth was restored with a post-core system and a prosthetic crown. After a 3 years of follow-up, there was no evidence of apical periodontitis and the tooth was satisfactory both esthetically and functionally.

Este relato de caso apresenta os procedimentos clínicos envolvidos no tratamento de um caso de fratura corono-radicular complicada de um incisivo superior esquerdo com ápice aberto de um paciente de 10 anos de idade devido à queda da própria altura. O tratamento envolveu pulpotomia cervical e fixação do fragmento. Após 1 ano, os exames clínicos e radiográficos demonstraram necrose pulpar e lesão perirradicular associada. O tratamento endodôntico foi realizado com a utilização de pasta de hidróxido de cálcio, obturação endodôntica e extrusão ortodôntica. Após aproximadamente 16 semanas, o processo de extrusão foi finalizado e o dente restaurado com pino e coroa protética. Após acompanhamento de 3 anos, não havia evidência de lesão perirradicular e o dente estava estética e funcionalmente satisfatório.

Influência de dois irrigantes na infiltração bacteriana em perfurações de furca obturados com MTA e cimento Portland / Influence of two irrigants in bacterial microleakage of furcal perforation sealed with MTA and Portland cement

O objetivo deste estudo foi avaliar a influência de duas soluções irrigadoras antibacterianas na capacidade de vedamento do MTA e do cimento Portland brancos utilizados como material obturador de perfurações de furca, em quarenta e seis molares humanos extraídos. Após a realização das perfurações na furca realizadas com brocas esféricas # 2, os dentes foram divididos em quatro grupos de dez dentes, sendo os seis dentes restantes divididos em grupos controle positivo e negativo. Os grupos 1 e 2 foram irrigados com hipoclorito de sódio 5,25% e obturados com MTA e cimento Portland respectivamente. Os grupos 3 e 4 foram irrigados com clorexidina gel 2% e também obturados com MTA e cimento Portland respectivamente. Após a obturação das perfurações, os espécimes foram montados em aparatos e inoculados com uma suspensão de Enterococcus faecalis por 61 dias. Os resultados foram submetidos ao teste de Log-rank que demonstrou não haver diferença estatística significativa entre os quatro grupos (p < 0,05). Sob as condições experimentais deste trabalho, a clorexidina gel 2% e o hipoclorito de sódio 5,25% não prejudicaram a capacidade de vedamento do MTA assim como do cimento Portland.

The aim of this study was to evaluate the effect of two endodontic irrigation solutions on the ability of white mineral trioxide aggregate (MTA), compared to Portland cement, to seal furcal perforations in 46 extracted human mandibular molars. Furcal perforations were made in the center of the pulp chamber floor using a high-speed round bur #2. The teeth were randomly divided into four experimental groups of 10, with the remaining six teeth used as positive and negative groups. Experimental groups 1 and 2 were irrigated with 5,25% sodium hypoclorite, and then repaired with MTA and Portland cement, respectively. Experimental groups 3 and 4 were irrigated with 2% chlorhexidine gluconate gel, and then repaired with MTA and Portland cement respectively. After placing the repair materiais into the perforations, the specimens were mounted in an apparatus and inoculated with a suspension of Enterococcus faecalis for 61 days. The leakage data were analysed statistically by a log-rank test (p < 0,05). There was no statistically significant difference among the four groups. Under the conditions of this study, 2% chlorhexidine gluconate gel and 5,25% sodium hypoclorite did not adversely affect the sealing ability of MTA. Portland cement and MTA demonstrated similar ability to seal furcal perforations.

Influência de dois irrigantes na microinfiltração em perfurações de furca obturada com MTA / Influence of two irrigants in microleakege of furcal perforation sealed with MTA

O objetivo deste estudo foi avaliar a influência de duas soluções irrigadoras antibacterianas na capacidade de vedamento de duas marcas comerciais de MTA utilizados como materiais obturadores de perfurações de furca, em 70 molares humanos extraídos. As perfurações criadas artificialmente foram irrigadas com hipoclorito de sódio 5% ou clorexidina gel 2% e obturados com MTA (de dois fabricantes diferentes). Os dentes foram submersos em Rodamina B 2% e, posteriormente, clivados longitudinalmente para que a infiltração fosse verificada e medida através de um perfilômetro com micrômetro digital. Os resultados submetidos aos testes estatísticos F de ANOVA (p<0,05) e t de Tukey (p<0,05) demonstraram maior infiltração nos grupos da clorexidina, não havendo diferença estatisticamente significativa entre o MTA Agelus® e o Pro Root MTA®.

The aim of this study was to evaluate the influence of two antibacterial irrigant solutions in the MTA sealing ability when used as perforation of furcation sealer in 70 extracted human molars. The artificially created perforations were irrigated with 5% NaOCl and 2% chlorhexidine gel and sealed with MTA (Angelus™ and Pro Root MTA™). The teeth were sunk in 2% Rodamina B dye and later longitudinally sectioned. The microleakage was length by means of a profile projector and a digital micrometer. The results were submitted to statistical analyses with One-way ANOVA (p<0.05) and Tuckey test (p<0.05) that showed greater microleakage means in the chlorhexidine groups and no significant statistical difference between MTA Angelus™ and Pro Root MTA™.

Bacterial leakage in root canals filled with calcium hydroxide paste associated with different vehicles

This in vitro study evaluated, using a bacterial leakage model, whether intracanal medication with calcium hydroxide [Ca(OH)2]-based pastes prepared with different vehicles, has inhibitory effect on corono-apical leakage of bacteria. Forty instrumented human canines were dressed with Ca(OH)2 p.a. associated with: G1= distilled water; G2= polyethylene glycol (PG); G3= PG + CMCP; and G4= glycerin. Five teeth with intact crowns served as negative controls and 5 instrumented teeth without temporary dressing served as positive controls. All teeth were mounted in a 2-chamber apparatus and then exposed to human saliva for 63 days. Leakage was recorded when turbidity was observed in the lower chamber. Fifty percent of the samples of G1 and G2, 10 percent of G3 and 80 percent of G4 were fully contaminated after 9 weeks. Statistically significant differences were observed with paired comparisons G3 and G4 (p=0.0069), with G3 achieving better seal against bacterial leakage than G4.

Este estudo in vitro avaliou, por um modelo de infiltração bacteriano, se a medicação intracanal com hidróxido de cálcio associado a diferentes veículos, tem efeito inibitório na penetração coronária de bactéria. Quarenta caninos humanos instrumentados foram medicados com Ca(OH)2 p.a. associados à G1= água destilada; G2= polietilenoglicol (PG); G3= polietilenoglicol e paramonoclorofenol canforado (PMCP); e G4= glicerina. Cinco dentes hígidos foram utilizados como grupo controle negativo e cinco dentes instrumentados sem medicação intracanal serviram como grupo controle positivo. Todos os dentes foram montados em um aparato de duas câmaras e expostos a saliva humana por 63 dias. A infiltração foi verificada através da observação do turvamento do meio de cultura na câmara inferior. Cinqüenta por cento das amostras do G1 e G2, 10 por cento do G3 e 80 por cento do G4 foram totalmente contaminadas após 9 semanas. Diferenças estatisticamente significantes foram observadas quando foram realizadas comparações pareadas entre G3 e G4 (p=0,0069), com G3 alcançando um melhor selamento contra infiltração bacteriana do que G4.

Estudo in vitro da capacidade de difusão de algumas formulações de EDTA na dentina radicular / In vitro study of diffusion ability of different EDTA formulations through root dentin

A utilização de soluções de EDTA. isolada ou associada ao hipoclorito de sódio, como auxiliar na instrumentação de canais radiculares atrésicos e na remoção do smear layer é bastante difundida. Neste trabalho foi avaliado o comportamento do quelante EDTA (liquido e gel) e sua difusão através dos túbulos dentinários. Os corpos de prova foram divididos em três grupos: Grupo 1 - EDTA 17%; Grupo 2 - EDTA 24% e Grupo 3 - EDTA gel trissódico. A técnica escolhida, para esse estudo, foi a reação histoquímica de sulfato de cobre e ácido rubeânico. Após o tratamento estatístico podemos concluir que: 1. Todas as substâncias quelantes estudadas se difundiram nos canalículos dentinários; 2. As substâncias empregadas se comportaram de maneira semelhante na difusão dos canalículos dentinários; 3. Não houve diferença estatística entre as permeabilidades médias dos terços das raízes envolvidas (p<0,05).

The use of the salt solution of EDTA, alone or in combination with NaOCl as an auxiliary in root canal instrumentation or in smear layer removing is very exposed in scientific literature. In this study were evaluated the EDTA chelant behavior (solution or gel) for its diffusion through the dentinal tubules. The teeth were divided in three groups: Group 1 - 17% EDTA; Group 2 - 24% EDTA and Group 3 - EDTA gel. They were submitted to a histochemical reaction with copper sulfate and rubianic acid. After statistical analyzes we could conclude that: 1. All the tested substances diffused through the dentinal tubules; 2. The tested substances diffused themselves through the dentinal tubules equally; 3. There is no statistical difference among the permeability of the tested root thirds (p

Microbiota de infecções endodônticas primárias e sua relação com aspectos clínicos radiográficos / Microbiota of primary endodontic infections and its relationship with clinical and radiographic aspects

O presente trabalho teve por objetivo avaliar a composição da microbiota presente em infecções endodônticas primárias, buscando relacioná-las com alguns aspectos clínicos, como presença de dor, fístula, estado da câmara pulpar, presença e tamanho de lesão perirradicular. Foram selecionados 111 casos de dentes unirradiculares com polpas necróticas que apresentavam ou não sintomatologia ou rarefação periapical. As amostras foram coletadas dos canais radiculares com o auxílio de limas tipo Hedstrõen #15 e de duas pontas de papel absorvente estéril introduzidas até l mm aquém do forame apical. A presença de até 40 espécies bacterianas foi determinada em cada uma das amostras, por meio da utilização de sondas de DNA e da técnica do Checkerboard DNA-DNA hybridization. Os testes de Mann-Whitney e t-independente foram utilizados para avaliar as diferenças entre prevalência, os níveis e as proporções das espécies ou grupos de espécies testadas e as condições clínicas avaliadas. Foi encontrada uma média de 22 espécies diferentes por amostra. E. faecalis, C. gracilis, L. buccalis, N. mucosa, P. melaninogenica e F. nucleatum sp. vincentii foram as espécies mais prevalentes, e as espécies encontradas em níveis médios mais altos foram F. nuclealum sp. vincentii, E. saburreum, E. faecalis, N. mucosa, V. parvula, C. gracilis, T. socranskii, P. endodontalis, P. gingivalis, M. micros, P. nigrescens e F. nucleatum sp. nucleatum. T. forsythensis estava em nível significativamente mais alto nos casos de dor (p < 0,05); E. faecalis, S. anginosus, C. sputigena e C. gingivalis nos casos de ausência de fístula (p < 0,05); F.nucleatum sp. vincentii e C. ochracea nos casos de câmara pulpar fechada (p < 0,05) e S. intermedius e A. naeslundii nos casos de lesões [maior ou igual a] 20mm2 (p < 0,05). Nos casos de dor presente, foram encontrados também níveis totais bacterianos mais altos e uma proporção mais elevada do complexo vermelho (p < 0,05). Nos casos de lesões [maior ou igual a] 20mm2 foi encontrada uma proporção mais elevada do grupo azul (p < 0,05). Baseado nos resultados obtidos parece-nos lícito concluir que a microbiota de infecções endodônticas primárias apresenta grande variedade de espécies e que algumas delas podem estar relacionadas com características clínicas apresentadas nestes mesmos processos patológicos.

Antimicrobial activity of different concentrations of NaOCl and chlorhexidine using a contact test

The purpose of this study was to analyze the in vitro antimicrobial activity of sodium hypochlorite (1 percent and 5 percent) and chlorhexidine (0.12 percent, 0.5 percent and 1 percent). Bacterial samples (ATCC) of Staphylococcus aureus, Enterococcus faecalis, Escherichia coli, Porphyromonas gingivalis and Fusobacterium nucleatum were submitted to a contact test. Solutions were evaluated at different time intervals: immediately, 5 min, 15 min, and 30 min after contact and repeated 10 times. The results of the contact test showed that 0.12 percent chlorhexidine did not eliminate E. faecalis at any time interval, while 0.5 percent and 1 percent chlorhexidine and 1 percent and 5 percent sodium hypochlorite did. These results permit us to conclude that to obtain better antimicrobial activity, chlorhexidine in a concentration greater than 0.12 percent should be used