Current trends in technological armamentarium and treatment among Brazilian endodontists

Aim: To determine the current trends in technological armamentarium and endodontic treatment among Brazilian endodontists. Methods: A total of 279 endodontists answered a web-based survey questionnaire about their region of activity in Brazil and years as a specialist, average number of endodontic cases treated per month, number of visits to complete the treatment, use of rubber dam for isolation, type of irrigant, obturation technique and device used for this purpose, temporary filling materials, and greater difficulty encountered during treatment and technological armamentarium. A descriptive analysis, expressed in terms of frequency and percentage, was performed and the data were correlated using the chi-square test (p<0.05). Results: Most of the respondents had up to 10 years as specialists. More than 50% of endodontists preferred to complete the endodontic treatment in a single visit. Ninety-nine percent of endodontists used rubber dam for isolation. NaOCl was the most widely used irrigant. Most of the respondents associated different techniques for root canal filling. Lateral condensation and Continuous wave of condensation were the isolated technique most reported. Filling devices (thermocompactors) were used by 53% of endodontists. Glass ionomer was the preferred temporary filling material. The answers for the use of technological armamentarium revealing that 94% of endodontists used an apex locator; 67.38% utilized magnification (loupe: 23.66%; microscope: 35.48%; microscope and loupe: 8.24%); 58% reported to digital radiography; and 47.31% used computed tomography as a complementary tool. About mechanized instrumentation, 44.44% endodontists employed rotary and reciprocating files. The difficulties encountered during endodontic treatment were classified as preparation > access > obturation > anesthesia > isolation. Conclusions: Most endodontists have implemented new technologies, such as mechanical instrumentation, apex locators, magnification, digital radiography, computed tomography, ultrasound, and obturation tools, in their clinical practice (AU)

Investigation in vivo of Enterococcus faecalis in endodontic retreatment by phenotypic and genotypic methods / Investigação in vivo de Enterococcus faecalis em retratamento endodôntico por meio de métodos fenotípicos e genotípicos

This study aimed to investigate the prevalence of E. faecalis in root-filled canals using culture and molecular approaches. It was evaluated the antimicrobial susceptibility to different antibiotics and the virulence factors of E. faecalis isolates. Microbial samples were taken from thirty root-filled canals. Culture methods and 16S rDNA assay were used to identify E. faecalis. The antimicrobial susceptibility of E. faecalis was determined by MIC values using the E test. Cultivable strains of E. faecalis were investigated for virulence factors by PCR technique. E. faecalis were detected by culture (7/30), traditional PCR assay (13/30) and nested PCR (23/30). Both PCR were significantly more effective than culture in detecting E. faecalis (p < 0.05). All tested E. faecalis were highly sensitive to amoxicillin. Some strains of E. faecalis were resistant to antibiotics such as rifampicin (4/12), erythromycin (3/12) and azythromycin (8/12). The genes efaA and ace were detected in all isolates. The other virulence genes were found in 91.6 (gelE), 83.3 (asa), 25 (esp) and 16.6% (cylA). Strains of E. faecalis isolated from root-filled canals showed virulence factors related to adherence. They also showed resistance to some antibiotics commonly used in dentistry.

O objetivo deste estudo foi investigar a prevalência de E. faecalis em dentes tratados endodonticamente utilizando as técnicas de cultura e molecular. Foram avaliados a suscetibilidade antimicrobiana frente a diferentes antibióticos e os fatores de virulência de E. faecalis isolados. As amostras foram coletadas de 30 dentes tratados endodonticamente. Métodos de cultura e 16S rDNA foram utilizados para identificar E. faecalis. A suscetibilidade antimicrobiana de E. faecalis foi determinada por valores de MIC, utilizando o E test. Os fatores de virulência de cepas de E. faecalis cultiváveis foram investigados pela técnica de PCR. E. faecalis foram detectados por cultura (7/30), PCR tradicional (13/30) e nested PCR (23/30). Ambas as técnicas de PCR foram significativamente mais eficazes do que a cultura na detecção de E. faecalis (p < 0,05). Todos os E. faecalis testados foram altamente sensíveis à amoxicilina. Algumas cepas de E. faecalis foram resistentes a antibióticos, como a rifampicina (4/12), eritromicina (3/12) e azitromicina (8/12). Os fatores de virulência efaA e ace foram detectados em todos os isolados. Os outros genes de virulência foram encontrados em 91,6 (gelE), 83,3 (asa), 25 (esp) e 16,6% (cylA). As cepas de E. faecalis isoladas em dentes tratados endodonticamente mostraram fatores de virulência relacionados à adesão. Eles também apresentaram resistência a alguns antibióticos comumente utilizados na odontologia.

Prevalence of Treponemaspp. in endodontic retreatment-resistant periapical lesions

This study investigated the presence of the Treponema species in longstanding endodontic retreatment-resistant lesions of teeth with apical periodontitis, the association of this species with clinical/radiographic features, and the association among the different target species. Microbial samples of apical lesions were collected from twenty-five adult patients referred to endodontic surgery after unsuccessful root canal retreatment. Nested-PCR and conventional PCR were used for Treponema detection. Twenty-three periradicular tissue samples showed detectable levels of bacterial DNA. Treponema species were detected in 28% (7/25) of the cases. The most frequently detected species were T. socranskii (6/25), followed by T. maltophilum (3/25), T. amylovorum (3/25), T. lecithinolyticum(3/25), T. denticola (3/25), T. pectinovorum (2/25) and T. medium(2/25). T. vicentii was not detected in any sample. Positive statistical association was found between T. socranskiiand T. denticola,and between T. maltophilumand T. lecithinolyticum. No association was detected between the presence of any target microorganism and the clinical or radiographic features. Treponemaspp.are present, in a low percentage, in longstanding apical lesions from teeth with endodontic retreatment failure.

Eficácia das limas manuais e do sistema MTwo R na redução bacteriana em dentes tratados endodonticamente com lesão periapical crônica / Effectiveness of hand files and the MTwo R system in bacterial reduction in endodontically treated teeth with chronic apical periodontitis

Objetivo: o objetivo desse estudo foi comparar, in vivo,a eficácia de duas técnicas para remoção da guta-percha(limas manuais e o sistema MTwo R) na redução microbianaapós o preparo químico-mecânico em dentes tratadosendodonticamente e com lesão periapical crônica.Material: trinta dentes unirradiculares obturados, comlesão periapical crônica, foram divididos em dois grupos.Um grupo teve a remoção da guta-percha por meiode limas manuais (n = 15), enquanto o outro grupo utilizouas limas rotatórias MTwo R (n = 15). Após a remoçãoda guta-percha, a primeira amostra (S1) foi obtida.Em seguida, foi realizado o preparo químico-mecânico euma segunda coleta (S2). A carga bacteriana foi determinadapor meio da técnica de cultura. Aplicou-se ostestes estatísticos de Wilcoxon e de Mann-Whitney. Resultados:em S1, todos os canais mostraram a presençabacteriana nos grupos manual e MTwo R, com medianade 5,14 x 103 (variação 20-1,7 x 105) e 3,4 x 102 (variação20-3,14 x 103), respectivamente. Em S2, a redução bacterianafoi detectada nos dois grupos (p < 0,05). Conclusão:conclui-se que o MTwo R mostrou significativaredução bacteriana durante o retratamento endodôntico.

Culture and molecular detection of Enterococcus faecalis from patients with failure endodontic treatment and antimicrobial susceptibility of clinical isolates / Cultura e detecção molecular de Enterococcus faecalis de pacientes com insucesso no tratamento endodôntico e suscetibilidade antimicrobiana dos isolados clínicos

Objective: The aim of this study was to evaluate the minimal inhibitory concentrations (MIC) of different antibiotic agents against to the most prevalent microorganism found in root-filled canals by culture and molecular approaches. Material and Methods: The microbial samples were taken either from thirty root-filled canals after removal of gutta-percha. Culture methods and 16s rDNA assay were used to identify the E faecails present in the samples. The antimicrobial susceptibilities of the isolates of E faecalis were determined by MIC values using the E test System and interpreted according to the Clinical and Laboratory Standards Institute guidelines. The following antibiotics were used: benzylpenicillin, amoxicillin, amoxicillin-clavulanic acid, erythromycin, azithromycin, vancomycin, chloramphenicol, tetracycline, doxycycline, ciprofloxacin, rifampicin and moxifloxacin. Results: E faecalis were isolated (7/30) and detected (13/30) by culture and PCR assay, respectively. All tested E faecalis (n = 12) were highly sensitive to amoxicillin, moxifloxacin, vancomycin, benzylpenicillin and amoxicillin-clavulanic acid. Isolated E faecalis strains were resistant to some antibiotics such as rifampicin (4/12), tetracycline (2/12), doxycycline (1/12), erythromycin (3/12) and azythromycin (8/12). Conclusion: Amoxicillin, amoxicillin-clavulanic acid, benzylpenicillin, vancomycin and moxifloxacin were the most active antibiotics, in vitro, against E faecalis clinical strains, with all the isolates being susceptible Azithromycin and erythromycin were least effective, with none percentage of isolates being susceptible, during laboratory testing. Moreover, E faecalis were identified more frequently by PCR assay than by culture technique.

Objetivo: O objetivo deste estudo foi avaliar as concentrações inibitórias mínimas (CIM) de diferentes antibióticos contra micro-organismos mais prevalentes em canais radiculares pelos métodos moleculares e de cultura. Material e Métodos: As amostras microbianas foram obtidas de trinta canais radiculares após a remoção da gutapercha. Os métodos de cultura e ensaio 16s rDNA foram utilizados para identificar E. faecalis presente nas amostras. As susceptibilidades antimicrobianas dos isolados de E. faecalis foram determinadas pelos valores de CIM utilizando o sistema E teste e interpretados de acordo com as diretrizes CLSI(Clinical and Laboratory Standards Institute). Foram utilizados os seguintes antibióticos: benzilpenicilina, amoxicilina, amoxicilina com ácido clavulânico, eritromicina, azitromicina, vancomicina, cloranfenicol, tetraciclina, doxiciclina, ciprofloxacina, moxifloxacina e rifampicina. Resultados: E. faecalis foram isolados (7/30) e detectados (13/30) por cultura e pelo método PCR, respectivamente. Todos E. faecalis (n = 12) foram altamente sensíveis à amoxicilina,moxifloxacina,vancomicina, benzilpenicilina e amoxicilina com ácido clavulânico. Cepas isoladas de E. faecalis foram resistentes a alguns antibióticos como a rifampicina (4/12), tetraciclina (2/12), doxiciclina (1/12), eritromicina (3/12) e azitromicina (8/12). Conclusão: Amoxicilina, amoxicilina com ácido clavulânico, benzilpenicilina, vancomicina e moxifloxacina foram os antibióticos mais ativos, in vitro, contra cepas clínicas de E. faecalis, com todos os isolados sendo suscetíveis. Azitromicina e eritromicina foram menos eficazes, com nenhuma porcentagem de isolados suscetível durante os testes laboratoriais. E ainda, E. faecalis foram identificados mais frequentemente pela técnica PCR do que pela técnica de cultura.