A comparison of the physicochemical properties of AH Plus Jet with samples taken from the beginning, middle and final portions of the automix syringe system

Aim To evaluate physicochemical properties and semi-quantitative elemental analysis of AH Plus Jet with samples from the beginning, middle and final portions of the automix syringe system. Methodology Three experimental groups based on the source of the material used (beginning, middle and final portion) were established for each of the evaluated properties. Setting time, flow and radiopacity were evaluate following ANSI/ADA n. 57 specification. Set specimens was used in the semi-quantitative elemental analysis in an energy-dispersive X ray spectroscopy and scanning-electron microscopy (EDS/SEM). Statistical analysis was performed using one-way ANOVA followed by Tukey test (P<0.05). Results Flow, setting time, solubility and EDS/SEM tests showed no significant differences among the three portions of the automix syringe (P>0.05). Radiopacity test showed significant differences in the beginning of the syringe comparing to the middle and final portions (P<0.05). EDS/SEM analysis identified the presence of C, O, Al, Ca, Zr and W. The element Al, however, was found only in the final portion of the syringe. Conclusions The results of AH Plus Jet suggested an adequate ratio of the components, without segregation between organic and inorganic components, since the results of setting time, flow, solubility and EDS/SEM analysis presented similar values regardless of the portion of the syringe from where the sealer was taken.

Preparos endodônticos minimamente invasivos: construção de bases científicas / Minimally invasive endodontic prepararions: the construction of scientific bases

O conceito de Endodontia Minimamente Invasiva é amplo, e envolve não só a realização de acessos, mas também o uso de instrumentos com conicidades reduzidas ou geometrias inovadoras. Buscando avaliar se as estratégias minimamente invasivas adotadas apresentam vantagens frente aos tratamentos tradicionais, a presente tese foi dividida em três estudos. O estudo 1 avaliou a preservação da dentina perirradicular e o alargamento da porção apical dos canais de molares inferiores com instrumentos TruNatomy e ProTaper Gold. Para isso, vinte molares inferiores foram microtomografados, pareados e distribuídos em 2 grupos. No grupo ProTaper Gold, os canais mesial e distal foram preparados até os instrumentos F2 e F3, respectivamente, enquanto no grupo TruNatomy, os canais mesial e distal foram ampliados até os instrumentos prime e medium, respectivamente. Após um novo escaneamento, os parâmetros de instrumentação foram calculados. Os dados foram analisados pelos testes de Mann-Whitney, T Student e escalonamento multidimensional não-métrico. Não foram encontradas diferenças entre os grupos em relação à área não preparada e redução de espessura de dentina. O grupo ProTaper Gold removeu mais dentina que o TruNatomy no terço coronal das raízes mesiais. O estudo 2 avaliou a formação de microtrincas dentinárias em molares inferiores acessados de forma ultraconservadora (UltraAC), instrumentados com Reciproc e XP-Endo Shaper. Quarenta molares inferiores foram microtomografados, pareados e distribuídos em 4 grupos de acordo com o tipo de cavidade de acesso e protocolo do sistema de instrumentação: tradicional/Reciproc; tradicional/XP-endo Shaper; UltraAC/Reciproc e UltraAC/XP-endo Shaper. Após os preparos dos canais, os dentes foram escaneados novamente e as imagens transversais das raízes mesiais e distais, do nível da furca ao ápice foram avaliadas com o objetivo de identificar a presença de microtrincas dentinárias. Em todos os grupos, as microtrincas verificadas nas imagens pós-operatórias já estavam presentes no exame pré-operatório. O estudo 3 avaliou a influência de instrumentos com o mesmo diâmetro de ponta e diferentes conicidades no percentual de área não preparada e volume de dentina removida após o preparo dos canais mesiovestibular e distovestibular de molares superiores com ou sem o canal mesiovestibular 2 (MV2). Vinte e dois molares superiores foram selecionados, microtomografados, pareados e classificados em dois grupos, de acordo com a anatomia das raízes: dentes com MV2 e dentes sem MV2. Após o acesso, os canais radiculares foram preparados com instrumentos 25/.01, 25/.03, 25/.05, 25/.06 e 25/.08v. Os dentes foram submetidos a novos escaneamentos por micro-CT após preparo com cada instrumento descrito anteriormente. Os dados foram analisados usando o Modelo linear generalizado misto e aproximação de Kenward-Roger para testes Wald F. Em dentes com e sem canais MV2, a porcentagem de área não preparada apresentou uma diminuição significativa ao longo do tratamento após cada instrumento utilizado e a porcentagem de dentina removida apresentou um aumento significativo ao longo do tratamento. Com base nos estudos, concluiu-se que as estratégias minimamente invasivas adotadas não apresentaram vantagens frente aos tratamentos tradicionais(AU)

The concept of Minimally Invasive Endodontics is broad, and involves not only the realization of accesses, but also the use of instruments with reduced tapers or innovative geometries. Seeking to assess whether the minimally invasive strategies adopted have advantages over traditional treatments, this thesis was divided into three studies. Study 1 evaluated the preservation of periradicular dentin and enlargement of the apical portion of the mandibular molar canals prepared with TruNatomy and ProTaper Gold instruments. For this, twenty lower molars were microtomography, paired and divided into 2 groups. In the ProTaper Gold group, the mesial and distal canals were prepared up to the F2 and F3 instruments, respectively, while in the TruNatomy group, the mesial and distal canals were prepared up to the prime and medium instruments, respectively. After a new scan, the instrumentation parameters were calculated. Data were analyzed by Mann-Whitney, T Student and non-metric multidimensional scaling tests. No differences were found between groups regarding unprepared area and dentin thickness reduction. The ProTaper Gold group removed more dentin than TruNatomy in the coronal third of the mesial roots. Study 2 evaluated the formation of dentinal microcracks in mandibular molars accessed by ultraconservative cavites (UltraAC), instrumented with Reciproc and XP-Endo Shaper. Forty lower molars were microtomography, paired and divided into 4 groups according to the type of access cavity and instrumentation system protocol: traditional/Reciproc; traditional/XP-endo Shaper; UltraAC/Reciproc and UltraAC/XP-endo Shaper. After the root canal preparations, the teeth were scanned again and the transverse images of the mesial and distal roots, from the furcation level to the apex, were evaluated in order to identify the presence of dentinal microcracks. In all groups, the microcracks seen in the postoperative images were already present in the preoperative examination. Study 3 evaluated the influence of instruments with the same tip diameter and different tapers on the percentage of unprepared area and volume of dentin removed after preparation of the mesiobuccal and distobuccal canals of maxillary molars with or without the mesiobuccal canal 2 (MV2). Twenty-two maxillary molars were selected, microtomography, paired and classified into two groups, according to root anatomy: teeth with MV2 and teeth without MV2. After access, the root canals were prepared with instruments 25/.01, 25/.03, 25/.05, 25/.06 and 25/.08v. The teeth were rescanned by micro-CT after preparation with each instrument described above. Data were analyzed using the Generalized Linear Mixed Model and Kenward-Roger approximation for Wald F tests. In teeth with and without MV2 canals, the percentage of unprepared area showed a significant decrease throughout the treatment after each instrument used and the percentage of removed dentin showed a significant increase during treatment. Based on the studies, it was concluded that the minimally invasive strategies adopted did not present advantages over traditional treatments(AU)

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.

Acessos endodônticos: o que todo endodontista deve saber / Endodontic accesses: what every endodontist should know

Introdução: Os acessos endodônticos minimamente invasivos (AEMI) surgiram com o intuito de, por meio da preservação de estrutura dentária, manter a resistência à fratura de dentes tratados endodonticamente. A partir do primeiro estudo, em 2010, vários trabalhos foram desenvolvidos buscando entender qual a influência dos AEMI na resistência à fratura de dentes tratados endodonticamente. No entanto, interferências coronárias causadas pelos AEMI poderiam prejudicar a realização dos procedimentos subsequentes à cavidade de acesso, como a localização, instrumentação, limpeza, descontaminação e obturação dos canais radiculares. Objetivo: Com base nessa premissa, a presente revisão teve como objetivo responder algumas perguntas para que o clínico entenda quais são as principais modalidades de AEMI, os impactos da sua abordagem no tratamento endodôntico e o verdadeiro papel do tratamento endodôntico na perda dos elementos dentários. Resultados: Considerando os dados disponíveis até o presente momento, faltam evidências robustas para apoiar a alegação de que os AEMIs preservem a resistência à fratura dos elementos tratados endodonticamente melhor do que nos dentes acessados de maneira tradicional. Além disso, cavidades de acesso minimamente invasivas podem interferir em outras etapas do tratamento endodôntico, podendo torná-lo imprevisível. Conclusão: Dessa forma, pode-se concluir que há uma falta de evidências que apoiem a utilização de cavidades de acesso minimamente invasivas na prática clínica de rotina e/ou no processo de formação de alunos de graduação e pós-graduação (AU).

Introduction: Minimally invasive access cavities emerged aiming to maintain the fracture resistance of endodontically treated teeth through the preservation of dental structure. Starting with the first study in 2010, several others were developed to evaluate the influence of minimally invasive access cavities in the fracture resistance of endodontically treated teeth. However, the coronal interference caused by those access cavities could impair the subsequent procedures of root canal treatment, such as the location, instrumentation, cleaning, disinfection and filling of the root canals. Objective: Based on this premise, the aim of the present review was to answer some questions so that the clinician knows the main modalities of minimally invasive access cavities, the impacts of this approach and the real role of endodontic treatment in the tooth loss. Results: Considering the available data, there is a lack of robust evidence in literature to support the claim that the minimally invasive access cavities preserve the fracture resistance of endodontically treated teeth better than the traditional one. In addition, these access cavities can interfere in other stages of endodontic treatment, making it unpredictable. Conclusion: Thus, it can be concluded that there is a lack of evidence to support the use of minimally invasive access cavities in routine clinical practice and/or in the process of training undergraduate and graduate students (AU).

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.